Do screening and a randomized brief intervention at a Level 1 trauma center impact acute stress reactions to prevent later development of posttraumatic stress disorder?

BACKGROUND: Approximately 20% to 40% of trauma survivors experience posttraumatic stress disorder (PTSD). The American College of Surgeons Committee on Trauma reports that early screening and referral has the potential to improve outcomes and that further study of screening and intervention for PTSD would be beneficial. This prospective randomized study screened hospitalized patients for traumatic stress reactions and assessed the effect of a brief intervention in reducing later development of PTSD. METHODS: The Primary Care PTSD (PC-PTSD) screen was administered to admitted patients. Patients with symptoms were randomized to an intervention or control group. The brief intervention focused on symptom education and normalization, coping strategies, and utilizing supports. The control group received a 3-minute educational brochure review. Both groups completed in-hospital interviews, then 45- and 90-day telephone interviews. Follow-up collected the PTSD checklist-civilian (PCL-C) assessment and qualitative data on treatment-seeking barriers. RESULTS: The PC-PTSD screen was successful in predicting later PTSD symptoms at both 45 days (ß = 0.43, p < 0.001) and 90 days (ß = 0.37, p < 0.001) even after accounting for depression. Correlations of the intervention with the PCL-C scores and factor score estimates did not reach statistical significance at either time point (p = 0.827; p = 0.838), indicating that the brief intervention did not decrease PTSD symptoms over time. Of those at or above the PCL-C cutoff at follow-ups, a minority had sought treatment for their symptoms (43.2%). Primary barriers included focusing on their injury or ongoing rehabilitation, financial concerns, or location of residence. CONCLUSION: The PC-PTSD screen identified patients who later assess positive for PTSD using the PCL-C. The brief intervention did not reduce 45- and 90-day PTSD development. Follow-up interviews revealed lack of treatment infrastructure in the community. It will be important for trauma centers to align with community resources to address the treatment needs of at-risk patients. LEVEL OF EVIDENCE: Prospective randomized controlled trial, level II.

Proteínas de fase aguda em cães e gatos / Acute-phase proteins in dogs and cats / Proteínas de fase aguda en perros y gatos

As proteínas de fase aguda (PFA) são um grupo de proteínas sanguíneas que apresentam alterações nas suas concentrações em animais acometidos por infecções, inflamações, trauma cirúrgico ou mesmo submetido ao estresse. São proteínas que alteram as suas concentrações em pelo menos 25% durante a inflamação. As PFA consistem em proteínas de fase aguda negativa e/ou positiva, diminuindo ou aumentando a sua concentração, respectivamente, em resposta a um estímulo inflamatório. Dentre as PFA negativas mais importantes estão a albumina e a transferina. As PFA positivas são a haptoglobina (Hp), proteína C-reativa (CRP), amiloide A-sérico (SAA), ceruloplasmina (Cp), fibrinogênio e a alfa 1 glicoproteina ácida(APG). As avaliações da concentração das PFA e proteínas totais propiciam subsídios para adequada interpretação do estado de hidratação, bem como de inflamação, infecção, doença imunomediada e alteração da síntese proteica. Sendo as PFA mediadores inflamatórios das respostas imunes agudas, e consideradas marcadoras das lesões teciduais na sua fase aguda nos animais, é importante realizar uma revisão sobre as PFA mais importantes e suas funções nos cães e gatos.

Acute-phase proteins (APP) are a group of blood proteins exhibiting changes in their concentrations in animals suffering from infections, inflammation, surgical trauma or even which have been subjected to stress. These proteins present at least 25% changes in their concentrations during inflammation. APPs consist of negative- and positive-phase proteins that can decrease or increase their concentration in response to an inflammatory stimulus. The most important negative APP are albumin and transferrin; and the most important positive APP are haptoglobin (Hp) , C-reactive protein (CRP), serum amyloid A (SAA), ceruloplasmin (Cp), fibrinogen and alpha 1 glycoprotein acid (AGP). APP concentration and total protein reviews provide information for proper interpretation of hydration status, as well as inflammation, infection, immune-mediated diseases and impaired protein synthesis. APPs are inflammatory mediators of acute immune responses and are considered markers for tissue damages in the acute phase in animals. Therefore, it is important to further review the most important APPs and their functions in dogs and cats.

Las proteínas de fase aguda (PFA) son un grupo de proteínas sanguíneas que presentan cambios en sus concentraciones en animales acometidos por infecciones, inflamaciones, trauma quirúrgico o mismo sometido a estrés. Son proteínas que alteran sus concentraciones de al menos 25 % durante la inflamación. Las PFA consisten en proteínas de fase aguda negativa y/o positiva, disminuyendo o aumentando su concentración, respectivamente, en respuesta a un estímulo inflamatorio. Entre las PFA negativas más importantes están la albúmina y la transferrina. Las PFA positivas son la haptoglobina (Hp), proteína C - reactiva (CRP), amiloideo A-sérico (SAA), ceruloplasmina (Cp), fibrinógeno y la alfa 1-glicoproteína ácida (APG). Las evaluaciones de la concentración de las PFA y proteínas totales proporcionan informaciones para la interpretación apropiada del estado de hidratación, así como de la inflamación, infección, enfermedad inmune-mediada y alteración de síntesis proteica. Siendo las PFA mediadores de respuestas inmunes inflamatorias agudas y consideradas marcadoras de lesiones tisulares en su fase aguda en los animales, es importante llevar a cabo una revisión sobre las PFA más importantes y sus funciones en los perros y gatos.

Proteínas de fase aguda em cães e gatos / Acute-phase proteins in dogs and cats / Proteínas de fase aguda en perros y gatos

As proteínas de fase aguda (PFA) são um grupo de proteínas sanguíneas que apresentam alterações nas suas concentrações em animais acometidos por infecções, inflamações, trauma cirúrgico ou mesmo submetido ao estresse. São proteínas que alteram as suas concentrações em pelo menos 25% durante a inflamação. As PFA consistem em proteínas de fase aguda negativa e/ou positiva, diminuindo ou aumentando a sua concentração, respectivamente, em resposta a um estímulo inflamatório. Dentre as PFA negativas mais importantes estão a albumina e a transferina. As PFA positivas são a haptoglobina (Hp), proteína C-reativa (CRP), amiloide A-sérico (SAA), ceruloplasmina (Cp), fibrinogênio e a alfa 1 glicoproteina ácida (APG). As avaliações da concentração das PFA e proteínas totais propiciam subsídios para adequada interpretação do estado de hidratação, bem como de inflamação, infecção, doença imunomediada e alteração da síntese proteica. Sendo as PFA mediadores inflamatórios das respostas imunes agudas, e consideradas marcadoras das lesões teciduais na sua fase aguda nos animais, é importante realizar uma revisão sobre as PFA mais importantes e suas funções nos cães e gatos.

Acute-phase proteins (APP) are a group of blood proteins exhibiting changes in their concentrations in animals suffering from infections, inflammation, surgical trauma or even which have been subjected to stress. These proteins present at least 25% changes in their concentrations during inflammation. APPs consist of negative- and positive-phase proteins that can decrease or increase their concentration in response to an inflammatory stimulus. The most important negative APP are albumin and transferrin; and the most important positive APP are haptoglobin (Hp) , C-reactive protein (CRP), serum amyloid A (SAA), ceruloplasmin (Cp), fibrinogen and alpha 1 glycoprotein acid (AGP). APP concentration and total protein reviews provide information for proper interpretation of hydration status, as well as inflammation, infection, immune-mediated diseases and impaired protein synthesis. APPs are inflammatory mediators of acute immune responses and are considered markers for tissue damages in the acute phase in animals. Therefore, it is important to further review the most important APPs and their functions in dogs and cats.

Las proteínas de fase aguda (PFA) son un grupo de proteínas sanguíneas que presentan cambios en sus concentraciones en animales acometidos por infecciones, inflamaciones, trauma quirúrgico o mismo sometido a estrés. Son proteínas que alteran sus concentraciones de al menos 25 % durante la inflamación. Las PFA consisten en proteínas de fase aguda negativa y/o positiva, disminuyendo o aumentando su concentración, respectivamente, en respuesta a un estímulo inflamatorio. Entre las PFA negativas más importantes están la albúmina y la transferrina. Las PFA positivas son la haptoglobina (Hp), proteína C - reactiva (CRP), amiloideo A-sérico (SAA), ceruloplasmina (Cp), fibrinógeno y la alfa 1-glicoproteína ácida (APG). Las evaluaciones de la concentración de las PFA y proteínas totales proporcionan informaciones para la interpretación apropiada del estado de hidratación, así como de la inflamación, infección, enfermedad inmune-mediada y alteración de síntesis proteica. Siendo las PFA mediadores de respuestas inmunes inflamatorias agudas y consideradas marcadoras de lesiones tisulares en su fase aguda en los animales, es importante llevar a cabo una revisión sobre las PFA más importantes y sus funciones en los perros y gatos.

Services provided by volunteer psychiatrists after 9/11 at the New York City family assistance center: September 12-November 20, 2001.

OBJECTIVE: To characterize the experience of volunteer disaster psychiatrists who provided pro bono psychiatric services to 9/11 survivors in New York City, from September 12, 2001 to November 20, 2001. METHOD: Disaster Psychiatry Outreach (DPO) is a non-profit organization founded in 1998 to provide volunteer psychiatric care to people affected by disasters and to promote education and research in support of this mission. Data for this study were collected from one-page clinical encounter forms completed by 268 DPO psychiatrists for 2 months after 9/11 concerning 848 patients served by the DPO 9/11 response program at the New York City Family Assistance Center. RESULTS: In this endeavor, 268 psychiatrist volunteers evaluated 848 individuals and provided appropriate interventions. The most commonly recorded clinical impressions indicated stress-related and adjustment disorders, but other conditions such as bereavement, major depression, and substance abuse/dependence were also observed. Free samples were available for one sedative and one anxiolytic agent; not surprisingly, these were the most commonly prescribed medications. Nearly half of those evaluated received psychotropic medications. CONCLUSIONS: In the acute aftermath of the attacks of September 11, 2001, volunteer psychiatrists were able to provide services in a disaster response setting, in which they were co-located with other disaster responders. These services included psychiatric assessment, provision of medication, psychological first aid, and referrals for ongoing care. Although systematic diagnoses could not be confirmed, the fact that most patients were perceived to have a psychiatric diagnosis and a substantial proportion received psychotropic medication suggests potential specific roles for psychiatrists that are unique and different from roles of other mental health professionals in the early post-disaster setting. In addition to further characterizing post-disaster mental health needs and patterns of service provision, future research should focus on the short- and long-term effects of psychiatric interventions, such as providing acute psychotropic medication services and assessing the effectiveness of traditional acute post-disaster interventions including crisis counseling and psychological first aid.

Acute stress response and recovery after whiplash injuries. A one-year prospective study.

Chronic whiplash-associated disorder (WAD) represents a major medical and psycho-social problem. The typical symptomatology presented in WAD is to some extent similar to symptoms of post traumatic stress disorder. In this study we examined if the acute stress reaction following a whiplash injury predicted long-term sequelae. Participants with acute whiplash-associated symptoms after a motor vehicle accident were recruited from emergency units and general practitioners. The predictor variable was the sum score of the impact of event scale (IES) completed within 10 days after the accident. The main outcome-measures were neck pain and headache, neck disability, general health, and working ability one year after the accident. A total of 737 participants were included and completed the IES, and 668 (91%) participated in the 1-year follow-up. A baseline IES-score denoting a moderate to severe stress response was obtained by 13% of the participants. This was associated with increased risk of considerable persistent pain (OR=3.3; 1.8-5.9), neck disability (OR=3.2; 1.7-6.0), reduced working ability (OR=2.8; 1.6-4.9), and lowered self-reported general health one year after the accident. These associations were modified by baseline neck pain intensity. It was not possible to distinguish between participants who recovered and those who did not by means of the IES (AUC=0.6). In conclusion, the association between the acute stress reaction and persistent WAD suggests that post traumatic stress reaction may be important to consider in the early management of whiplash injury. However, the emotional response did not predict chronicity in individuals.

A randomised controlled trial to assess the effectiveness of providing self-help information to people with symptoms of acute stress disorder following a traumatic injury.

BACKGROUND: Patients attending accident and emergency (A&E) may develop long-term psychological difficulties. Psycho-education has been suggested to reduce the risk of post-injury disorders. AIMS: We tested the efficacy of providing self-help information to a high-risk sample. METHODS: A&E attenders were screened for acute stress disorder and randomised to two groups: patients (n=116) receiving a self-help booklet and those who did not (n=111). A sample of 'low' scorers was also included (n=120); they did not receive a booklet. Psychological assessments were completed at baseline (within 1 month post-injury) and 3 and 6 months post-injury. RESULTS: Post-traumatic stress disorder (PTSD), anxiety and depression decreased (p<0.001) across time but there were no group differences in these measures or quality of life. However, subjective ratings of the usefulness of the self-help booklet were very high. CONCLUSIONS: This trial failed to support the efficacy of providing self-help information, as a preventative strategy to ameliorate PTSD.

Recovery after the tsunami: timeline for rehabilitation.

In the aftermath of the Asian tsunami, there is potentially a large, traumatized population in need of psychosocial support, but determining which individuals require psychological intervention and knowing how and when to treat them may be the key to positive long-term outcomes. The early identification of people at high risk of developing subsequent psychiatric disorders from among those experiencing a transient stress reaction following trauma is often the initial step in the recovery process. Clinical instruments for screening and/or predicting those most at risk are available and require validating for cultural and linguistic sensitivity. Timely treatment is essential, since inappropriately targeted therapy can compromise recovery and may even exacerbate posttraumatic stress symptoms, particularly if treatment is initiated before grief reactions have subsided. Finally, appropriate treatment interventions, which incorporate cognitive-behavioral therapy and prolonged exposure, offer the best current therapeutic options for the treatment of posttraumatic stress disorder and associated comorbid conditions such as anxiety, depression, and grief. However, since most of the supportive data for the psychosocial consequences of trauma were obtained from small-scale studies of discrete trauma events in Western countries, it may not be possible to extrapolate these findings to a large-scale natural disaster in Asia, such as the Asian tsunami. More data are required to assist in the development of strategies for the effective management of the psychological consequences of trauma worldwide, with emphasis on creating mental health strategies that are culturally sensitive and valid for various trauma events and disaster scenarios.