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The ongoing Israel-Hamas war is posing additional challenges for mental health workers in an already stressful workplace. This study centres on the psychological effects of the shared traumatic reality on mental health workers, arising from the Israel-Hamas war. One month after exposure to the terrorist attack of 7 October 2023 and the outbreak of war following this event, 147 mental health workers completed questionnaires regarding a variety of variables such as demographics, anxiety symptoms, acute stress symptoms, media-induced secondary trauma, personal resilience, National resilience (NR), and post-traumatic growth (PTG). The study found that mental health workers with previous trauma displayed higher anxiety symptoms, acute stress symptoms, and media-induced secondary trauma. Additionally, acute stress and anxiety were positively correlated with media-induced secondary trauma. Religiosity, personal resilience, and NR were found associated with lower anxiety and acute stress symptoms. Religiosity was also positively correlated with personal resilience, NR, and PTG. The PTG of mental health workers working with trauma survivors and evacuees was higher compared to that of other mental health workers. Both adverse and adaptive reactions were evident among mental health workers. While traumatic stress is expected, individual, professional, and NR factors may mitigate its effects. Providing training, social support, regulated media exposure, stress management, and meaning-focused coping strategies can help safeguard workers' well-being.
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Acute Stress Disorder (ASD) is a psychiatric condition that can develop shortly after trauma exposure. Although molecular studies of ASD are only beginning, groups of metabolites have been found to be significantly altered with acute stress phenotypes in various pre-clinical and clinical studies. ASD implicated metabolites include amino acids (ß-hydroxybutyrate, glutamate, 5-aminovalerate, kynurenine and aspartate), ketone bodies (ß-hydroxybutyrate), lipids (cortisol, palmitoylethanomide, and N-palmitoyl taurine) and carbohydrates (glucose and mannose). Network and pathway analysis with the most prominent metabolites shows that Extracellular signal-regulated kinases and c-AMP response element binding (CREB) protein can be crucial players. After highlighting main recent findings on the role of metabolites in ASD, we will discuss potential future directions and challenges that need to be tackled. Overall, we aim to showcase that metabolomics present a promising opportunity to advance our understanding of ASD pathophysiology as well as the development of novel biomarkers and therapeutic targets.
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BACKGROUND: Maxillofacial trauma often results in visible facial disfigurements and can lead to psychological complications such as post-traumatic stress disorder (PTSD). However, PTSD often remains unrecognized and un/undertreated. The goal of the current systematic review was to determine the incidence of PTSD after maxillofacial trauma, associated risk factors, assessment tools employed, and management. METHODS: A literature search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library databases following PRISMA guidelines up to March 2024. Collected variables included the number of patients included, PSTD assessment tool, PTSD incidence, and risk factors and management. The meta-analysis was conducted using random effect models in STATA 16. RESULTS: The review included 14 studies (1633 patients, male=1025, female=230, not mentioned=378). Assessment tools varied widely among studies. Meta-analysis revealed a pooled incidence of PTSD of 27 % (n = 14, 95 % CI, 24 %-30 %) at 1-3 months post-trauma and 10 % (n = 3, 95 % CI, 3 %-17 %) at the 6-12 months follow-up, with a statistically significant 60 % reduction between these periods. CONCLUSION: The overall incidence of PTSD following maxillofacial trauma was 27 % at 1-3 months and decreased to 10 % after 6 months. The emphasis should be given to the importance of early intervention strategies and awareness among the treating surgeon to prevent PTSD.
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OBJECTIVE: This review aims to present an updated overview of cardiac disease-induced trauma and stress-related disorders such as acute stress disorder (ASD), adjustment disorder (AjD), and posttraumatic stress disorder (PTSD). First, the prevalence of these disorders, their diagnostic criteria, and their differences from other trauma-related disorders are described. Special challenges in diagnosis and treatment are identified, with various screening tools being evaluated for symptom assessment. Additionally, the risk factors studied so far for the development of symptoms of cardiac-induced posttraumatic stress disorder and the bidirectional relationship between posttraumatic stress disorder and cardiovascular diseases are summarized. Various therapeutic interventions, including pharmacological approaches, are also discussed. Finally, various areas for future research are outlined. BACKGROUND: Experiencing a cardiovascular disease, particularly a life-threatening cardiac event, can potentially lead to stress-related disorders such as ASD, AjD, and cardiac disease-induced PTSD (CDI-PTSD). If left untreated, these disorders are associated with a worsening cardiac prognosis and higher mortality rates. Approaching treatment through a trauma-focused lens may be beneficial for managing CDI-PTSD and stress-related disorders. CONCLUSION: Future research should explore treatment options for both the patients and the caregivers as well as investigate the long-term effects of trauma-focused interventions on physical and mental health outcomes.
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Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/terapia , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/diagnóstico , Cardiopatías/etiología , Cardiopatías/terapia , Factores de Riesgo , Trastornos de Adaptación/diagnóstico , Trastornos de Adaptación/terapia , Trastornos de Adaptación/etiología , Trastornos de Adaptación/psicología , Prevalencia , Comorbilidad , Trastornos de Estrés Traumático Agudo/terapia , Trastornos de Estrés Traumático Agudo/diagnóstico , Trastornos de Estrés Traumático Agudo/etiología , Trastornos de Estrés Traumático Agudo/psicologíaRESUMEN
BACKGROUND: Adjustment and stress-related disorders are prevalent among psychiatric service users. Despite their prevalence, little is known about their prognosis. To reduce that gap, the present article documents the service use and diagnostic outcomes of people with adjustment or stress-related disorders presenting at Singapore's largest psychiatric emergency department. METHODS: Administrative data from 2014 to 2021 was retrieved to follow a group of 683 service users whose first-ever psychiatric presentation in 2014 warranted a diagnosis of adjustment or stress-related disorder. People were grouped a priori depending on whether different diagnoses were recorded within 7 days, 9 months, after 9 months or not at all. Survival curves characterized conversion to other diagnoses and engagement with healthcare services. Service use outcomes include the number of hospitalizations, outpatient appointments, emergency department visits, and prescriptions. RESULTS: Sixty-one percent (n = 417) never received another diagnosis over the 8-year period. This group used emergency services most and received the most pharmacotherapy shortly after their first visit. Of those who received another diagnosis, depression, personality disorders, and psychotic disorders were the most common. Those who received another diagnosis within 7 days (n = 70, 10%) received it on their first day of hospitalization (IQR 1-1), making the most use of inpatient services. The group who received another diagnosis within 9 months (n = 105, 15%) did so after 42 days (IQR 26-84) and had the highest relative number of deaths. Those who received another diagnosis after 9 months (n = 91, 13%) did so after 1,134 days (IQR 613-1,823) and had the longest period of engagement but made the least use of any psychiatric service, potentially suggesting a group whose early index diagnosis heralded vulnerability to future disorders. CONCLUSIONS: A large group of service users with acute stress or adjustment disorders will likely never be given another psychiatric diagnosis and appear to disengage following an initial period of high-intensity service use. The group that received a different diagnosis after the 9-month mark had prolonged contact with services but low intensity of service use and may represent a target for preventative intervention to help them improve their stress-managing skills and avoid developing other disorders.
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Trastornos de Adaptación , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trastornos de Adaptación/epidemiología , Trastornos de Adaptación/diagnóstico , Trastornos de Adaptación/psicología , Singapur/epidemiología , Estudios Longitudinales , Hospitalización/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto Joven , Servicios de Urgencia Psiquiátrica/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricosRESUMEN
Introduction: trauma-related disorders following a road accident have both a health and an economic impact. Methods: we conducted a prospective study to determine the prevalence of these disorders, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. Results: a total of sixty-ten subjects were included in this study. The prevalence of acute stress disorder was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. Conclusion: It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.
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Accidentes de Tránsito , Ansiedad , Depresión , Trastornos por Estrés Postraumático , Humanos , Femenino , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Masculino , Accidentes de Tránsito/estadística & datos numéricos , Factores de Riesgo , Adulto , Prevalencia , Estudios Prospectivos , Persona de Mediana Edad , Túnez/epidemiología , Depresión/epidemiología , Depresión/etiología , Ansiedad/epidemiología , Ansiedad/etiología , Adulto Joven , Escolaridad , Adaptación Psicológica , Trastornos de Estrés Traumático Agudo/epidemiología , Factores Sexuales , Adolescente , Anciano , Heridas y Lesiones/epidemiología , Heridas y Lesiones/psicología , Hospitales UniversitariosRESUMEN
In this narrative, a general practitioner and psychotherapist trained in anthroposophic medicine presents the narrative and treatment of a 60-year-old woman who experienced the horrors of the "Dark Sabbath" attack in southern Israel on October 7, 2023. The patient's story is narrated by the physician, who shares his multi-disciplinary and multi-modal anthroposophic medicine approach to address the patient's acute stress disorder-related symptoms and concerns.
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Medicina Antroposófica , Humanos , Femenino , Persona de Mediana EdadRESUMEN
Background: During epidemic outbreaks, hospitalized patients, especially those with cerebrovascular disease, were identified as a vulnerable group suffering from acute stress disorder (ASD) and consequent psychological distress. For stroke patients, not only will they suffer from physical illness, but the uncertainty of illness caused by sudden illness may also cause patients to experience different degrees of ASD. Relevant studies have shown that the impact of ASD on individuals may vary according to age, gender, disease characteristics, individual personality, treatment methods, income level, family support, cognitive psychology and other factors. However, non-adaptive cognitive emotion regulation plays a crucial role in influencing individual psychological states. At present, the risk factors of ASD after stroke and the mechanism between illness uncertainty and cognitive emotion regulation are not fully understood. Therefore, we focus on exploring the predictive effects of general demographic and disease-related characteristics, maladaptive cognitive emotion regulation, and illness uncertainty on ASD after stroke, and make hypotheses. When a disease acts on the body, the patient will have the corresponding cognition of the disease, and ASD will appear at the same time. Then the maladaptive cognitive emotion regulation as an important mediating variable can aggravate the level of acute stress disorder and be verified. Methods: We used a cross-sectional design, which can be used to investigate the distribution of a disease or health condition and its related factors in a specific population at a specific time, so as to describe the distribution of the disease or health condition and its relationship with related factors. A total of 256 hospitalized patients with ischemic stroke were enrolled, including 145 males and 111 females, aged from 26 to 90 years, with a mean age of (64.71 ± 12.20) years. All patients completed and returned a self-report questionnaire that included demographic information, illness uncertainty, cognitive emotion regulation, and ASD. We then compared the differences in general demographic data, illness uncertainty, and maladaptive cognitive emotion regulation in acute stress disorders. Results: The majority of hospitalized stroke patients (67.6%) developed ASD due to the COVID-19 pandemic and were therefore at risk for PTSD. More than one third (39.1%) of stroke survivors also suffered from severe psychological distress. More specifically, younger stroke patients are more likely to experience ASD than older patients. Although higher illness uncertainty scores indicate more severe ASD, adaptive cognitive emotion regulation was a protective factor. Conclusion: Given that individuals with ASD are susceptible to PTSD, it is critical to follow up hospitalized patients with ischemic stroke for screening for PTSD and referral to appropriate psychological services. Maladaptive cognitive emotion regulation can increase the impact of uncertainty on the traumatic experience of stroke patients. Therefore, health care institutions should increase their efforts to provide psychosocial support services to hospitalized patients and make continuous efforts to screen for symptoms of trauma and psychological distress in hospitalized stroke patients.
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Background: The outbreak of war in Israel on 7 October and the unique events of that day have presented unprecedented challenges to first responders (FRs), who are professionally trained to engage in providing assistance in such circumstances. Moreover, while research demonstrates the long-term psychological consequences of FRs, little is known regarding how FR's engagement in providing assistance relates to stress and resilience levels as events continue to unfold.Objective: The current study examined the relationship between traumatic stress symptoms (TSS) and resilience levels among FRs and controls during the first weeks of the Iron Swords war, while focusing on the moderating role of active engagement in providing assistance.Method: Data were collected during the first month of the Iron Swords war from 374 participants living in Southern Israel, of whom 77 (20.6%) were FRs. All participants filled out scales assessing TSS and resilience and provided relevant background information.Results: High TSS levels were associated with reduced resilience in FRs and non-FRs. Moreover, both the study group and active engagement were significant moderators for the TSS-resilience link, which was insignificant among FRs who provided assistance and for civilians who did not provide assistance. However, the TSS-resilience association remained significant for FRs who did not engage in providing assistance and for civilians who did.Conclusions: Our findings highlight the importance of examining the extent to which FRs act in line with their duties during times of adverse stress. Clinical interventions aimed towards FRs who did not engage in providing assistance are needed and should focus on the extent to which their moral values, beliefs and expectations are met, as these appear critical parameters in preserving resilience.
First responders report increased traumatic stress and reduced resilience.Active engagement moderated first responders' traumatic stressresilience link.Findings are discussed in the context of potentially morally injurious events.
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Socorristas , Resiliencia Psicológica , Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/psicología , Brotes de Enfermedades , HierroRESUMEN
Introduction: Fleeing from war can be terrifying and result in Acute Stress Disorder (ASD), a mental health condition that can occur in the first month after a traumatic event. The study aimed to identify the prevalence of ASD among Ukrainian refugees and identify its risk factors to create a profile of the most vulnerable refugees. Methods: This cross-sectional study of 637 Ukrainian war-displaced persons and refugees in 2022 used the Acute Stress Disorder Scale. Results: The prevalence of ASD among participants was high (93.5%). Several factors increasing the risk of developing ASD in the sample were identified, e.g., witnessing Russian attacks (OR 2.92, 95% CI 1.26-6.78), insufficient financial resources (OR 3.56, 95% CI 1.61-7.91), and feeling of loneliness in the host country (OR 3.07, 95% CI 1.58-8.69). Pre-existing depression and the death of a close person, among others, were found to significantly (p < 0.05) exacerbate the ASD symptoms. At the same time, neither age, the distance traveled, time spent on fleeing the country, nor the type of companionship during refuge (escaping alone, with children, pets or the older adults) correlate with the severity of symptoms. Conclusion: The study shows extreme levels of trauma among Ukrainian war refugees and displaced persons. Knowledge regarding ASD vulnerabilities in the present conflict may facilitate prompt and adequate psychological help. Since ASD can be an antecedent of PTSD and several autoimmune disorders, these results may also serve as a predictor of future challenges for Ukrainian society.
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Refugiados , Trastornos por Estrés Postraumático , Trastornos de Estrés Traumático Agudo , Niño , Humanos , Anciano , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Trastornos de Estrés Traumático Agudo/complicaciones , Refugiados/psicología , Estudios Transversales , Depresión/psicologíaRESUMEN
Introduction: Children and adolescents with autism spectrum disorder (ASD) may be particularly vulnerable to the impact of traumatic events, yet the association between ASD and the risk of developing acute stress disorder and post-traumatic stress disorder (PTSD) remains uncertain. This study aims to investigate this association, addressing the gap in large-scale evidence on the subject. Methods: Conducted as a retrospective and matched cohort study, data was sourced from the National Health Insurance Research Database (NHIRD) in Taiwan, spanning from January 1, 2000, to December 31, 2015. The study included patients aged 18 years or under newly diagnosed with ASD (n=15,200) and compared them with a matched control group (n=45,600). The Cox proportional regression model was employed to assess the risk of acute stress disorder and PTSD. Results: Over the 15-year follow-up period, a total of 132 participants developed either acute stress disorder or PTSD. Among them, 105 cases (0.691% or 64.90 per 100,000 person-years) were in the ASD group, while 27 cases (0.059% or 5.38 per 100,000 person-years) were in the control group. The adjusted hazard ratio for the ASD group was significantly higher compared to the control group (25.661 with 95% CI = 15.913-41.232; P < .001). Discussion: This study provides compelling evidence that individuals with ASD face an elevated risk of developing acute stress disorder and PTSD. The findings underscore the importance of clinicians recognizing and addressing this vulnerability in ASD individuals exposed to traumatic events. This emphasizes the need for heightened attention to the risk of PTSD and acute stress disorder in the ASD population.
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BACKGROUND: While clinical diagnosis of mental health issues focuses on factual details represented by literal language (e.g., the onset and process of the triggering event and duration of symptom), the relationship between metaphorical language and psychopathological experiences remains an intriguing question. Focusing on psychological trauma triggered by the 2019-2020 Hong Kong social unrest, this study explored the correlations between trauma victims' quantitative metaphor usage patterns and their experience of specific Acute Stress Disorder (ASD) symptoms. METHODS: Forty-six individuals with trauma exposure within 28 days were recruited through convenience sampling. Each completed a 20- to 30-minute semi-structured interview and filled out the Chinese version of the Stanford Acute Stress Reaction Questionnaire (SASRQ; 1). Metaphors in the interviews were identified using the discourse dynamic approach (2), and clinically interesting categories related to trauma and emotion expression, as revealed by previous literature, were sorted out. Standardized frequencies of the categories were correlated with participants' SASRQ scores of five major ASD symptoms, and the correlational patterns were interpreted from a discourse analytic perspective. RESULTS: The study reveals how metaphor usage patterns can reflect the speakers' differentiated experiences of psychopathological symptoms. Compared with individuals who experienced less trauma, those more disturbed by the re-experiencing symptom were more inclined to use emotion-related metaphors and to metaphorize about the self and the self-society relationship. Individuals who experienced more severe anxiety and hyperarousal showed a heightened awareness of self-related issues and diminished attention to others. Those who suffered from more severe impairment in functioning produced more metaphors in the negative valence. Dissociation and avoidance, which were less experientially salient and intense than the others, were not significantly correlated with metaphor usage patterns. CONCLUSION: This study establishes symptom-level metaphor usage patterns as a previously overlooked but interesting avenue in trauma evaluation, treatment, and research. While the study is confined to a single context, it nevertheless reveals the potential for metaphor research findings to be incorporated as useful materials in psychology education and therapist training.
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Trastornos Mentales , Metáfora , Humanos , Lenguaje , Emociones , Hong KongRESUMEN
BACKGROUND: Ketamine is an anesthetic and analgesic known for its psychotomimetic properties, such as dissociation and altered perception. Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are characterized by unwanted memories, intrusive thoughts, and dissociative flashbacks following an acute traumatic event. It is unknown how analgesic ketamine affects the symptomatology of ASD when administered to patients in the posttraumatic period. OBJECTIVE AND METHODS: In this article, we present the case of a 26-year-old man who sustained gunshot wounds and developed worsened ASD after receiving analgesic ketamine. We also present a review of the current literature on peritraumatic ketamine and its subsequent effect on ASD and PTSD. RESULTS: In 2 out of 3 articles examining ketamine and ASD, ketamine was associated with worsened symptomatology of ASD. There were 6 articles examining ketamine and PTSD. In 1 of 6 articles, ketamine was associated with increased incidence and/or severity of PTSD, and in 2 of 6, it was associated with decreased incidence and/or severity of PTSD. There was no relationship between ketamine and subsequent PTSD in 3 of 6 articles. CONCLUSION: We conclude that ketamine's psychotomimetic properties may exacerbate the dissociative and perceptual symptoms of ASD, but its long-term effects on PTSD are still unclear. In patients with preexisting ASD, the potential risks and benefits of using analgesic ketamine must be weighed carefully.
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I report five cases in which chikujountanto and untanto were effective for trauma and stressor-related disorders. Post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) are both psychiatric disorders that occur as a reaction to severe stress, and are distinguished by the duration of the disorder. Chikujountanto is indicated for those who have cough and insomnia after late yang stage pattern in case of cold, and for chronic diseases such as depression and sleep disorders, and is applied to various psychiatric disorders. In this paper, I cite the grounds for applying chikujountanto to PTSD from the classics, examine the similarities and differences with other Kampo medicines reported to be used for PTSD from the characteristics of the constituent crude drug centered on Huang lian. I also infer the relationship between the therapeutic mechanism of Kampo and neuroinflammation. Regardless of the severity of the trauma, rapid administration of this drug is expected to hasten the healing process.
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COVID-19 centralized quarantine may cause acute stress disorder (ASD). However, it is unknown how individuals present heterogeneous ASD trajectories during the COVID-19 centralized quarantine and what factors contribute to these patterns. This study aimed to identify the ASD trajectories and their determinants during the centralized quarantine period, and the mediating effects of resilience on these associations. A longitudinal survey with three waves was conducted in a randomly selected quarantine hotel in Shenzhen, China from October to November 2020. A total of 273 participants completed online measures assessing ASD symptoms, Eysenck's personality constructs of extraversion (E), neuroticism (N), psychoticism (P), and resilience on Day 1, and reported ASD symptoms on Days 7 and 14 during their 14-day centralized quarantine periods. Latent class growth analysis identified three trajectories: constantly high symptoms (CHS, 4.76%), decreasing symptoms (DS, 11.72%), and constantly low symptoms (CLS, 83.52%). The CHS and DS subgroups both reported lower E and higher N scores, but not P, compared with the CLS subgroup. Resilience mediated the effects of three personality constructs on ASD trajectories, except for the association between N and DS membership. Our study highlights the heterogeneity in stress responses to the COVID-19 centralized quarantine. The high-risk subgroup with persistent ASD symptoms was characterized by lower E and higher N. The resilience process accounted for the effects of personality in shaping distinct ASD trajectories. Our findings have implications to detect the populations vulnerable to ASD and provide insights for developing timely resilience enhancement intervention programs.
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COVID-19 affected the well-being of healthcare workers (HCWs) globally. Mental health app interventions (MHAIs) may offer appropriate and accessible means to support HCWs' mental health. We conducted a pilot randomised controlled crossover trial involving 34 clinicians randomised to either a MHAI or a waitlisted group. After one month, outcome assessments were repeated and the waitlisted group then crossed over to the MHAI; they again completed outcome assessments after a month. The primary outcomes were feasibility, assessed with the Systems Usability Scale (SUS), and acceptability, assessed with the Client Satisfaction Questionnaire (CSQ). Secondary outcomes included efficacy for various mental health parameters. The SUS and CSQ scores indicated above average feasibility and acceptability. There was a significant difference in anxiety from baseline to 1-month follow-up between the groups, with greater improvement in the MHAI group. The groups differed in resilience and patient-related burnout from baseline to 1-month follow-up, with a trend towards significance, with greater improvements in the MHAI group. Anxiety and acute stress disorder severity improved significantly from pre- to post-intervention. We demonstrated that MHAIs hold potential for improving well-being of HCWs, although these findings will need to be replicated in adequately powered trials.
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COVID-19 , Aplicaciones Móviles , Automanejo , Humanos , Salud Mental , Proyectos Piloto , Pandemias , Estudios de FactibilidadRESUMEN
BACKGROUND: Appropriate medication is very important for pilots with acute stress disorder. Improper medication can not only affect the physical and mental health of the pilots but can also endanger flight safety. Hence, we aimed to quickly and effectively relieve symptoms and restore cognitive function by forming a consensus of Chinese experts on the pharmacological treatment of acute stress disorder in pilots using the Delphi method. METHODS: Relevant literature was searched to enumerate the current status of pharmacological treatment of acute stress disorder in pilots, followed by two rounds of expert consultation and discussion according to the listed status of the survey using the Delphi method. A descriptive statistical method was used to analyze the basic information, authority coefficients, concentration of opinions, and survey items of the experts to develop a consensus on the pharmacological treatment of acute stress disorder in pilots. RESULTS: A total of 16 experts in psychiatry, pharmacology, and aerospace medicine from different provinces and cities across China were invited for consultation. The recovery rate of the two rounds of consultation was 100%, and the expert authority coefficients were 0.897 and 0.906, respectively. Kendall's coefficient of concordance of indicators at all levels was 0.564-0.594 (p < 0.01). Based on the number of votes received, alprazolam tablets (16), eszopiclone tablets (15), and lorazepam tablets (14) were recommended for the treatment of excitatory psychomotor symptoms of acute stress disorder; paroxetine tablets (15) and sertraline tablets (15) were available for psychomotor depressive symptoms; olanzapine tablets (15), olanzapine orally disintegrating tablets (14), and quetiapine fumarate tablets (14) were selected for psychotic symptoms. CONCLUSIONS: This study formed a consensus on rapid and effective pharmacological treatment for different symptoms of acute stress disorder pilots, which provides a reference for clinical treatment.
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Pueblos del Este de Asia , Pilotos , Trastornos de Estrés Traumático Agudo , Humanos , Consenso , Técnica Delphi , Olanzapina , Pilotos/psicologíaRESUMEN
On 6 February, southeastern Turkey and parts of Syria were struck by two powerful earthquakes, one measuring a magnitude of 7.8 and the other, nine hours later, at a magnitude of 7.5. These earthquakes have been recorded as some of the deadliest natural disasters worldwide since the 2010 Haiti earthquake, impacting around 14 million people in Turkey. For trauma survivors, the stressors associated with an event can lead to the development of acute stress disorder (ASD) or other psychiatric disorders. Trauma experiences during adolescence can impact development and affect adolescents differently than adults. Although ASD in adults has been addressed in several studies, there is much less information available about how younger populations respond to acute stress. The aim of our study was to assess the occurrence of ASD among individuals seeking help at the Sanliurfa Mehmet Akif Inan Research and Training Hospital Child and Adolescent Outpatient Clinic following the 2023 Turkey Earthquakes and the factors associated with acute stress reactions. A child and adolescent psychiatry specialist conducted psychiatric interviews with the adolescents, and the individuals were also asked to complete 'The National Stressful Events Survey Acute Stress Disorder Short Scale' (NSESSS) to evaluate acute stress symptoms. ASD diagnoses were established according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Results showed that 81.6% of the participants (n = 49) were diagnosed with ASD, and drug treatment was initiated in 61.7% of the cases (n = 37). It was determined that ASD rates did not differ according to gender, and patients without physical injury had higher acute stress symptom scores (p > 0.05). According to the logistic regression models, paternal educational levels and adolescents' own requests for psychiatric assistance were predictors of acute stress disorder (OR 10.1, ß = 2.31, p = 0.006 and OR 16.9, 95 ß = 2.83, p = 0.001, respectively). Our findings revealed striking results in demonstrating the need for careful evaluation of adolescents without physical injury in terms of acute stress disorder and the need to pay close attention to the psychiatric complaints of adolescents willing to seek mental health assistance. Moreover, our study suggests that the proportion of adolescents experiencing acute stress symptoms after earthquakes might be higher than previously reported. Estimation of the incidence rate and symptoms of psychiatric distress in the short-term period following a disaster is important for establishing disaster epidemiology and implementing efficient relief efforts in the early stages. The outcomes of this study have the potential to yield novel insights into the realms of disaster mental health and emergency response policies, as well as their pragmatic implementations.
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The majority of bite wounds that we encounter in the emergency department are caused by dogs, cats and humans, but bite injuries can be caused by a variety of animals. Here, we describe a case of bite wound and trauma caused by a large gorilla (Western lowland gorilla) weighing over 170 kg. Gorilla bites are rare, and the patient had an open fracture of the right distal radioulna in addition to multiple bite wounds. Treatment required careful consideration of gorilla antigenicity and a literature review to guide the selection of appropriate antimicrobial agents. Furthermore, trauma inflicted by large animals tends to require systemic traumatological screening, and patients can develop acute stress disorder because of a fear of being attacked again; therefore, early psychiatric intervention is important.