Ramsay R
Department of Psychiatry, Middlesex Hospital, London.
J Psychosom Res. 1990;34(4):355-65. doi: 10.1016/0022-3999(90)90059-d.
Recently a spate of large scale disasters has caught public attention. Survivors of unexpected catastrophes find their lives radically changed. They may develop a characteristic pattern of symptoms in response to their exposure to overwhelming stress. Ten years ago, American psychiatrists introduced a new diagnostic category, post-traumatic stress disorder (PTSD), referring to the range of psychological symptoms survivors demonstrate after extreme trauma (Diagnostic and Statistical Manual of Mental Disorders, APA, Washington D.C.). Although the validity of this syndrome remains debatable, the term PTSD is increasingly in use, a practice likely to continue given its inclusion in the draft edition of ICD 10 (WHO, Geneva). This review looks at the evidence that PTSD describes a specific clinical entity. The historical background to the belief that individuals respond to stress is summarized. The criteria that must be fulfilled and methods of establishing a diagnosis are described. A discussion of aetiological factors and the natural history of the psychological response to stress follows, with reference to clinical management, including the provision of effective intervention for survivors to prevent a full blown stress reaction emerging.
最近，一系列大规模灾难引起了公众的关注。意外灾难的幸存者发现他们的生活发生了彻底改变。他们可能会因遭受巨大压力而出现一系列典型症状。十年前，美国精神病学家引入了一种新的诊断类别——创伤后应激障碍（PTSD），用于描述幸存者在经历极端创伤后所表现出的一系列心理症状（《精神疾病诊断与统计手册》，美国精神病学协会，华盛顿特区）。尽管这种综合征的有效性仍存在争议，但PTSD这一术语的使用越来越广泛，鉴于其被纳入了ICD - 10草案版（世界卫生组织，日内瓦），这种使用情况可能会持续下去。本综述探讨了PTSD描述一种特定临床实体的证据。总结了关于个体对压力做出反应这一观点的历史背景。描述了必须满足的诊断标准以及确立诊断的方法。随后讨论了病因学因素以及对压力的心理反应的自然病程，并提及了临床管理，包括为幸存者提供有效干预以防止全面的应激反应出现。
