Psychological symptoms and syndromes

Depression, post-traumatic stress disorder, and phobic anxiety are common after frightening trauma and can be severe, whether or not there is evidence of previous psychological and social vulnerability. These psychological complications are not closely related to the severity of any physical injury. The general principles of assessment are those for similar psychological problems occurring in the absence of trauma.

Depression—A failure to recognise depression is distressingly common, perhaps because care focuses on physical injuries. Inquiries about depressive symptoms should therefore be routine.

Post-traumatic stress disorder is also common and disabling. It is characterised by intrusive memories of the trauma, avoidance of reminders of it, and chronic arousal and distress. It may be complicated by alcohol misuse. It usually has an early onset in the first few weeks (acute stress disorder). Many people improve rapidly but, if symptoms are still present two or three months after the injury, they are likely to persist for much longer. A few cases have a delayed onset. Psychological treatment is effective.

Phobic anxiety may be associated with post-traumatic stress disorder but can occur separately. A particularly common form

Effect of immediate debriefing on victims of road traffic injury. Those with high initial scores on the impact of events scale (intrusive thoughts and avoidance) had worse outcome than untreated controls at 4 months and 3 years

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\ BHomicide and road deaths (0.1%)

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\ HZlRape and other sexual crimes (1.6%)

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Other violence (20%)

Burglary (40%) Theft (22%)

Criminal damage and arson (11%)

Other crime (5%)

Other referrals (0.7%)

Reasons for people being offered help by Victim Support 1997-8

Reasons for people being offered help by Victim Support 1997-8

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