• 생물정신의학
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• 제24권1호
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• pp.10-18
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• 2017

Occupational hazards of firefighting and rescue works include frequent exposure to emergencies and life-threatening situations. These stressful work conditions of being constantly under pressure and exposed to potentially traumatic events put them at higher risk of developing posttraumatic stress disorder (PTSD), compared to the general population. PTSD is a potentially debilitating mental disorder, due to persistent intrusive thoughts, negative alterations of mood and cognition, hypervigilance, avoidance of similar situations and reminders, and re-experiences of the traumatic event. Previous studies have shown a relatively high prevalence of PTSD among firefighters, indicating the need for a systematic approach of early detection and prevention. Therefore, a critical review of the current literature on PTSD in firefighters would provide valuable insights into developing effective prevention and intervention programs. Literature indicated that there are risk factors of PTSD in firefighters, such as pre-existing depression, anxiety, sleep disorders, occupational stress, physical symptoms, and binge drinking, whereas social support and adequate rewards are protective factors. Although there are differences in the prevalence of PTSD across studies, partly due to various assessment tools utilized, different sample sizes, and sample characteristics, over one tenth of the firefighters were estimated to have PTSD. The current review warrants further investigations to precisely assess PTSD and co-morbid mental disorders, functional outcomes, and associated factors, and to develop evidence-based preventive and interventional programs to help firefighters with PTSD.

• 대한불안의학회지
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• 제6권1호
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• pp.3-9
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• 2010

Even experienced clinicians have difficulties in diagnosing posttraumatic stress disorder (PTSD) exactly, due to its diverse clinical features, which vary according to individuals, traumas, and various comorbid psychopathologies, and its related compensation issues. It is usually mandatory for clinicians and researchers to use screening and assessment tools when diagnosing and evaluating PTSD. To date, research has developed numerous PTSD screening and assessment tools ; therefore one of the cardinal issues is to select the best of the various tools, the one most suitable for the clinician's or researcher's purposes. This article reviews several currently-available subjective and objective instruments for the diagnosis and evaluation of PTSD and groups them according to whether they are Diagnostic and Statistical Manual for Mental Disorders-Correspondent Measures ; PTSD-Focused, Non-DSM-Correspondent Measures ; or Empirically Derived Measures. We present the instruments' psychometric properties and scoring methods and describe their merits and weak points, focusing on their practical usage.

• 대한불안의학회지
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• 제9권2호
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• pp.121-127
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• 2013

Objective : Several studies have reported the association between posttraumatic stress disorder (PTSD) and hypertension (HTN). The aim of this study was to evaluate the impact of PTSD symptoms on blood pressure. Methods : Korean veterans of the Vietnam War with (n=62) or without PTSD (n=87) participated in this study. The clinician administered PTSD scale (CAPS) and alcohol use disorder identification test (AUDIT) were applied. Blood pressure, pulse rate, risk factors of HTN and demographic data of the subjects were collected. Effects of potential explanatory variables on HTN were analyzed with logistic regression. Results : Diastolic blood pressure was significantly higher in PTSD group (p=0.015). However, PTSD subjects showed significantly lower pulse rate than non-PTSD subjects (p=0.004). Logistic regression analysis showed that avoidance symptom might be a predictor for hypertension (OR=1.065, p=0.030). Conclusion : These results suggest that PTSD, especially avoidance symptom, might be a risk factor on HTN in the elderly with PTSD. Further studies are needed to evaluate the change of blood pressure according to the clinical improvement of PTSD.

• 정신신체의학
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• 제7권2호
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• pp.174-183
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• 1999

본 연구는 자동차사고 이후 신체적 증상에 대한 치료를 받은 후 정신과적 진단 및 치료 또는 정신감정을 위해 정신과로 의뢰되었던 44명의 환자를 대상으로 자동차사고와 외상후 스트레스장애와의 관계를 평가하기 위한 것이다. 외상후 스트레스장애 진단은 외상후 스트레스장애 척도(CAPS)를 사용하여 DSM-IV 진단기준에 따라 분류하였고, 축소형 부상척도(AIS)를 사용하여 신체적 손상과 외상후 스트레스장애 증상과의 관계를 조사하고 외상후 스트레스장애와 Axis I 공존질환 유무에 대해 알아 보았다. 자동차 사고후 정신과에 의뢰된 대상자 44명중 20명(45.5%)이 외상후 스트레스장애로 진단되었고 13명(29.5%)이 아증후성 외상후 스트레스장애에 속하였다. 신체적 부상의 정도는 외상후 스트레스장애 증상을 예견하는 것으로 나타났다. 외상후 스트레스장애군은 외상후 스트레스장애 진단 기준 BCD 모든 증상에서 높은 비율을 나타냈고, 아증후성 외상후 스트레스장애군은 기준 B와 D 증상에서 비교적 높은 비율을 나타냈으며, 두 군 모두 기준 B 가운데 '사건에 대한 반복된 꿈' 항목의 비율이 가장 높았다. 외상후 스트레스장애군의 55%가 주요우울증을 동반하였다. 결론적으로 본연구의 결과는 외상후 스트레스장애가 자동차사고 이후 흔히 올 수 있는 정신장애임을 시사하고 있다. 따라서 자동차사고 후 신체적 손상에 대한 치료를 받고 마지막으로 정신과에 의뢰된 환자들에 대해서는 적어도 치료계획에서 외상후 스트레스장애라는 진단을 정규적으로 고려해야만 할 젓이고. 특히 취약성이 있는 환자들에 대해서는 조기 중재가 외상후 스트레스장애 증상을 예방할 수 있을 것이라고 생각된다.

• 생물정신의학
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• 제16권4호
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• pp.256-265
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• 2009

Objectives : The aims of this study were to assess a) the prevalence of trauma and posttraumatic stress disorder(PTSD) in schizophrenic patients and b) the differences in symptomatology and outcome after 1year treatment between those with and without PTSD. Methods : Twenty eight schizophrenia and schizoaffective disorder patients completed the Positive and Negative Syndrome Scale(PANSS), Life Stressor Checklist-Revised(LSCL-R), Clinician-Administered PTSD Scale(CAPS), Dissociative Experiences Scale(DES), Hamilton Psychiatry Rating Scale for Depression(HAM-D), and Rosenberg Self-Esteem Scale(RSE). Results : Twenty six patients(92.9%) had at least one trauma in their life time. Eleven patients(39.3%) were diagnosed with PTSD. PTSD group had significantly higher scores on HAM-D and DES but lower scores on RSE. PTSD group also had significantly lower score in the baseline PANSS Negative score. Higher CAPS scores were significantly correlated with lower baseline PANSS Negative score and greater change after 1year of PANSS Negative score. Conclusion : These results showed that the prevalences of trauma and PTSD are high in schizophrenic patients and suggested that PTSD and trauma-related symptoms affected the symptomatology and treatment outcome. More research is warranted to better understand the effects of PTSD in schizophrenic patients.

• 대한불안의학회지
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• 제16권2호
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• pp.83-90
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• 2020

Objective : Heart rate variability (HRV) is known to reflect autonomic nervous system activity. Individuals with posttraumatic stress disorder (PTSD) are reported to have lower HRVs. We attempted to find HRV indices with head up tilt position that reflect the symptoms well in order to evaluate PTSD symptoms. Methods : Sixty-seven patients with PTSD and 72 patients without PTSD were assessed using the PTSD Checklist for DSM-5 (PCL-5), the Beck Depression Inventory, the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Index. HRV was measured in the head-up tilt position. We collected data regarding heart rate (HR), standard deviation of the NN intervals (SDNN), the square root of the mean squared differences of successive NN intervals (RMSSD), log low-frequency (LNLF) and log high-frequency (LNHF). Results : The value of LNHF was different according to presence or absence of PTSD after head-up tilt position. In the findings of the association between PTSD symptoms and HRV indices as based on head-up tilt, LNHF had a significant correlation with the total score of PCL-5. Conclusion : The reduction of the high-frequency component of HRVs in the PTSD group might reflect more PTSD symptoms.

• Psychiatry investigation
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• 제15권11호
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• pp.1071-1078
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• 2018

Objective We developed easily accessible imagery-based treatment program for patients with post-traumatic stress disorder (PTSD) related to workplace accidents and investigated the effects of the program on various PTSD related symptoms. Methods The program was based on an online platform and consisted of eight 15-min sessions that included script-guided imagery and supportive music. Thirty-five patients with workplace-related PTSD participated in this program 4 days per week for 4 weeks. Its effects were examined using self-report questionnaires before and after the take-home online treatment sessions. Results After completing the 4-week treatment program, patients showed significant improvements in depressed mood (t=3.642, p=0.001) based on the Patient Health Questionnaire-9 (PHQ-9), anxiety (t=3.198, p=0.003) based on the Generalized Anxiety Disorder seven-item (GAD-7) scale, and PTSD symptoms (t=5.363, p<0.001) based on the Posttraumatic Stress Disorder Check List (PCL). In particular, patients with adverse childhood experiences exhibited a greater degree of relief related to anxiety and PTSD symptoms than those without adverse childhood experiences. Conclusion The present results demonstrated that the relatively short online imagery-based treatment program developed for this study had beneficial effects for patients with workplace-related PTSD.

• 대한불안의학회지
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• 제5권2호
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• pp.75-79
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• 2009

In this article, we review the efficacy of early interventions after traumatic incidents and during acute stress disorder (ASD). There are some evidences that psychopharmacological medications such as propronolol, morphine, and hydrocortisone are effective in the prevention of posttraumatic stress disorder (PTSD). Considering the role of selective serotonin reuptake inhibitors in hippocampal neurogenesis and an animal model of PTSD, early administration of selective serotonin reuptake inhibitors is also fairly promising. Other pharmacological treatments including benzodiazepines did not treat ASD nor prevent PTSD. There are good evidences that cognitive behavioral therapy including cognitive therapy and prolonged exposure is a valuable intervention for ASD and the most effective prevention for PTSD. No contolled researches on eye movement desensitization&reprocessing, psychodynamic psychotherapy and hypnotherapy have performed. Recent randomized controlled studies using psychological debriefing did not prove as a useful intervention for the prevention of PTSD until now, although the efficacy of debriefing has been at the centre of controversy.

• 정신신체의학
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• 제28권2호
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• pp.155-160
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• 2020

연구목적 본 연구는 외상후 스트레스장애(Posttraumatic Stress Disorder, PTSD)를 비롯한 정신질환자의 기질과 성격의 변화 양상을 확인하고 한다 방 법 PTSD 환자 33명과 비PTSD 환자 69명을 대상으로 Temperament and Character Inventory (TCI)를 1, 2차에 걸쳐 측정하였고, 그 결과값에 대해 반복측정 ANOVA와 단순 주효과분석을 시행하였다. 결 과 비PTSD 집단에서는 1차와 2차 검사 결과의 차이가 나타나지 않았다. 반면, PTSD 집단에서는 위험회피, 사회적 민감성, 자율성, 연대감에서 유의미한 차이가 있었다. 또한 위험회피, 사회적 민감성, 자율성, 연대감에서 시간과 그룹 간의 상호작용과 시간에 따른 주효과가 유의하게 나타났다. 결 론 본 연구는 외상적 사건이 자율성, 연대감과 같은 성격적 특성은 물론, 위험회피와 사회적 민감성과 같은 기질적 특성의 변화에 영향을 미칠 수 있음을 확인하였다는 점에서 의의가 있다.

• 대한불안의학회지
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• 제8권2호
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• pp.113-119
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• 2012

Objective : The purpose of this study is to assess the utility of clinician administered posttraumatic stress disorder scale (CAPS) to diagnose combat related posttraumatic stress disorder (PTSD) in Korean veterans of the Vietnam War. Methods : Sixty-one Korean male veterans of the Vietnam war participated in this study. We compared the diagnostic values of CAPS, Korean version of mini international neuropsychiatric interview (MINI) against the Structured Clinical Interview for DSM-IV (SCID) in diagnosing PTSD. Results : The overall internal consistency of CAPS was 0.93. Compared to the SCID, total severity 45 (TSEV45) showed the best results among 5 CAPS scoring rules. In detail, sensitivity was 71.4%, specificity was 85.1, positive predictive value was 58.8%, negative predictive value was 90.9%, and accuracy was 82.0. Conclusion : CAPS was demonstrated as a reliable tool to diagnose combat related PTSD in the elderly. The optimum CAPS scoring was TSEV45.