Disturbo post-traumatico da stress: fattori di ... - Marco Cannavicci

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Giornale di Medicina Militare - A. 154°, Fasc. 1-2, gen. - apr. 2004 Altre persone con meccanismi psicologici cognitivi inadeguati e rigidi si scompensano psicopatologicamente anche per eventi stressanti minimi. Fra gli uni e gli altri risulta determinante la capacità di adattamento del soggetto alla tensione, alla frustrazione, al lutto, ad una realtà che non piace e che non si condivide. Capacità che si evincono da affermazioni del tipo: “C’è qualcosa che non va in me, che non va in te o nella situazione, ma va bene lo stesso”. Bibliografia 1. American Psychiatric Association, (2002): DSM - IV-TR. Masson Editrici - Milano. 2. Glen O. Gabbard (1995): Psichiatria Psicodinamica. Raffaello Cortina Ed.. 30 3 Adrien Wells (1999): Trattamento cognitivo dei disturbi d’ansia. Mc Graw Will. 4. Stephen Reed, (1994): Psicologia cognitiva. Ed. Rubino. 5. Lo Iacono A., Troiano M. (2002): Psicologia dell’emergenza. Editori Riuniti. 6. Yule W. (2000): Disturbo post-traumatico da stress: aspetti clinici e terapia. Mc Graw will. 7. Noto R., Hnguenord P., Lascan A. (1989): Medicina delle Catastrofi. Massan. 8. Klzin E. (1994): Psicologia e Psichiatria di una Guerra. Ed. Universitarie Romane.
Giornale di Medicina Militare - A. 154°, Fasc. 1-2, gen. - apr. 2004 1. Introduction Post-traumatic stress disorder: risk factors Historically the concept of a psychogenic reaction to stressful and traumatising events was introduced by Bleuler in 1911. However similar concepts had already been elaborated at the end of the last century in the definitions of “post-traumatic neurosis” by Oppenheim (1892) and “fright neurosis” by Kraeplin (1896). (Table 1). The concept of “psychic trauma” originated then at the end of the last century at the same time as events linked with changes in technological and industrial development. These were railway accidents, mining accidents and those related to industrial gas, and later the Great War with the psychic impact of new longrange firearms. These arms brought about the appearance of mass traumatic events. The concept of “war neurosis” came about with the First World War, and not by chance, the first congress of the International Psychoanaltical Society, in Budapest in 1924, was in fact dedicated to war neurosis. Sigmund Freud, himself, dealing with dreams and traumatic nightmares linked to disorders of Austrian First World War veterans, was forced to revise his first theory of instincts, and introduce, for example, the psychoanalytical concept of “repitition compulsion”. The current case histories of “Post traumatic stress disorder” are mostly reported in North American literature, thanks above all to the work of researchers who collect systematic data in the event of natural catastrophes, wars, industrial and technological disasters, etc. There are also case histories which are less ample but equally interesting, supplied by organisations such as the police, military corps, fire service, Red Cross, etc. 2. Diagnostic and Clinical Criteria Schematically the general criteria for defining “post traumatic stress disorder” in the DSM-IV are represented by: • persistent tendency to relive the traumatic event through dreams, nightmares, intrusive memories when thinking, flashbacks, etc; • persistent avoidance of stimuli associated with the trauma and general reactive weakening; and protective factors Marco Cannavicci Michele Donvito 31 • persistent symptoms of increased “neuro-vegetative” arousal. It is possible however to recognise symptoms that are more specific than others for differential diagnosis of Post-traumatic stress disorder compared to other anxiety and mood disorders, as in Table 2. These are for example, nightmares, flashbacks, keeping at a distance from others, loss of interest in carrying out one’s business, avoiding things, people, situations that recall the event. The groups of symptoms present in the DSM-IV cannot all be considered at the same level, in that some symptoms or psychopathological reactions are often the effect of the other symptoms. Pathological avoidance (phobia), for example, has a defensive function towards suffering that is considered intollerable, neurovegetative hyperactivation is a psychic correlation in reaction to the psychological situation of avoidance. Intrusive memories and nightmares seem to represent instead an attempt to “reprocess” cognitively the information linked to the event of the trauma, moreover without success. Table 1 - Evolution of the concept of psychic trauma. Post-traumatic neurosis Oppenheim 1892 Fright neurosis Kraepelin 1896 War neurosis Simmel 1918 Psychogenic disorders Bleuler 1911 Reactions to events Jaspers 1913 Physioneurosis Kardiner 1941 Abnormal reactions to events Schneider 1946 Key Events Kretschmer 1966 Transitory situational disorders DSM-II 1968 Acute reactions to stress ICD-9 1978 Adaptation disorders DSM-III-R 1987 Post-traumatic stress disorder DSM-III-R 1987 Acute reaction to stress ICD-10 1989 Post-traumatic stress disorder ICD-10 1989 Adaptation disorder ICD-10 1989 Post-traumatic stress disorder DSM-IV 1996
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Disturbo post-traumatico da stress: fattori di ... - Marco Cannavicci

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