Acute Stress Disorder as a Predictor of Posttraumatic Stress Disorder: A Systematic Review
Acute Stress Disorder as a Predictor of Posttraumatic Stress Disorder: A Systematic Review
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DOI：
10.4088/jcp.09r05072blu
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发表时间：
2011-02-01
影响因子：
5.3
通讯作者：
Bryant, Richard A.
中科院分区：
文献类型：
--
作者：
Bryant, Richard A.
目的：评估急性应激障碍诊断描述急性应激反应和预测随后的创伤后应激障碍（PTSD）的效用。数据来源：在PsycINFO、MEDLINE和PubMed数据库中进行系统检索，检索1994年至2009年期间发表的英文文章，使用结合急性应激障碍和创伤后应激障碍的关键词。研究被选中，评估急性应激障碍1个月内的创伤暴露和评估在稍后的时间为PTSD.Data Extraction的急性应激障碍和PTSD.Data的措施：对于每一项研究，急性应激障碍的诊断预测PTSD的能力计算的敏感性，特异性，阳性和阴性预测能力。对于亚综合征急性应激障碍的研究报告，同样的分析计算的情况下，最初满足亚综合征急性应激障碍criteria.Data Synthesis：22项研究被确定为适合分析（19与成人和3与儿童）。急性应激障碍的诊断导致了一半的比率，痛苦的人在急性期被确定相对于包括亚综合征急性应激障碍的情况。在预测方面，急性应激障碍诊断具有合理的阳性预测能力（急性应激障碍患者后来发展为PTSD的比例）。相比之下，敏感性（比例的人谁开发的PTSD最初符合急性应激障碍的标准）是poor.Conclusions：急性应激障碍的诊断不足以确定大多数人谁最终会发展PTSD。有必要正式描述急性应激反应，但这一目标可能会更有效地通过描述广泛的初始反应，而不是试图预测随后的PTSD。J Clin Psychiatry 2011;72（2）：233-239（C）版权所有2010 Physicians Postgraduate Press，Inc.
Objective: The utility of the acute stress disorder diagnosis to describe acute stress reactions and predict subsequent posttraumatic stress disorder (PTSD) was evaluated.Data Sources: A systematic search was conducted in the PsycINFO, MEDLINE, and PubMed databases for English-language articles published between 1994 and 2009 using keywords that combined acute stress disorder and posttraumatic stress disorder.Study Selection: Studies were selected that assessed for acute stress disorder within 1 month of trauma exposure and assessed at a later time for PTSD, using established measures of acute stress disorder and PTSD.Data Extraction: For each study, capacity of the acute stress disorder diagnosis to predict PTSD was calculated in terms of sensitivity, specificity, and positive and negative predictive power. For studies that reported subsyndromal acute stress disorder, the same analyses were calculated for cases that initially satisfied subsyndromal acute stress disorder criteria.Data Synthesis: Twenty-two studies were identified as suitable for analysis (19 with adults and 3 with children). Diagnosis of acute stress disorder resulted in half the rate of distressed people in the acute phase being identified relative to including cases with subsyndromal acute stress disorder. In terms of prediction, the acute stress disorder diagnosis had reasonable positive predictive power (proportion of people with acute stress disorder who later developed PTSD). In contrast, the sensitivity (proportion of people who developed PTSD who initially met criteria for acute stress disorder) was poor.Conclusions: The acute stress disorder diagnosis does not adequately identify the majority of people who will eventually develop PTSD. There is a need to formally describe acute stress reactions, but this goal may be achieved more usefully by describing the broad range of initial reactions rather than by attempting to predict subsequent PTSD. J Clin Psychiatry 2011;72(2):233-239 (C) Copyright 2010 Physicians Postgraduate Press, Inc.