[The broad spectrum of psychological sequelae of accidential trauma : Typical clinical pictures and stepped-care therapy]. / Das weite Spektrum psychischer Unfallfolgen : Typische klinische Bilder und deren gestufte Versorgung.

The somatic sequelae of accidents and violent events can vary from uninjured to fatal but the psychological impact can vary from integrity, to transient reactions up to severe and chronic trauma-related mental health disorders. In a dynamic interaction they determine the individual processing and coping in the aftermath, the mid-term and long-term outcome of medical treatment and of psychosocial rehabilitation.Appropriate consideration of the psychological sequelae of trauma requires attention and sensitization, knowledge about widespread complaints and symptoms after potential traumatic events and their typical courses over time. A careful perception of early warning signals and basic skills of clinical management are required. When more specific psychodiagnostic and psychotherapeutic interventions seem necessary, mental health specialists have to be consulted within a staged care model.

Post-traumatic stress disorder--a diagnostic and therapeutic challenge.

BACKGROUND: In Germany, the one-month prevalence of post-traumatic stress disorder (PTSD) is in the range of 1% to 3%. Soldiers, persons injured in accidents, and victims of domestic violence increasingly seek medical help for symptoms of emotional stress. Days lost from work and monetary compensation for emotional disturbances are markedly on the rise. The term "PTSD" is commonly used uncritically and imprecisely, with too little regard for the existing diagnostic criteria. It is at risk of turning into a nonspecific collective term for emotional stress of any kind. METHODS: We selectively reviewed the literature in the PubMed database and pertinent journals, with additional consideration of the recommendations and guidelines of medical societies from Germany and abroad. RESULTS: The characteristic types of reactions seen in PTSD are nightmares and an intense, repetitive, intrusive "reliving" of the traumatic event(s). Emotional traumatization manifests itself not only as PTSD but also through major effects on other mental and somatic diseases. An early, trauma-focused behavioral therapeutic intervention involving several sessions, generally on an outpatient basis, can prevent the development of PTSD. The most important components of effective treatment are a focus on the particular trauma experienced and confrontation with the patient's memories of the trauma. The best existing evidence is for cognitive therapy, behavioral therapy according to the exposure paradigm of Foa, and eye movement desensitization and reprocessing therapy. The most recent meta-analysis reveals effect strengths of g = 1.14 for all types of psychotherapy and g = 0.42 for all types of pharmacotherapy taken together (with considerable differences among psychotherapeutic methods and among drugs). The efficacy of psychodynamic therapy, systemic therapy, body-oriented therapy, and hypnotherapy has not been adequately documented in randomized controlled trials. CONCLUSION: PTSD can be precisely diagnosed and effectively treated when the diagnostic criteria and guideline recommendations are taken into account. Referral for trauma-focused psychotherapy should be considered if the acute symptoms persist for several weeks.

Posttraumatic stress disorders and extent of psychosocial impairments five years after a traffic accident.

This five year long-term follow-up study estimated the prevalence of Posttraumatic Stress Disorder (PTSD) and other mental health problems in traffic accident victims. 70 patients were invited for a personal interview to assess mental disorders (DIA-X), depression (BDI), mental distress (SCL-90-R), and psychosocial (SDS) and physical impairments at least five years after their first admission to a university hospital (Department of Traumatology). Prevalence of PTSD was 10%, and another 14.2% of the patients also had a partial PTSD. Other mental disorders had a lower prevalence (7.2%). Patients with PTSD did not differ in sociodemographic characteristics from patients without PTSD. PTSD patients were more depressed and showed more general psychological distress. Furthermore, PTSD was associated with impairments in job, social interaction, and leisure activities. Persistent medical and mental problems correlated highly with PTSD. Implications for secondary prevention of persistent mental health problems of traffic accident patients are discussed in their connection with PTSD.

Comparison between paroxetine and behaviour therapy in patients with posttraumatic stress disorder (PTSD): A pilot study.

Antidepressants and cognitive-behavioural therapy (CBT) have been reported to decrease severity of psychopathology in PTSD-patients. To date, no study has been carried out which compares psychopharmacolo-gical and psychotherapeutic treatments. In a randomized pilot study, PTSD-patients were treated either with paroxetine or CBT. Diagnoses were made by structured clinical interviews (ADIS, CAPS). The duration of treatment was 3 months; the paroxetine dosage was 10-50 mg; exposure and cognitive restructuring were the main elements in cognitive-behavioural therapy. Twenty-one patients were included. Drop-outs in both groups occurred within the first 2 weeks. Paroxetine and CBT significantly decreased PTSD-symptoms (CAPS) as well as concurrent depression (MADRS) after 3 months treatment. At 6 month follow-up, symptoms of PTSD had slightly increased in the paroxetine group and further decreased in the cognitive-behavioural therapy group. (Int J Psych Clin Pract 2004; 8: 19-23).