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意外災害後 常見 精神疾病 創傷後症候群( Post-traumatic Stress Disorder)

意外災害後 常見 精神疾病 創傷後症候群( Post-traumatic Stress Disorder). Post-traumatic stress disorder Depressive disorders Major depression Dysthymic disorder Mixed anxiety & depression Panic disorder Generalized anxiety disorder. Common post-disaster psychiatric disorders. Insomnia

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意外災害後 常見 精神疾病 創傷後症候群( Post-traumatic Stress Disorder)

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  1. 意外災害後常見精神疾病創傷後症候群(Post-traumatic Stress Disorder)

  2. Post-traumatic stress disorder Depressive disorders Major depression Dysthymic disorder Mixed anxiety & depression Panic disorder Generalized anxiety disorder Commonpost-disaster psychiatric disorders

  3. Insomnia Substance abuse (alcohol ) Suicide Survivor guilt Domestic violence Commonpost-disaster psychiatric problems

  4. Post-traumatic Stress Disorder • Events • Actual or threatened death or serious injury • Threat to physical integrity • Response • Intense fear, helplessness, or horror

  5. 創傷後症候群的症狀 • 經常重歷災難經驗 (Re-experience) • 迴避與災難相關之人事物 (Avoidance) • 對外界事物反應麻木 (Emotional Numbness) • 過度覺醒 (Hyperarousal)

  6. 創傷後症候群的症狀 • 經常重歷災難經驗 (Re-experience) • 重複侵入腦海之影像或念頭 (Intrusive recollection) • 惡夢連連 (Recurrent nightmare) • 解離症狀 (Dissociative flashback) • 情緒或生理反應再現

  7. 創傷後症候群的症狀 • 迴避與災難相關之人事物 (Avoidance) • 迴避討論或感受 • 迴避場合與人物 • 無法回憶創傷事件過程

  8. 創傷後症候群的症狀 • 對外界事物反應麻木 (Emotional Numbness) • 參與重要活動的興趣明顯降低 • 與他人疏離 • 情感表達鈍化 • Sense of forshortened future

  9. 創傷後症候群的症狀 • 過度覺醒 (Hyperarousal) • 失眠 • 無法控制的憤怒 • 無法專心 • Hypervigilance • 強烈驚嚇反應

  10. Post-traumatic Stress Disorder 類型 (Types) • 急性壓力障礙 (Acute Stress Disorder) • 急性創傷後症候群 (Acute PTSD) • 慢性創傷後症候群 (Chronic PTSD) • 晚發型 (Delayed onset)

  11. Demographic correlates Sex Age Education Income Marital status Region Urbanity Trauma related Type of trauma Severity of trauma Biological correlates Genetics Personality Psychophysiology Risk Factors of PTSD

  12. 創傷後症候群的治療 • 藥物治療 • SSRIs 或 SNRI 抗鬱劑 • Nefazodone, Trazodone • 三環抗鬱劑 • Benzodiazepines

  13. ANXIETY 創傷後症候群的治療 • 非藥物治療 • 焦慮管理 (Anxiety Management) • Relaxation training • Breathing training • Positive thinking • Assertive training • Though stopping

  14. 創傷後症候群的治療 • 非藥物治療 • 精神衛教 (Psychoeducation) • 認知治療 (Cognitive therapy) • 遊戲治療 (Play therapy) • 暴露治療 (Exposure therapy) • Imaginal exposure • In vivo exposure

  15. 埔里基督教醫院 黃蔚院長 李智貴醫師 劉永昌醫師 台中靜和醫院 柯毅文院長 施義賢醫師 成功大學附設醫院 陳純誠主任 楊延光醫師 葉宗烈醫師 陳信昭醫師 MHRP at Puli town

  16. THANK YOU !

  17. 埔里基督教醫院 黃蔚院長 李智貴醫師 劉永昌醫師 台中靜和醫院 柯毅文院長 施義賢醫師 成功大學附設醫院 陳純誠主任 楊延光醫師 葉宗烈醫師 陳信昭醫師 MHRP at Puli town

  18. Mental Health Relief Programme • Debriefing group for hospital staffs • Screening in community • Establishment of psychiatric services in community and shelter-camp • Home visit and treatment for severe • psychiatric morbidity

  19. Subjects and Methods • 13114,  18 years old, surveyed • Mean age = 41  16 • 53.3% female, 46.7% male

  20. Subjects and Methods • Damage of house • complete destroyed 16.4% • partial destroyed 35.1% • Injury of relatives • death 6.4% • serious injured 2.2% • mild injured 9.6%

  21. Subjects and Methods • Financial status • Marked difficulty 10.8% • Moderate difficulty 17.4% • Mild difficulty 46.6%

  22. Subjects and Methods • Death witness 16.0% • Personality traits • Nervous trait 38.0% • Obsessive trait 28.5% • Inhibition trait 16.7% 要求完美

  23. Assessment Instruments • Psychiatric Morbidity • CHQ-12 • Symptom Check List for • PTSD symptoms • Depressed mood • Guilt feeling • Suicide idea

  24. Outcomes • Post-traumatic Stress Disorder • Psychiatric Morbidity • Depression • Suicide idea

  25. Anxiety symptoms

  26. Depression symptoms

  27. Post-traumatic stress symptoms According to DSM-IV

  28. Cross-section prevalence (6-month) Post-traumatic Stress Syndromes • Three dimension syndrome 593 ( 4.5 %) • Any two dimension syndrome 2596 (19.9%) Re-experience + Avoidance 122 ( 0.9 %) Re-experience + Hyperarousal 2445 (18.7 %) Avoidance + Hyperarousal 29 ( 0.2 %) • Any one dimension syndrome 4745 (36.3%) Re-experience 3731 ( 6.4 %) Avoidance 29 ( 0.2%) Hyperarousal 985 ( 7.5%)

  29. Cross-section prevalence (6-month) • Suicide idea 386 (2.9 %) • Psychiatric morbidity 0-2 9648 (73.6 %) 3-4 1703 (13.0 %) 5-6 921 ( 7.0 %)  7 842 ( 6.4 %) • Probable psychiatric case (CHQ 4) 2457 (18.8%)

  30. Psychiatric Disorder among Victims (N=149) • Major depression • First episode 39 (26.2%) • Recurrent 13 ( 8.7%) • Dysthymic disorder20 (13.4%) • Panic disorder7 ( 4.7%) • PTSD50 (33.6%) • GAD17 (11.4)

  31. Psychiatric Disorder among subjects with suicidal ideation(N = 71) • All psychiatric disorders 55 (77.5%) • Major depression • First episode 22 (30.9%) • Recurrent 9 ( 12.7%) • Dysthymic disorder18 (25.4%) • PTSD28 (39.4%)

  32. Demography and occurrence of PTSD, suicide idea, and psychiatric morbidity

  33. Damage index and occurrence of PTSD, suicide idea, and psychiatric morbidity

  34. Death witness, personality and occurrence of PTSD, suicide idea, and psychiatric morbidity

  35. CONCLUSIONS • Depression and PTSD are major psychiatric disorders • Measures to reduce financial strain of victims facilitate process of psychological rehabilitation • Neurotic personality traits are vulnerability • Out-reach team is important for efficiently conveying psychiatric care

  36. THANK YOU !

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