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題名 | 震災後緊急醫療站所見之急性壓力症候群=Acute Stress Syndromes in Patients at an Emergency Medical Station after a Major Earthquake |
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作者 | 廖士程; 李宇宙; 劉絮愷; 李明濱; 王聲昌; 陳嘉新; 鄭致道; Liao, Shih-cheng; Lee, Yue-joe; Liu, Shi-kay; Lee, Ming-been; Wang, Sheng-chung; Chen, Jia-shin; Cheng, Chih-tao; |
期刊 | 臺灣精神醫學 |
出版日期 | 20000300 |
卷期 | 14:1 2000.03[民89.03] |
頁次 | 頁31-40 |
分類號 | 415.996 |
語文 | chi |
關鍵詞 | 地震; 急性壓力疾患; 創傷後壓力疾患; 米你國際神經精神會談工具; Earthquake; Acute stress disorder; Posttraumatic stress disorder; MINI; |
中文摘要 | 目的:九二一大地震是臺灣近百年來最嚴重之自然災害,本研究是針對某災區救援醫療站於震災後第二至第三週內就診受災民眾,進行與急性壓力相關之症狀學與現象學分析。方法:採用米你國際神經精神會談工具(Mini International Neuropsychiatric Interview:MINI)中創傷後壓力症候群診斷問句部分作為結構式面談篩選指引。由接受過行前訓練之精神科醫師進行臨床評估,依個案症狀嚴重度,社會、個人以及工作等生活功能之受損程度,接受藥物治療之需要,判定是否需要危機處理。結果:4350名至醫療站就醫之受災民眾中,有401位照會精神科,照會率為9.21%;於此401名個案中,有103位(25.7%)個案符合需接受危機處理之臨床判斷。在症狀學部分,以警戒狀態(75.8%)、睡眠障礙(62.1%)、驚嚇反應(60.1%)、創傷經驗再體驗(51.1%)表現為最多。符合亞症候群診斷之個案有257名(64.0%),符合PTSD症狀學標準界定之個案有26名(6.5%)。結論:本研究之結果與部分國外發表針對災後壓力症候群研究之結果相近。就急性壓力疾患而言,其立意在於篩檢出壓力事件發生後急性期具有特殊致病機轉之個案,並提供作為日後發生創傷後壓力症候群及其他精神科疾患之預測因子。然而目前部分實證研究質疑急性壓力疾患之診斷效度。更新並驗證此一診斷之效度,有賴於未來針對災後壓力症候群之前瞻性實證研究。 |
英文摘要 | Objective: The earthquake, which occurred on September 21, 1999, was the most catastrophic event in Taiwan during the past century. The requirement for mental health intervention began immediately after the disaster. Previous studies of acute stress syndrome have not adequately measured the cross-sectional symptom characteristics in the acute stage due to the methodological limitation. This study sought to determine the symptomatology of acute stress syndromes in patients treated at an emergency medical services station during the second and third week after the earthquake. Methods: A total of 401 subjects who visited an emergency medical station were recruited for the participation in this study. The subschedule for posttraumatic stress disorder (PTSD) in the Chinese Version of the Mini International Neuropsychological Interview (MINI) was applied as the diagnostic schedule. The final decision to perform crisis intervention was based on clinical evaluation by senior psychiatric residents and attending doctors. The frequencies of and relationship among demographic data, symptomatology, and requirements for crisis intervention were analyzed. Results: There were 103 (25.7%) subjects who required crisis intervention and 257 (64.0%) subjects who met the criteria for one dimension of PTSD syndrome. Only 26 (6.5%) subjects fulfilled the diagnostic requirements for full symptom dimensions of PTSD in MINI. The most frequent symptoms included nervousness and constant guard (75.8%), difficulty in sleeping (62.1%), easily startled (60.1%), and re-experiencing the event in a distressing way (51.1%). Gender and age differences were found in some of the symptom dimensions. However, no significant gender and age differences were found in the decision to perform crisis intervention. Conclusion: Our data is grossly comparable with the findings of other studies of acute stress syndrome after natural disaster. The diagnosis of acute stress disorder (ASD) demonstrates unique psychopathological processes and predicts the future development of psychiatric morbidity, especially PTSD. However, some recent empirical data, including the present study, question the predictive validity of ASD and its emphasis on dissociative symptoms. Prospective follow-up studies to determine the influences of specific impacts, the predictive power of early stress related symptoms, and the course and outcome of acute stress syndromes are needed to refine the diagnostic validity of ASD. |
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