Verletzungen und Verletztsein

 

 Buy Article Permissions and Reprints

Injuries and being injured. Unvisible wounds after accidental trauma

Summary

Motor vehicle accidents may cause apart from physical also psychological aftermaths. Despite of posttraumatic psychologic symptoms may remit after 2-3 months, 10-20 % of the injured persons will develop sustainable psychopathological symptoms. This report aims at an overview on possible psychopathological disturbances and their perpetuating conditions. Possible treatments are shown and the necessity of an interdisciplinary cooperation with the aim of a secondary prevention is emphasized.

Zusammenfassung

Verkehrsunfälle können neben körperlichen auch psychische Folgeschäden verursachen. Wenngleich posttraumatische psychische Symptome nach 2-3 Monaten remittieren können, liegt die Zahl derjenigen Unfallverletzten, die eine gravierende psychopathologische Symptomatik entwickeln, bei ca. 10-20 %. Der vorliegende Artikel zielt auf einen Überblick der möglichen psychischen Störungsbilder und deren aufrechterhaltende Determinanten ab. Behandlungsmöglichkeiten werden aufgezeigt und die Notwendigkeit einer interdisziplinären Zusammenarbeit mit dem Ziel einer Sekundärprävention unterstrichen.

Literatur

• 1 Acierno R, Hersen M, Hasselt V B, Meuser K T. Review of the validation and dissemination of eye-movement desensitization and reprocessing: A scientific and ethical dilemma.  Clinical Psychology Review. 1994;  14 287-299
  CrossrefPubMedGoogle Scholar
• 2 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders. (4th ed), Author, Washington DC 1994
  Google Scholar
• 3 Awerbuch M. Whiplash in Australia: Illness or injury.  Med J Australia. 1992;  157 193-196
  PubMedGoogle Scholar
• 4 Barton K A, Blanchard E B, Hickling E J. Antecedents and consequences of acute stress disorder among motor vehicle accident victims.  Behav Res Ther. 1996;  34 805-813
  PubMedGoogle Scholar
• 5 Blanchard E B, Hickling E J, Vollmer A J, Loos W R, Buckley T C, Jaccard J. Short-Term follow-up of post-traumatic stress symptoms in motor vehicle accident victims.  Behav Res Ther. 1995;  33 369-377
  PubMedGoogle Scholar
• 6 Blanchard E B, Hickling E J, Barton K, Taylor A E, Loos W R, Jones-Alexander J. One-year prospective follow-up of motor vehicle accident victims.  Behav Res Ther. 1996;  34 775-786
  PubMedGoogle Scholar
• 7 Blanchard E B, Hickling E J, Taylor A E, Loos W R, Foreneris C A, Jaccard J. Who develops PTSD from motor vehicle accidents.  Behav Res Ther. 1996;  34 1-10
  PubMedGoogle Scholar
• 8 Blanchard E B, Hickling E J, Taylor A E, Buckley T C, Loos W R, Walsh J. Effects of litigation settlement on posttraumatic stress symtoms in motor vehicle accident victims.  J Trauma Stress. 1998;  11 337-355
  CrossrefPubMedGoogle Scholar
• 9 Blanchard E B, Buckley T C, Hickling E J, Taylor A E. Posttraumatic stress disorder and comorbid major depression: is the correlation an illusion.  J Anxiety Disorders. 1998;  12 21-37
  PubMedGoogle Scholar
• 10 Bohnen N, Jolles J. Neurobehavioral aspects of postconcussive symptoms after mild head injury.  J Nerv Ment Dis. 1992;  180 683-692
  PubMedGoogle Scholar
• 11 Boudewyns P A, Stwertkas L A, Hyer J W, Albrecht X, Sperr E G. Eye movement desensitization for PTSD of combat: A treatment outcome pilot study.  Behav Therap. 1993;  16 29-33
  PubMedGoogle Scholar
• 12 Brady K T. Posttraumatic stress disorder and comorbidität: recognizing the many faces of PTSD.  J Clin Psychiatry. 1997;  58 12-14
  PubMedGoogle Scholar
• 13 Breslau N, Davis G C, Andreski P, Peterson E L, Schultz L R. Sex differences in posttraumatic stress disorder archives.  Gen Psychiatry. 1997;  54 1044-1048
  Google Scholar
• 14 Brom D, Kleber R J, Defares P B. Brief psychotherapy for posttraumatic stress disorders.  J Consult Clin Psych. 1989;  57 607-612
  PubMedGoogle Scholar
• 15 Bronisch T. Posttraumatic Stress Disorder - Posttraumatische Belastungsstörung.  Fortsch Neurol Psychiatrie. 1997;  65 195-207
  PubMedGoogle Scholar
• 16 Bryant R A, Harvey A G. Psychological impairment following motor vehicle accidents.  Australian J Public Health. 1995;  19 185-188
  PubMedGoogle Scholar
• 17 Bryant R A, Harvey A G. Avoidant coping style and post-traumatic stress following motor vehicle accident.  Behav Res Ther. 1995;  33 631-635
  PubMedGoogle Scholar
• 18 Bryant R A, Harvey A G. Initial post-traumatic stress responses following motor vehicle accidents.  Behav Res Ther. 1996;  33 632-636
  PubMedGoogle Scholar
• 19 Bryant R A, Harvey A G. Acute stress disorder: a critical review of diagnostic issues.  Clin Psychol Rev. 1997;  17 757-773
  PubMedGoogle Scholar
• 20 Buckley T C, Blanchard E B, Hickling E J. A prospective examination of delayed onset of PTSD secondary to motor vehicle accidents.  J Abnormal Psychol. 1996;  105 617-625
  PubMedGoogle Scholar
• 21 Davidson J RT, Fairbank J A. The epidemiology of posttraumatic stress disorder. In: Davidson JRT, Foa EB (Eds). Posttraumatic stress disorder: DSM-IV and beyond. American Psychiatric Press, Washington 1992
  Google Scholar
• 22 De Girolamo G, McFarlane A C. The epidemiology of PTSD: A comprehensive review of the international literature. In: Mak FL, Nadelson CC (Eds). International Review of Psychiatry 2: American Psychiatric Press, Washington DC 1996; 93-119
  Google Scholar
• 23 Delahanty D L, Herberman H B, Craig K J, Hayward M C, Fullerton C S, Ursano R J. Acute and chronic distress and posttraumatic stress disorder as a function of responsibility for serious motor vehicle accidents.  J Consult Clin Psychol. 1997;  65 560-567
  CrossrefPubMedGoogle Scholar
• 24 Di Gallo A, Barton J, Parry-Jones W L. Road traffic accidents: early psychological consequences in children and adolescents.  Br J Psychiatry. 1997;  170 358-362
  PubMedGoogle Scholar
• 25 Dilling H, Mombour W, Schmidt M H. Internationale Klassifikation psychischer Störungen. Huber, Bern 1991
  Google Scholar
• 26 Dressing H, Berger M. Posttraumatische Streßerkrankungen. Die Entwicklung des gegenwärtigen Krankheitskonzeptes.  Nervenarzt. 1991;  62 16-62
  PubMedGoogle Scholar
• 27 Ehlers A, Steil R. Maintenance of intrusive memories in posttraumatic stress disorder: A cognitive approach.  Behav Cognit Psychother. 1995;  23 217-249
  CrossrefPubMedGoogle Scholar
• 28 Ehlers A, Mayou R A, Bryant B. Psychological predictors of chronic PTSD after vehicle accidents.  J Abnormal Psychol. 1998;  107 508-519
  PubMedGoogle Scholar
• 29 Frank J B, Kosten T R, Giller E L, Dan E. A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder.  Am J Psych. 1988;  145 1289-1291
  PubMedGoogle Scholar
• 30 Frey D, Rogner O, Havemann D. Kognitive und psychosoziale Determinanten des Genesungsprozesses von Unfallpatienten. Universität Kiel 1985
  Google Scholar
• 31 Foa E B, Rothbaum B O, Riggs D S, Murdock T B. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling.  J Consult Clin Psychol. 1991;  59 715-723
  CrossrefPubMedGoogle Scholar
• 32 Frommberger U, Schlickewei W, Stieglitz R D, Nyberg E, Kuner E, Berger M. Die psychischen Folgen nach Verkehrsunfällen Teil II: Ergebnisse einer prospektiven Studie.  Unfallchirurgie. 1998;  24 122-128
  CrossrefPubMedGoogle Scholar
• 33 Frommberger U, Käppler C, Stieglitz R D, Schlickewei W, Kuner E, Berger M. Die Entwicklung von posttraumatischen Belastungsstörungen nach Verkehrsunfällen. Erste Ergebnisse einer prospektiven Studie. In: Möller H-J, Engel RR, Hoff P (Hrsg). Befunderhebung in der Psychiatrie: Lebensqualität, Negativsymptomatik und andere aktuelle Entwicklungen. Springer, Wien 1996; 309-312
  Google Scholar
• 34 Green M M, McFarlane A C, Hunter C E, Griggs W M. Undiagnosed posttraumatic stress disorder following motor vehicle accidents.  Med J Australia. 1993;  159 529-534
  PubMedGoogle Scholar
• 35 Heim E. Coping und Anpassungsvorgänge in der psychosomatischen Medizin.  Z psychosomatische Med Psychoanalyse. 1979;  25 251-262
  PubMedGoogle Scholar
• 36 Hickling E J, Blanchard E B, Schwarz S P, Silverman J. Headaches and motor vehicle accidents: Results of the psychological treatment of post-traumatic headache.  Headache Quarterly. 1992;  3 285-289
  PubMedGoogle Scholar
• 37 Hodge J R. The whiplash neurosis.  Psychosomatics. 1971;  12 245-249
  PubMedGoogle Scholar
• 38 Jensen J A. An investigation of eye movement desensitization and reprocessing (EMD/R) as a treatment for posttraumatic stress disorder (PTSD) symptoms of Vietnam combat veterans.  Behav Ther. 1994;  25 311-325
  PubMedGoogle Scholar
• 39 Internetseiten des Statistischen Bundesamtes. 23. 08. 1999
  Google Scholar
• 40 Kessler R, Sonnega A, Bromet E. et al . Posttraumatic stress disorder in the national comorbidity survey.  Arch Gen Psychiatry. 1995;  52 1048-1060
  Google Scholar
• 41 Koutsosimou M, McDonald A S, Davey G CL. Coping and psychopathology in surgery patients: A comparision of accident patients with other surgery patients.  Br J Health Psychol. 1996;  1 357-364
  PubMedGoogle Scholar
• 42 Kuch K K, Cox B J, Evans R, Shulman I. Phobias, panic, and pain in 55 survivors of road vehicle accidents.  J Anxiety Disorders. 1994;  8 181-187
  PubMedGoogle Scholar
• 43 Kuch K K, Cox B J, Evans R J. Posttraumatic stress disorder and motor vehicle accident: a multidisciplinary overview.  Canad J Psychiatry. 1996;  41 429-434
  PubMedGoogle Scholar
• 44 Lauer G. Fahrängste und Fahrphobien. In: Höfling S, Butollo W (Hrsg). Psychologie für Menschenwürde und Lebensqualität. Deutscher Psychologen-Verlag, München 1989
  Google Scholar
• 45 Lazarus R S. Streß und Streßbewältigung. In: Filip SH (Hrsg). Kritische Lebensereignisse. Psychologie-Verlagsunion, Weinheim 1995; 198-232
  Google Scholar
• 46 Mayou R A, Bryant B, Duthie R. Psychiatric consequences of road traffic accidents.  Br Med J. 1993;  307 647-651
  PubMedGoogle Scholar
• 47 Mayou R, Tyndel S, Bryant B. Long-term outcome of motor vehicle accident injury.  Psychosom Med. 1997;  59 578-584
  PubMedGoogle Scholar
• 48 Meyer C, Steil R. Die posttraumatische Belastungsstörung nach Verkehrsunfällen.  Unfallchirurg. 1998;  12 878-894
  PubMedGoogle Scholar
• 49 Meyer C, Markgraf E. Die posttraumatische Belastungsstörung nach Verkehrsunfällen. Editorial.  Unfallchirurg. 1998;  12 877
  PubMedGoogle Scholar
• 50 Norris F H. Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups.  J Consult Clin Psychol. 1992;  60 409-418
  Google Scholar
• 51 Parker R S. The spectrum of emotional distress and personality changes after minor head injury incurred in a motor vehicle accident.  Brain Injury. 1996;  10 287-302
  CrossrefPubMedGoogle Scholar
• 52 Pfefferbaum B. Posttraumatic stress disorder in children: a review of the past 10 years.  J Am Acad Child Adolesc Psychiatry. 1997;  36 1503-1511
  PubMedGoogle Scholar
• 53 Radanov B P, Di Stefano G, Schnidrig A, Ballinari P. Role of psychological stress in recovery from common whiplash.  Lancet. 1991;  338 712-715
  CrossrefPubMedGoogle Scholar
• 54 Radanov B P, Di Stefano G, Schnidrig A, Sturzenegger M. Psychosocial stress, cognitive performance and disability after common whiplash.  J Psychosom Res. 1993;  37 1-10
  PubMedGoogle Scholar
• 55 Ritter G, Kramer J. Unfallneurose, Rentenneurose. Perimed, Erlangen 1991
  Google Scholar
• 56 Rothbaum B O. A controlled study of eye movement desensitization and reprocessing in the treatment of posttraumatic stress disordered sexual assault victims.  Bull Menninger Clin. 1997;  61 317-334
  PubMedGoogle Scholar
• 57 Shapiro F. Eye movement desensitization: A new treatment for posttraumatic stress disorder.  J Behav Ther Exp Psychiatry. 1989 a;  20 211-217
  Google Scholar
• 58 Shapiro F. Efficiacy of the eye movement desensitization procedure in the treatment of traumatic memories.  J Traum Stress. 1989 b;  2 199-223
  CrossrefPubMedGoogle Scholar
• 59 Shapiro F. Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. Guilford, New York 1995
  Google Scholar
• 60 Shestatzky M, Greenberg D, Lerer B A. A controlled trial of phenelzine in posttraumatic stress disorder.  Psychiatric Res. 1988;  24 149-155
  PubMedGoogle Scholar
• 61 Solomon S D, Gerrity E T, Muff A M. Efficiacy of treatments for posttraumatic stress disorder.  1992;  268 633-638
  CrossrefPubMedGoogle Scholar
• 62 Solomon S. Psychosocial treatment of posttraumatic stress disorder.  In Session: Psychotherapy in Practice. 1997;  3 27-41
  CrossrefPubMedGoogle Scholar
• 63 Solomon Z, Mikulincer M, Avitzur E. Coping, locus of control, social support and combat-related posttraumatic stress disorder: A prospective study.  J Nerv Mental Dis. 1988;  175 277-285
  PubMedGoogle Scholar
• 64 Steil R, Ehlers A. Cognitive correlates of intrusive memories after road traffic accidents.  Behav Res Ther (submitted).
  PubMedGoogle Scholar
• 65 Steil R. Posttraumatische Intrusionen nach Verkehrsunfällen. Faktoren der Aufrechterhaltung. Peter Lang Verlag, Frankfurt 1996
  Google Scholar
• 66 Taylor S, Koch W J. Anxiety disorders due to motor vehicle accidents: Nature and treatment.  Clin Psychol Rev. 1995;  15 721-738
  PubMedGoogle Scholar
• 67 Winter H. Posttraumatische Belastungsstörung nach Verkehrsunfällen. Peter Lang Verlag, Frankfurt 1996
  Google Scholar

Dr. phil. Christina Meyer

Klinik für Unfallchirurgie
Klinikum der Friedrich-Schiller-Universität

Bachstraße 18

D-07743 Jena