POSTTRAUMATIC STRESS DISORDER EXPLAINS REDUCED QUALITY OF LIFE IN SUBARACHNOID HEMORRHAGE PATIENTS IN BOTH THE SHORT AND LONG TERM
POSTTRAUMATIC STRESS DISORDER EXPLAINS REDUCED QUALITY OF LIFE IN SUBARACHNOID HEMORRHAGE PATIENTS IN BOTH THE SHORT AND LONG TERM
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DOI：
10.1227/01.neu.0000327580.91345.78
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发表时间：
2008-12-01
期刊：
影响因子：
4.8
通讯作者：
Schenk, Thomas
中科院分区：
文献类型：
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作者：
Noble, Adam J.;Baisch, Stefanie;Schenk, Thomas
目的：蛛网膜下腔出血在短期和长期都会降低患者的生活质量（QoL），仅神经系统问题不能解释这种降低。我们研究了创伤后应激障碍（PTSD）和疲劳是否提供了一个explanation.METHODS：我们前瞻性地研究了105例蛛网膜下腔出血患者的代表性样本。患者在发病后约3个月和13个月接受检查。检查包括评估创伤后应激障碍、疲劳、睡眠、认知和身体结果以及生活质量。患者的应对技能也进行了评估。回归分析确定了生活质量和PTSD.RESULTS预测：百分之三十七符合PTSD的诊断标准，在两个评估点。与一般人群中PTSD的发病率相比，这一比例增加了四倍。患者的疲劳程度也持续升高，事实上，高于接受化疗的癌症患者众所周知的高疲劳水平。PTSD是精神生活质量的最佳预测因子，这是最持久受损的领域。它还有助于预测身体QoL。此外，创伤后应激障碍与睡眠问题增加有关，因此可能导致急性和后期恢复阶段的疲劳。为了确定创伤后应激障碍的原因，进行了逻辑回归。这表明，适应不良的应对是最好的预测PTSD.CONCLUSION：PTSD解释了为什么一些蛛网膜下腔出血患者，尽管相对较好的临床结果，继续经历生活质量下降。鉴于适应不良的应对技能似乎是PTSD的主要原因，早期教会患者更好的应对技能可能会防止PTSD和生活质量下降。
OBJECTIVE: A Subarachnoid hemorrhage reduces patients' quality of life (QoL) in both the short and long term, Neurological problems alone cannot explain this reduction. We examined whether posttraumatic stress disorder (PTSD) and fatigue provide an explanation.METHODS: We prospectively studied a representative sample of 105 subarachnoid hemorrhage patients. Patients were examined at approximately 3 and 13 months postictus. Examinations included assessments of PTSD, fatigue, sleep, cognitive and physical outcomes, and QoL. Patients' coping skills were also assessed. Regression analyses identified predictors for QoL and PTSD.RESULTS: Thirty-seven percent met the diagnostic criteria for PTSD at both assessment points. This is a fourfold increase compared with the rate of PTSD in the general population. Fatigue in patients was also consistently elevated, higher, in fact, than the notoriously high fatigue level reported for cancer patients undergoing chemotherapy. PTSD was the best predictor for mental QoL, the domain most persistently impaired. It also helped predict physical QoL. Moreover, PTSD was linked to increased sleep problems and may, therefore, have led to fatigue in both the acute and later stages of recovery. To establish the cause of PTSD, a logistic regression was performed. This showed that maladaptive coping was the best predictor of PTSD.CONCLUSION: PTSD explains why some subarachnoid hemorrhage patients, despite relatively good clinical outcomes, continue to experience a reduced QoL. Given that maladaptive coping skills seem the main cause of PTSD, teaching patients better coping skills early on might prevent PTSD and QoL reduction.