创伤后应激障碍背景下的自杀行为--精神和社会心理方面

V. A. Rozanov, T. Karavaeva, A. V. Vasil'eva, D. Radionov
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引用次数: 0

摘要

背景:压力和创伤对于创伤后应激障碍和自杀的发展都很重要,然而,创伤后应激障碍中的自杀行为却没有得到足够的重视。 本综述旨在介绍自杀行为(表现形式多种多样--从自杀念头和自杀未遂到自杀完成)与创伤后应激障碍的精神诊断之间的关系,或与该障碍在不同情况下的个别症状之间的关系,以及最新和最有证据基础的数据。 材料与方法:在 PubMed 和电子图书馆以及相关专著中进行了数据检索,主要是以证据为基础的来源。 结果:现有数据有力地表明,创伤后应激障碍并不是导致自杀风险增加的首要因素,但却是一个重要因素,尤其是在与抑郁症和成瘾并发的情况下。特定群体遭受创伤压力越大,创伤后应激障碍症状与自杀行为之间的关系就越密切。创伤后应激障碍对自杀行为的影响在很大程度上受创伤后应激障碍的并发症和社会心理适应不良的严重程度的影响。在创伤后应激障碍、抑郁和自杀的发病机制中,对创伤事件的依赖性和应激易感性是共同的环节。 结论:在临床实践中,如果出现创伤后应激障碍的诊断或特定症状,就需要密切关注患者的自杀倾向,并采取有针对性的预防措施。在人群层面,有必要更加关注一般的耐受力和抗压能力。
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Suicidal Behavior in the Context of Post-Traumatic Stress Disorder — Psychiatric and Psychosocial Aspects
   Background: stress and trauma are important both for the development of PTSD and suicide, however, suicidal behavior in PTSD is not characterized enough.   The aim of this narrative review is to present the latest and most evidence-based data on the relationship between suicidal behavior (in its wide range of manifestations — from suicidal thoughts and attempts to completedsuicide) with a psychiatric diagnosis of PTSD, or with individual symptoms of this disorder in different contingents.   Materials and methods: data search was performed in PubMed and e-Library, as well as in relevant monographs, mostly evidence-based sources.   Results: the data available strongly suggest that PTSD is not a priority, but a significant factor in an increased risk of suicide, especially in case of comorbidity with depression and addictions. The more a particular group is exposed to traumatic stress, the stronger the relationship between PTSD symptoms and suicidal behavior. The impact of PTSD on suicidality is largely mediated by the comorbidity and severity of psychosocial maladjustment that often accompanies PTSD. Dependence on a traumatic event and stress vulnerability are common links in the pathogenesis of PTSD, depression, and suicide.   Conclusion: in clinical practice, the presence of a diagnosis or selected symptoms of PTSD is the reason for closer attention to the suicidal tendencies of the patient and the use of targeted prevention measures. On the population level, it is necessary to pay more attention to general hardiness and stress resilience.
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