Recovery from post-traumatic stress disorder in children following road traffic accidents: the role of talking and feeling understood

2001 ◽  
Vol 11 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Paul Stallard ◽  
Richard Velleman ◽  
Sarah Baldwin
1998 ◽  
Vol 172 (5) ◽  
pp. 443-447 ◽  
Author(s):  
K. A. H. Mirza ◽  
B. R. Bhadrinath ◽  
Ian M. Goodyer ◽  
Carol Gilmour

BackgroundPost-traumatic stress disorder (PTSD) can be a persistent and disabling psychiatric disorder. There is little systematic research into the psychiatric consequences of road traffic accidents (RTAs) in children and adolescents.MethodA consecutive sample of 8–16-year-olds attending an accident and emergency department following RTAs were screened for PTSD. Potential cases and their parent(s) were interviewed with semi-structured research instruments about six weeks and six months after the accident.ResultsFifty-three (45%) of the 119 subjects fell above PTSD cut-off on the Frederick's Reaction Index. Thirty-three (75%) of the 44 cases met DSM–IV criteria for PTSD. In half of these other psychiatric disorders were present, including major depressive disorder and anxiety disorders. Being female, involvement in car accidents and pre-existing depression and anxiety were associated with developing PTSD. Seventeen per cent of the sample continued to be symptomatic six months after the accident.ConclusionsPTSD is a common consequence of RTAs. Liaison with accident and emergency departments would enhance the early detection and follow-up of children at risk of developing PTSD.


Author(s):  
Susanne Fischer ◽  
Tabea Schumacher ◽  
Christine Knaevelsrud ◽  
Ulrike Ehlert ◽  
Sarah Schumacher

Abstract Background Less than half of all individuals with post-traumatic stress disorder (PTSD) remit spontaneously and a large proportion of those seeking treatment do not respond sufficiently. This suggests that there may be subgroups of individuals who are in need of augmentative or alternative treatments. One of the most frequent pathophysiological findings in PTSD is alterations in the hypothalamic–pituitary–adrenal (HPA) axis, including enhanced negative feedback sensitivity and attenuated peripheral cortisol. Given the role of the HPA axis in cognition, this pattern may contribute to PTSD symptoms and interfere with key processes of standard first-line treatments, such as trauma-focused cognitive behavioural therapy (TF-CBT). Methods This review provides a comprehensive summary of the current state of research regarding the role of HPA axis functioning in PTSD symptoms and treatment. Results Overall, there is preliminary evidence that hypocortisolaemia contributes to symptom manifestation in PTSD; that it predicts non-responses to TF-CBT; and that it is subject to change in parallel with positive treatment trajectories. Moreover, there is evidence that genetic and epigenetic alterations within the genes NR3C1 and FKBP5 are associated with this hypocortisolaemic pattern and that some of these alterations change as symptoms improve over the course of treatment. Conclusions Future research priorities include investigations into the role of the HPA axis in day-to-day symptom variation, the time scale in which biological changes in response to treatment occur, and the effects of sex. Furthermore, before conceiving augmentative or alternative treatments that target the described mechanisms, multilevel studies are warranted.


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