PTSD, Psychosomatische Komorbidität und Risikofaktoren bei Patienten mit akuter Unfallverletzung

Treatment and rehabilitation of accident victims is of great public interest because traumatic injuries are the main cause of invalidity or death, especially among young adults. Post-traumatic stress disorder (PTSD) may be one of the main complications (besides other physical disorders) after accidents. These symptoms influence recovery during initial rehabilitation treatment, and they are important in gaining expert opinions before medical boards. Psychotraumatology and the care of polytraumatised patients are crossover fields of work and research. The present study was within the framework of a project of cooperation between the Klinik für Psychosomatik und Psychotherapeutische Medizin and the Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie at the Universitätsklinikum Aachen, The present interdisciplinary study intended to demonstrate interactions between physical and psychical effects due to accidents. Special attention was given to psychical consequences with their comorbidities. In this study, 65 acutely traumatized patients were examined, both shortly after an accident and about four months later. We used psychometric analytical techniques to investigate the psychical consequences of their traumata. Our results show that PTSD is not an isolated aspect of a disease but does often coexist with comorbidities such as anxiety, depression and physical symptoms. Factors of comorbitity that are analyzed with psychometric tools are pronounced differently when patients with symptoms of PTSD are compared with patients without this disorder. The physical pains of burn victims rate on a higher partial scale than those of patients with other injuries. However, it was not possible to see a significant difference between the degree of seriousness of an injury and the scale of comorbidity. In women almost all factors of comorbidity are significantly more pronounced than in men. The final logistic regression analysis showed that the the variables anxiety and gender had a clear predictive value. We also investigated whether an early rise of comorbidity factors followed by later PTSD symptoms would be of predictive value. In patients showing PTSD symptoms after four months the variables anxiety, depression and trait-anxiety are significantly higher. Patients with accident trauma should get professional help already before they develop clinical symptoms, to prevent such a disease or a chronification. Thus, the results of the present investigation may contribute to develop a screening test for discerning risk patients in every emergency room. These patients should then undergo professional care. To provide this care sufficiently, a solid base consisting of qualified regional psychotherapists, medical centers and university clinics should be created