Engdahl B, Dikel T N, Eberly R, Blank A
Psychology Service, VA Medical Center, Minneapolis, MN 55417, USA.
Am J Psychiatry. 1998 Dec;155(12):1740-5. doi: 10.1176/ajp.155.12.1740.
The authors assessed DSM-III-R disorders among American former prisoners of war. Comorbidity, time of onset, and the relationship of trauma severity to complicated versus uncomplicated posttraumatic stress disorder (PTSD) were examined.
A community sample (N=262) of men exposed to combat and imprisonment was assessed by clinicians using the Structured Clinical Interview for DSM-III-R.
The rates of comorbidity among the men with PTSD were lower than rates from community samples assessed by lay interviewers. Over one-third of the cases of lifetime PTSD were uncomplicated by another axis I disorder; over one-half of the cases of current PTSD were uncomplicated. PTSD almost always emerged soon after exposure to trauma. Lifetime PTSD was associated with increased risk of lifetime panic disorder, major depression, alcohol abuse/dependence, and social phobia. Current PTSD was associated with increased risk of current panic disorder, dysthymia, social phobia, major depression, and generalized anxiety disorder. Relative to PTSD, the onset of the comorbid disorders was as follows: major depression, predominantly secondary; alcohol abuse/dependence and agoraphobia, predominantly concurrent (same year); social phobia, equal proportions primary and concurrent; and panic disorder, equal proportions concurrent and secondary. Trauma exposure was comparable in the subjects with complicated and uncomplicated PTSD.
The types of comorbid diagnoses and their patterns of onset were comparable to the diagnoses and patterns observed in other community samples. The findings support the validity of the PTSD construct; PTSD can be distinguished from comorbid disorders. Uncomplicated PTSD may be more common than previous studies suggest, particularly in clinician-assessed subjects exposed to severe trauma.
作者评估了美国前战俘中的《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）所定义的精神障碍。研究了共病情况、发病时间以及创伤严重程度与复杂性和非复杂性创伤后应激障碍（PTSD）之间的关系。
由临床医生使用针对DSM-III-R的结构化临床访谈，对一个有过战斗和被俘经历的男性社区样本（N = 262）进行评估。
患有PTSD的男性中的共病率低于由非专业访谈者评估的社区样本中的共病率。超过三分之一的终生PTSD病例未合并其他轴I障碍；超过一半的当前PTSD病例未合并其他障碍。PTSD几乎总是在接触创伤后不久出现。终生PTSD与终生惊恐障碍、重度抑郁症、酒精滥用/依赖和社交恐惧症的风险增加相关。当前PTSD与当前惊恐障碍、恶劣心境、社交恐惧症、重度抑郁症和广泛性焦虑症的风险增加相关。相对于PTSD，共病障碍的发病情况如下：重度抑郁症，主要为继发性；酒精滥用/依赖和广场恐惧症，主要为同时发生（同一年）；社交恐惧症，原发性和同时发生的比例相同；惊恐障碍，同时发生和继发性的比例相同。复杂性和非复杂性PTSD患者的创伤暴露情况相当。
共病诊断的类型及其发病模式与在其他社区样本中观察到的诊断和模式相当。这些发现支持了PTSD概念的有效性；PTSD可以与共病障碍区分开来。非复杂性PTSD可能比以前的研究所表明的更为常见，尤其是在经临床医生评估的遭受严重创伤的受试者中。
