Rolf-Dieter Stieglitz

PREDICTION OF POSTTRAUMATIC STRESS DISORDER BY IMMEDIATE REACTIONS TO TRAUMA : A PROSPECTIVE STUDY IN ROAD TRAFFIC ACCIDENT VICTIMS

Abstract Road traffic accidents often cause serious physical and psychological sequelae. Specialists of various medical faculties are involved in the treatment of accident victims. Little is known about the factors which might predict psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after accidents and how psychological problems influence physical treatment. In a prospective study 179 unselected, consecutively admitted road traffic accident victims were assessed a few days after the accident for psychiatric diagnoses, severity of injury and psychopathology. All were inpatients and had to be treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the patients were interviewed again. Of the patients, 18.4% fulfilled the criteria for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the accident. Patients who developed PTSD were injured more severely and showed more symptoms of anxiety, depression and PTSD a few days after the accident than patients with no psychiatric diagnosis. Patients with PTSD stayed significantly longer in the hospital than the other patients. Multiple regression analysis revealed that the length of hospitalization was due mainly to a diversity of factors such as severity of injury, severity of accident, premorbid personality and psychopathology. Posttraumatic stress disorder is common after road traffic accidents. Patients with PTSD at follow-up can be identified by findings from early assessment. Untreated psychological sequelae such as PTSD cause longer hospitalization and therefore more costs than in non-PTSD patients.

Adaptation and psychometric properties of the German version of the dissociative experience scale

We introduce the ‘Fragebogen zu Dissoziativen Symptomen’ (FDS), a German adaptation of the Dissociative Experience Scale (DES) which was developed to screen for dissociation within an ICD-10 framework. In addition to the original 28 DES items, the FDS contains 16 items covering dissociative phenomena included in the ICD-10, particularly pseudoneurological conversion symptoms. The psychometric properties of the FDS were studied in 927 clinical and nonclinical subjects from different diagnostic groups and compared to results of American studies. The scale had good test-retest reliability of .88, high internal consistency (split-half = .90, Cronbachs alpha = .94) and good construct validity. These results indicate that the FDS may be a valuable screen for dissociative psychopathology in German-speaking countries.

Evaluation of the German Version of the PTSD Symptom Scale (PSS)

The psychometric properties of the PTSD Symptom Scale (PSS) were evaluated in a clinical sample of severely injured in-patients after a traffic accident (n = 123). The PSS contains 17 items which were derived from the DSM-III-R criteria of posttraumatic stress disorder (PTSD). The results indicate that the PSS has satisfactory reliability and validity (internal and external). The results are in correspondence with the results of Foa et al. using a sample of rape and non-sexual-assault patients.

Entwicklung eines Screeninginstrumentes zur Identifizierung von Risikopatienten für die Entwicklung einer Posttraumatischen Belastungsstörung (PTB) nach einem Verkehrsunfall

Zusammenfassung. Theoretischer Hintergrund: Verkehrsunfalle stellen haufige Ereignisse dar, die von Personen als Trauma erlebt werden konnen. Oft weisen die Verletzten eine Reihe psychischer Symptome auf, die meist jedoch vorubergehend sind. Eine Minderheit entwikkelt jedoch psychische Storungen, vor allem eine Posttraumatische Belastungsstorung (PTB). Fragestellung: Entwicklung eines Screeningfragebogens zur Identifizierung von Patienten mit dem Risiko der Entwicklung einer PTB oder dem subsyndromalen Bild einer PTB. Methode: Einer Stichprobe von 182 Unfallpatienten wurde kurz nach dem Unfall verschiedene Selbstbeurteilungsverfahren vorgelegt. Nach 6 Monaten wurde untersucht, welche Patienten innerhalb dieser Zeit eine PTB resp. ein subsyndromales Bild einer PTB entwickelten hatten. Diejenigen Items, die am besten zur Trennung dieser Patienten von den anderen Patienten beitrugen, wurden zu einem Screeningfragebogen zusammengestellt. Ergebnisse: Es konnte ein aus 10 Items bestehender Screeningfragebogen e...

Comparison between paroxetine and behaviour therapy in patients with posttraumatic stress disorder (PTSD): A pilot study

Antidepressants and cognitive-behavioural therapy (CBT) have been reported to decrease severity of psychopathology in PTSD-patients. To date, no study has been carried out which compares psychopharmacolo-gical and psychotherapeutic treatments. In a randomized pilot study, PTSD-patients were treated either with paroxetine or CBT. Diagnoses were made by structured clinical interviews (ADIS, CAPS). The duration of treatment was 3 months; the paroxetine dosage was 10-50 mg; exposure and cognitive restructuring were the main elements in cognitive-behavioural therapy. Twenty-one patients were included. Drop-outs in both groups occurred within the first 2 weeks. Paroxetine and CBT significantly decreased PTSD-symptoms (CAPS) as well as concurrent depression (MADRS) after 3 months treatment. At 6 month follow-up, symptoms of PTSD had slightly increased in the paroxetine group and further decreased in the cognitive-behavioural therapy group. (Int J Psych Clin Pract 2004; 8: 19-23)

On the validity of the Bech-Rafaelsen Melancholia Scale (BRMS)

BACKGROUND The findings published to date on convergent validity of the BRMS are mainly concerned with the correlation with other observer-rating scales for depression. In many studies on the evaluation of therapeutic interventions self-rating scales are used in connection with observer-rating scales. Therefore, findings on the relations among instruments of both groups are necessary in order to justify the combination of a particular observer-rating scale with a particular self-rating scale. In the ICD-10 three different degrees of severity of depressive episodes are distinguished. No data on the discriminant validity of the BRMS with respect to this new diagnostic classification are available till now. METHODS 45 depressed inpatients were assessed with two observer-rating scales (BRMS and DEPRES of the AMDP system) and two self-rating scales (BDI and DS). RESULTS The discriminant validity with reference to the three degrees of severity of depressive episodes as defined in ICD-10 is at r = 0.80 very high. The convergent validity of the BRMS is high at r = 0.70, related to the DEPRES. The correlations between the BRMS and the BDI as well as the DS were clearly lower, at 0.53 and 0.32 each. CONCLUSIONS The only moderate convergent validity between self-rating and observer-rating scales is a strong argument for a multi-methodological approach in the context of therapy evaluation.

Diagnostic Instruments for the Assessment of Disorders due to Psychoactive Substance Use

The current research on diagnostic instruments for the assessment of psychological and behavioral disorders due to psychoactive substance use was reviewed. Recent developments are oriented towards the

Erfassung von Lebensqualität bei schizophrenen Patienten

Die Erfassung von Lebensqualitat im Kontext somatischer Erkrankungen ist seit Jahren von Bedeutung (vgl. Bullinger in diesem Band), wahrend sie im Bereich psychiatrischer Erkrankungen erst in den letzten Jahren an Interesse gewonnen hat. Dies ist um so erstaunlicher, daz.B. bereits 1958 von seiten der Weltgesundheitsorganisation (WHO) hinsichtlich der Definition von Gesundheit dieser Bereich implizit angesprochen worden ist: „… not merely the absence of disease, but complete physical, psychological, and social well-being“. Auch aus dem Manual der WHO (1980) zur „classification relating to the consequences of disease“ mit der Unterscheidung von disease (Krankheit), impairment (Schaden), disability (Behinderung bei basalen Tatigkeiten des Lebens) und handicap (soziale Nachteile aus unvollkommener Rollenerfullung) last sich gerade aus den letzten beiden Aspekten die Relevanz der Lebensqualitat als wichtiges Konstrukt ableiten. Bei psychiatrischen Patienten allgemein (z.B. Helmchen, 1990; Bech, 1993) und schizophrenen Patienten im besonderen (z.B. Katschnig und Konig, 1994) tritt dieser Bereich jedoch erst allmahlich in den Fokus der Uberlegungen in der Praxis wie der Forschung, wenngleich erste Ansatze bereits vor uber 10 Jahren zu erkennen waren (vgl. auch Abschnitt 4.2). Warum dieses Thema jetzt starker beachtet wird, last sich u.a. aus einer Erweiterung der Perspektive psychiatrischer Forschung begrunden. Insbesondere Forschungsanstose aus der Coping-/Bewaltigungsforschung sind hier zu nennen (vgl. Saupe et al., 1991).

Instruments in the Assessment of Psychosomatic and Neurotic Disorders

The introduction of DSM-III/DSM-III-R and ICD-10 implies fundamental innovations to the diagnostic process. The changes relate both to formal aspects (e.g. symptom and time-related criteria) and to content (e.g. the abandonment of the concept of neurosis). Additionally, specific assessment instruments are introduced. However, other aspects important for the description and treatment of patients easily become neglected when concentrating on a system of diagnoses which aim at the classification of patients by groups of disorders. The present article will present instruments which make it possible to do justice to both points of view.