Characteristics And Influencing Factors Of Stress Disorder, Posttraumatic Growth In Rehabilitation Patients After Traumatic Injury And Explore The Effective Of Transcranial Magnetic Stimulation For PTSD

Objective: To study the Characteristics of Posttraumatic Stress Disorder(PTSD), PosttraumaticGrowth (PTG) in rehabilitation patients after traumatic injury, and affect of resilience, social support,copying style, emotional experience for the Stress disorder. Explore the effective of RepetitiveTranscranial Magnetic Stimulation (rTMS) to core symptoms, positive and negative affect, PTG,resilience in rehabilitation patients with PTSD. For rehabilitation patients after traumatic injury provideevidence for setting out efficient intervention measures.Mothods: One hundred and ninety-six rehabilitation in-patients with dysfunction after traumaticinjury admitted in two high-grade hospitals in Chongqing，were assessed according to the PTSDChecklist-Civilian Version(PCL-C), Posttraumatic Growth Inventory(PTGI), Connor-DavidsonResilience Scale(CD-RISC), Copying Style Questionnaire（CSQ）, Perceived Social Support Scale（PSSS）and Positive and Negative Affect Scale（PANAS）.30patients（PTSD score≥38）from196persons were selected. Require conscious clear, normalexpressing, normal writing, no history of brain trauma and epilepsy, at present did not have other diseaseand willing to take part in the study.30subjects with PTSD were assigned to the following treatments：Active group(20subjects) receive20Hz rTMS to the right dorsolateral prefrontal cortex(DLPFC),stimulus intensity80%threshold, active time1s,20per sequence pulse, interval of15s, a total of56sequences1120pulses; Control group(10subjects) receive sham rTMS using the magnetic coil verticalto the same area. Treatments were administered in daily sessions over2weeks. Subjects were assessedat before and after10rTMS sessions according to the PTSD Checklist-Civilian Version(PCL-C),Posttraumatic Growth Inventory(PTGI), Connor-Davidson Resilience Scale(CD-RISC) and Positive andNegative Affect Scale(PANAS). Compare the two groups in PTSD, PTG, resilience, positive andnegative emotional level changes before and after treatment. All dates were processed with SPSS17.0.The main statistical methods include t test, variance analysis, relevance analysis and regression analysis. Results:1. The average PTSD score of this cohort was32.96±12.72. PTSD group were higher than no PTSDgroup in negative copying and emotion score（p＜0.05，p＜0.01）, significantly lower than no PTSDgroup in resilience total score、positive copying、support from family、support out of family and positivemood（p＜0.01）.2. The total PTG score was34.76±18.68,with an interpersonal score of13.59±7.39, a newpossibility score of6.88±4.98，a personal power score of6.38±4.66，a mental change score of2.27±2.13，and an appreciate life score of5.78±2.99. No significant difference was found in each factorand between the total score of PTG and distinct sex, age as well as education（p＞0.05）.3. PTSD was significant negatively correlated with resilience, positive copying, support fromfamily, support out of family and positive mood（p＜0.01）;positively correlated with negative copyingand emotion（p＜0.05，p＜0.01）.PTG was positively correlated with resilience, positive copying, support from family, support outof family and positive mood（p＜0.05，p＜0.01）.4. Positive mood and negative emotion could be used to effectively predict the PTSD with anexplanation rate of28.5%.Resilience, support from family, and support from out of family could be used to effectivelypredict the PTG with an explanation rate of20.3%.5. The total score of PTSD and each factor were significantly lower in high resilience score groupthan in low resilience score group（p＜0.01）.The total score of PTSD and each factor were lower in highsocial support score group than in low social support score group（p＜0.05，p＜0.01）.The total score of PTG and each factor were significantly higher in high resilience score groupthan in low resilience score group（p＜0.01）.The total score of PTG and interpersonal, new possibilityand personal power score were significantly higher in high social support score group than in low socialsupport score group（p＜0.05，p＜0.01）. No significant difference was found in a mental change scoreand an appreciate life score between high social support score group and low social support score group（p＞0.05）.6. The10daily treatments of20Hz rTMS to right DLPFC induced a significant improvements inPTSD core symptoms、positive and negative affect（p<0.01）, but resilience total score and PTG totalscore had not markedly improved with this treatment (p>0.05). Sham rTMS had not resulted instatistically significant improvement（p＞0.05）. Conclusion:1. Resilience、copying style、social support and emotional presentation style in rehabilitationpatients after traumatic injury are closely correlated with PTSD and PTG. Positive and negative affectcan be used as important predictive factors for PTSD. Resilience and social support could be used toeffectively predict the PTG.2. The total score of PTSD were more lower in high resilience and social supports group. The totalscore of PTG were more higher in high resilience and social support group. This suggests that patientswith high resilience can effectively utilize social resource to prevent PTSD happening, can flexiblyadjust cognization to acquire growth after meeting with trauma event. But some scholar have differentpoint of view, the relation between resilience and PTG exist controversy yet.3. Stress response inducing from trauma event be regulated by many element including internal andexternal cause, this element interact, influence the develop orientation of posttraumatic mental stress.4.20Hz rTMS of right DLPFC can significantly reduce negative affect，enhance positive emotion,alleviate the core symptoms of PTSD; suggest that high-frequency rTMS of right DLPFC might be theoptimal treatment strategy.