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1.
Ann Clin Psychiatry ; 28(3): 197-208, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27490836

RESUMO

BACKGROUND: The diagnosis of posttraumatic stress disorder (PTSD) has remained controversial from the time of its first inclusion in DSM-III. No reviews have fully documented the shifting PTSD definitions across editions of the criteria. This article chronicles the evolution of PTSD across editions of the DSM. METHODS: Diagnostic precursors to PTSD in DSM-I and DSM-II were briefly described, followed by systematic review of PTSD in subsequent editions of the DSM. Sections of the criteria and accompanying text were sorted into tables permitting visual comparisons across the editions. Research findings related to specific changes in the editions were provided from available research literature identified through specific PubMed searches using keywords relevant to each specific change. RESULTS: Fundamental topics of debate identified in this review are validity of the diagnosis, the trauma criterion, the role of symptoms in defining its psychopathology, differentiation from other disorders, and specifiers such as delayed onset. CONCLUSIONS: DSM-5 has corrected several major ambiguities and errors of the former editions that are fundamental to the construct of PTSD as a disorder that is defined conditionally in relation to exposure to trauma, but problems remain in DSM-5 trauma criteria, especially inconsistencies between exposure criteria and the definition of trauma. Discerning the critical distinctions required to understand PTSD depends on underlying clarity in terminology and precision in application of the diagnosis by academicians and clinicians. Trauma must be differentiated from other kinds of stressful events and conceptualized as an incident defined by physical injury rather than by emotional response.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Humanos , Transtornos de Estresse Pós-Traumáticos/classificação , Ferimentos e Lesões/psicologia
2.
Compr Psychiatry ; 60: 119-25, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25810098

RESUMO

BACKGROUND: Studies of survivors of the September 11, 2001 attacks on the World Trade Center in New York City suggest that postdisaster depressive disorders may be at least as prevalent, or even more prevalent, than posttraumatic stress disorder (PTSD), unlike findings from most other disaster studies. The relative prevalence and incidence of major depressive disorder (MDD) and PTSD were examined after the 9/11 attacks relative to trauma exposures. METHODS: This study used full diagnostic assessment methods and careful categorization of exposure groups based on DSM-IV-TR criteria for PTSD to examine 373 employees of 9/11-affected New York City workplaces. RESULTS: Postdisaster new MDD episode (26%) in the entire sample was significantly more prevalent (p<.001) than 9/11-related PTSD (14%). Limiting the comparison to participants with 9/11 trauma exposures, the prevalence of postdisaster new MDD episode and 9/11-related PTSD did not differ (p=.446). The only 9/11 trauma exposure group with a significant difference in relative prevalence of MDD and PTSD were those with a 9/11 trauma-exposed close associate, for whom postdisaster new MDD episode (45%) was more prevalent (p=.046) than 9/11-related PTSD (31%). CONCLUSIONS: Because of the conditional definition of PTSD requiring trauma exposure that is not part of MDD criteria, prevalence comparisons of these two disorders must be limited to groups with qualifying trauma exposures to be meaningful. Findings from this study suggest distinct mechanisms underlying these two disorders that differentially relate to direct exposure to trauma vs. the magnitude of the disaster and personal connectedness to disaster and community-wide effects.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Ataques Terroristas de 11 de Setembro/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Sobreviventes/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Adolescente , Adulto , Transtorno Depressivo Maior/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prevalência , Transtornos de Estresse Pós-Traumáticos/etiologia , Sobreviventes/psicologia , Local de Trabalho/psicologia
3.
Schizophr Res ; 110(1-3): 28-32, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19303744

RESUMO

Mental health visits represented an increasing fraction of all Emergency Department (ED) visits in the U.S. between 1992 and 2001. This study used the National Hospital Ambulatory Medical Care Survey, a 4-staged probability sample of ED visits from geographically diverse hospitals around the U.S., to assess the contribution of all psychosis-related visits to this overall trend. Unlike other mental-health-related ED visits, the rate of psychosis-related visits did not increase. This lack of change is notable in the context of dramatic changes in both healthcare financing and antipsychotic prescribing practices during this period. There was an unexpected decrease in Medicare-funded psychosis-related ED visits at a time of increasing Medicare enrollment overall. An important demographic trend over this decade was the increasing urbanization of psychosis-related ED visits coincident with a relative decrement in such visits within rural areas.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Transtornos Mentais/epidemiologia , Inquéritos Epidemiológicos , Humanos , Transtornos Mentais/classificação , Pacientes Ambulatoriais/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia
4.
Environ Health Perspect ; 116(9): 1248-53, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18795171

RESUMO

BACKGROUND: The World Trade Center (WTC) attacks exposed thousands of workers to hazardous environmental conditions and psychological trauma. In 2002, to assess the health of these workers, Congress directed the National Institute for Occupational Safety and Health to establish the WTC Medical Monitoring and Treatment Program. This program has established a large cohort of WTC rescue, recovery, and cleanup workers. We previously documented extensive pulmonary dysfunction in this cohort related to toxic environmental exposures. OBJECTIVES: Our objective in this study was to describe mental health outcomes, social function impairment, and psychiatric comorbidity in the WTC worker cohort, as well as perceived symptomatology in workers' children. METHODS: Ten to 61 months after the WTC attack, 10,132 WTC workers completed a self-administered mental health questionnaire. RESULTS: Of the workers who completd the questionnaire, 11.1% met criteria for probable post-traumatic stress disorder (PTSD), 8.8% met criteria for probable depression, 5.0% met criteria for probable panic disorder, and 62% met criteria for substantial stress reaction. PTSD prevalence was comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Point prevalence declined from 13.5% to 9.7% over the 5 years of observation. Comorbidity was extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers. CONCLUSIONS: Working in 9/11 recovery operations is associated with chronic impairment of mental health and social functioning. Psychological distress and psychopathology in WTC workers greatly exceed population norms. Surveillance and treatment programs continue to be needed.


Assuntos
Depressão/diagnóstico , Saúde Mental , Exposição Ocupacional , Transtorno de Pânico/diagnóstico , Ataques Terroristas de 11 de Setembro , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adulto , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/epidemiologia , Prevalência , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
5.
Crisis ; 29(2): 73-80, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18664232

RESUMO

This article describes trends in suicide attempt visits to emergency departments in the United States (US). Data were obtained from the National Hospital Ambulatory Medical Care Survey using mental-health-related ICD-9-CM, E and V codes, and mental-health reasons for visit. From 1992 to 2001, mental-health-related visits increased 27.5% from 17.1 to 23.6 per 1000 (p < .001). Emergency Department (ED) visits for suicide attempt and self injury increased by 47%, from 0.8 to 1.5 visits per 1000 US population (p(trend) = .04). Suicide-attempt-related visits increased significantly among males over the decade and among females from 1992/1993 to 1998/1999. Suicide attempt visits increased in non-Hispanic whites, patients under 15 years or those between 50-69 years of age, and the privately insured. Hospitalization rates for suicide attempt-related ED visits declined from 49% to 32% between 1992 and 2001 (p = .04). Suicide attempt-related visits increased significantly in urban areas, but in rural areas suicide attempt visits stayed relatively constant, despite significant rural decreases in mental-health related visits overall. Ten-year regional increases in suicide attempt-related visits were significant for the West and Northeast only. US emergency departments have witnessed increasing rates of ED visits for suicide attempts during a decade of significant reciprocal decreases in postattempt hospitalization. Emergency departments are increasingly important sites for identifying, assessing and treating individuals with suicidal behavior.


Assuntos
Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/tendências , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Etnicidade/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , População Rural/estatística & dados numéricos , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos
6.
Disaster Med Public Health Prep ; 5 Suppl 2: S205-13, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21900416

RESUMO

OBJECTIVE: Several studies have provided prevalence estimates of posttraumatic stress disorder (PTSD) related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD. METHODS: Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11-related PTSD as defined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. RESULTS: The direct exposure zone was largely concentrated within a radius of 0.1 mi and completely contained within 0.75 mi of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate's direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness. CONCLUSIONS: Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical assessments, estimating the magnitude of population PTSD burdens, and projecting needs for specific mental health interventions.


Assuntos
Emprego , Ataques Terroristas de 11 de Setembro/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Cidade de Nova Iorque , Estados Unidos , Adulto Jovem
7.
Am J Psychiatry ; 166(1): 34-41, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19047323

RESUMO

Unlike most psychiatric diagnoses, posttraumatic stress disorder (PTSD) is defined in relation to a potentially etiologic event (the traumatic "stressor criterion") that is fundamental to its conceptualization. The diagnosis of PTSD thus inherently depends on two separate but confounded processes: exposure to trauma and development of a specific pattern of symptoms that appear following the trauma. Attempts to define the range of trauma exposure inherent in the diagnosis of PTSD have generated controversy, as reflected in successive revisions of the criterion from DSM-III onward. It is still not established whether or not there are specific types of traumatic events and levels of exposure to them that are associated with a syndrome that is cohesive in clinical characteristics, biological correlates, familial patterns, and longitudinal diagnostic stability. On the other hand, the symptomatic description of PTSD is becoming more clear. Of three categories of symptoms associated with PTSD--intrusive memories, avoidance and numbing, and hyperarousal--avoidance and numbing appear to be the most specific for identification of PTSD. Research is now poised to answer questions about the relevance of traumatic events based on their relationship to symptomatic outcome. The authors recommend that future research begin with existing diagnostic criteria, testing and further refining them in accordance with the classic Robins and Guze strategy for validation of psychiatric diagnoses. In this process, diligent adherence to the criteria under examination is paramount to successful PTSD research, and changes in criteria are driven by empirical data rather than theory. Collaborations among trauma research biologists, epidemiologists, and nosologists to map the correspondence between the clinical and biological indicators of psychopathology are necessary to advance validation and further understanding of PTSD.


Assuntos
Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adaptação Psicológica , Diagnóstico Diferencial , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Acontecimentos que Mudam a Vida , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia
8.
J Clin Psychiatry ; 69(2): 286-94, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18363455

RESUMO

OBJECTIVE: To describe trends in anxiety-related mental health visits to U.S. emergency departments, an expanding portal of access for mental health care. METHOD: Data from 1992 through 2001 were obtained from the National Hospital Ambulatory Medical Care Survey using mental health-related ICD-9-CM, E- and V-codes as well as National Center for Health Statistics-assigned Patient Reason-for-Visit classification codes. Population-weighted anxiety-related emergency department visit rates were analyzed over time by age, gender, race, Hispanic ethnicity, insurance status, urban status, region of the country, urgency of presentation, and use of medication. RESULTS: There were 53 million mental health-related visits, increasing from 4.9% to 6.3% of all emergency department visits (p = .003) and from 17.1 to 23.6 per 1000 U.S. population across the decade (p = .000). Anxiety-related visits were common (16% of all mental health visits) and increased significantly from 3.5 to 5.0 visits per 1000 U.S. population over the decade (p = .011). Anxiety-related visits increased significantly among non-Hispanic whites, children (< 15 years), adults younger than 49 years, and the privately insured; changes among Medicare, Medicaid, and self-pay patients were not significant. Overall hospitalization rates declined from 23% to 21% between 1992 and 2001 (p = .037), but they did not change significantly for anxiety-related visits (8%), which remained the least likely visit type to be admitted of all mental health visits for the entire decade. In contrast to rural emergency departments, urban emergency departments witnessed significant increases in anxiety-related visits, rising from 2.9 to 5.2 per 1000 U.S. population across the decade (p trend = 0.007). Regionally, anxiety-related visits were highest in the Northeast, lowest in the West, and increased significantly in only the South and Northeast. CONCLUSION: During the decade, there was an expansion of anxiety-related visits to U.S. emergency departments, reflecting an increase in anxiety-related emergency department care-seeking, an increase in anxiety awareness among patients and practitioners, or both.


Assuntos
Ansiedade/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Distribuição por Idade , Idoso , Ansiedade/etnologia , Feminino , Hispânico ou Latino/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Seguro Saúde , Masculino , Transtornos Mentais/etnologia , Pessoa de Meia-Idade , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Distribuição por Sexo , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , População Branca/estatística & dados numéricos
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