Auxéméry Yann
Hôpital d'Instruction des Armées Percy, service médical de psychologie clinique appliquée à l'aéronautique [Medico-Psychological Service Applied to Aeronautics, Main Aeromedical Centre], 101, avenue Henri Barbusse, 92140 Clamart, France.
Presse Med. 2018 May;47(5):423-430. doi: 10.1016/j.lpm.2017.12.006. Epub 2018 Mar 24.
Traumatic events and their consequences are often hidden or minimised by patients for reasons linked to the post-traumatic stress disorder itself (inexpressibility, shame, depressive thoughts, fear of stigmatisation, etc.). Although post-traumatic stress disorder (PTSD) remains the most widely known disorder, chronic post-traumatic psychiatric disorders are many and varied. After a trauma, the practitioner has to check for the different clinical forms of post-traumatic psychological consequences: PTSD is not the only diagnosis. Based on our own clinical experience compared to the international literature, we think necessary to build a didactic classification describing chronic post-traumatic symptoms and syndromes. Post traumatic depressions and bereavement lead to high risk of suicidal crisis and self-harm behaviours. Re-experiencing are felt with anxiety, hyper arousal increases anxious reactivity, and avoidance strategies increase anticipatory anxiety, indicating post-traumatic anxiety disorders (agoraphobia, specific phobia, obsessive compulsive disorder, separation anxiety, social phobia). Characterising an often-severe clinical picture, the co-occurrence of post-traumatic and chronic psychotic symptoms is not unusual (post-traumatic schizophrenia, post-traumatic depression with mood-congruent psychotic features, non-schizophrenic post-traumatic psychotic disorder, and bipolar reaction to trauma). A physical injury occurring at the same time as a traumatic exposure increases the risk of developing post-traumatic stress disorder later which, in turn, afflicts the subjective perception of the physical health (development of somatoform and psychosomatic disorders, comorbidity with a post-concussion syndrome). The trauma may cause a rupture in the biography of a person, also in his/her internal physiological functioning as in his/her social activities (impacts of instinctive functions and behaviours, personality changes, and adjustment difficulties on professional and personal life). Although a nomenclature is necessary for semiological descriptions, a thorough analysis of the patient's general psychological functioning must also be conducted.
创伤性事件及其后果常常被患者隐藏或淡化，原因与创伤后应激障碍本身相关（难以表达、羞耻感、抑郁想法、害怕被污名化等）。尽管创伤后应激障碍（PTSD）仍是最广为人知的疾病，但慢性创伤后精神障碍种类繁多。创伤发生后，从业者必须检查创伤后心理后果的不同临床形式：PTSD并非唯一诊断。基于我们自身的临床经验并与国际文献比较，我们认为有必要构建一种教学分类法来描述慢性创伤后症状和综合征。创伤后抑郁和居丧反应会导致自杀危机和自我伤害行为的高风险。反复体验会伴有焦虑感，过度觉醒会增加焦虑反应性，而回避策略会增加预期性焦虑，表明存在创伤后焦虑障碍（广场恐惧症、特定恐惧症、强迫症、分离焦虑症、社交恐惧症）。创伤后和慢性精神病性症状同时出现并不罕见（创伤后精神分裂症、伴有心境一致的精神病性特征的创伤后抑郁、非精神分裂症性创伤后精神病性障碍以及对创伤的双相反应），这往往构成一种严重的临床图景。与创伤性暴露同时发生的身体损伤会增加日后患创伤后应激障碍的风险，而这反过来又会影响对身体健康的主观感受（躯体形式障碍和心身障碍的发展、与脑震荡后综合征的共病）。创伤可能会导致一个人生活经历的中断，也会影响其内部生理功能以及社交活动（本能功能和行为的影响、人格变化以及职业和个人生活中的适应困难）。尽管为症状学描述需要一种命名法，但也必须对患者的整体心理功能进行全面分析。
