粉紅鼠的世界
Proud mama of 3, the little sweet pea is on her way~
先來學習PTSD知識, 很多人經常把PTSD和depression混1起. 下麵報告是記錄Dr.G談話內容和讀完他給我的醫學資料總結.
Pls be advised that I'm not a MD or medical student, the following information does not substitute for advice or information provided by your physician, pls consult your physician for further information on specific medical conditions or symptoms that u may have..
什麽是PTSD ?
Post-traumatic Stress Disorder是指親身經曆或看到traumatic event發生,特別是當生命受到死亡威脅後的1種延遲性壓力反應. Traumatic event發生後的3月內出現symptom叫acute PTSD, 超過3月叫complex PTSD, 6月~2年以後才出現叫delayed onset PTSD, 如果不到1月就出現叫acute stress disorder. (我是屬於acute PTSD)
PTSD最早是在Vietnam veteran中被發現的, 1980正式寫入DSM-III, 才引起世人的注意. Symptoms: nightmares, flashbacks, staying asleep, feelings of intense distress and Intense physical reactions when reminded of the trauma, Inability to remember important aspects of the trauma, irritability or outbursts of anger, loss of interest in activities and life, guilt or self-blame, anorexia, increased anxiety and emotional arousal, feeling detached from others and emotionally numb, feeling jumpy and easily startled, hypervigilance, depression and hopelessness, physical aches and pains, suicidal thoughts and feelings etc….
War, Natural disasters, Accident, Childbirth (baby blues is the typical symptom of PTSD, wow, unbelievable~!) School bullying, Physical abuse, Bereavement, Kidnapping, Terrorist attacks, Serious illness, etc.
生理影響
1. Brain wave changes, Brain chemical reactions changes etc.
2. Sympathetic nervous system overreacting, Fright reaction increases, Sleep disorder, Neural hormonal changes, Stress reaction increases, Risk of depression increases etc.
3. Symptoms appear, headache, dyspepsia, compromised immunity system, dizziness etc.
人腦的Hippocampus負責認知和記憶, Amygdala被稱為brain’s fear center負責恐懼,驚嚇, anxious的情緒反應, Cortisol是負責steroid hormone. 因為受到強大的驚嚇刺激後, 人腦的原始生存本能為了保證身體的安全而做出“Fight (violent) vs. Run (autism, fear)”的選擇.
PTSD產生的過程:
Traumatic event occurs --> Limbic system --> Hypothalamus-->
a) Corticotropin releasing factor (CRF)--> Pituitary gland--> ACTH--> Adrenal Gland
b)Sympathetic Nervous System---> Adrenal Gland
7. Traumatic event發生後3月內是防止發展成delayed onset PTSD的急救黃金時間.
1. Pressure release: Anxiety management, Relaxation training, Assertiveness training , Breathing retraining, Eye movement desensitization & reprocessing (EMDR), Positive thinking, Self-talking, Thought-stopping, Psychoeducation, Critical incidence stress debriefing etc.
2. Therapy: Cognitive processing therapy (CPT), Exposure therapy, Role play, Psychodrama, Imaging rehearsal therapy, psychologicalde briefing, brief symptom inventory, Impact of event scale, Imaging rehearsal therapy etc.
3. Medication: Anxiolytic, Antidepressants, Sleeping pills etc.
1. Trauma 越激列，病征持續越長威脅就越大, 特別是麵臨過死亡威脅或財產損失超大
2. 當事人對情感挑戰的綜和應對能力.
3. 發生的Traumatic event對當事人的意義
4. 連續多次發生的Traumatic event要比單1發生, 需要更多時間恢複
5. Flexible working schedule, plenty of time to relax
很多人把PSTD和depression混合, 雖然2者之間overlap但發病起點卻完全不同.
什麽叫 Depression?
Depression from just feeling unhappy or sad, it’s like more intense, lasts longer and has a large negative impact on a person's life, symptoms are:
1. Depressed mood for almost every day and for the majority of the day.
2. Loss of interest or pleasure in activities.
3. Considerable weight loss or weight gain.
4. Difficulties falling asleep or sleeping too much.
5. Feeling worthless or guilty.
6. Difficulties concentrating and/or making decisions.
7. Feeling constantly on edge and restless or lethargic and "slowed down."
8. Thoughts of ending one's own life.
9. To be w/ a major depressive episode, a person must experience 5 of these all within the same 2 week period or longer.
PTSD comes from a traumatic event that has happened, it’s a mental injury not mental illness, the highlighting characteristic of PTSD is flashbacks to the traumatic event, it’s more anxiety than depression but curable. Depression can be caused by hormonal imbalances which affect the chemistry of the brain.
Depression和PTSD的Overgeneral Autobiographical Memory (OGM) 的病理機製是完全不同的, Depression的OGM是因為執行功能受到損害而PTSD是情緒調節的影響而產生, PTSD的OGM和其他認知困難有重要的關連, 包括問題解決的能力受損, etc.
Depression的人多數都曾經有過traumatic experiences, 這是因為PTSD的各種symptoms出現會讓當事人的身體變的很弱, 心理也很容易和家人和朋友detached or disconnected, 這樣就很容易會發展到depression….
PTSD: 盡量不要遇到traumatic event的機會….
PTSD是麵對死亡威脅, 人腦的自我保護和抵製機能失敗後的延遲性壓力反應, 跟個人的體能和個性無關. 因為任何人在經曆traumatic event後都會出現或強或弱的PTSD, 參加過戰爭的veteran的體能和心理素質都是經過專業的高強度訓練, 比多數的人更強, 但為什麽還是會出現PTSD呢? 那是因為直到今天, “死亡”仍然是人類無法承受的最大恐懼點!
待續
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