scholarly journals Update on the epidemiology, diagnosis, and treatment of posttraumatic stress disorder

2000 ◽  
Vol 2 (1) ◽  
pp. 37-43
Keyword(s):  
Posttraumatic Stress Disorder ◽  
General Population ◽  
Mental Disorders ◽  
Posttraumatic Stress ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Stress Disorder ◽  
Psychological Intervention ◽  
Traumatic Event ◽  
Psychological Trauma ◽  
Therapeutic Effects

Posttraumatic stress disorder (PTSD) is a maladaptive, pathological response to a traumatic event which is currently underdiagnosed and undertreated. This results in part from a lack of awareness regarding the prevalence of the disorder. It has been estimated that at least one third of the general population will be exposed to severe trauma throughout their lifetime, out of which approximately 10 % to 20 % develop PTSD. A prevalence of 3 % to 6 % of PTSD in the general population, found in several studies, corresponds well with these figures. Both the type of trauma and the personal characteristics of the individual involved are associated with the probability of developing PTSD. The Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) gives four diagnostic criteria: (i) exposure and emotional response to a traumatic event; (ii) reexperiencing; (iii) avoidance; and (iv) increased physiological arousal, along with severe impairment in occupational, social, and interpersonal functioning. The rate of comorbidity with other mental disorders is high, particularly for major depression, anxiety disorders, and substance abuse. Different types of psychological intervention, including cognitive-behavioral therapy and a host of pharmacological interventions, have been tried. Selective serotonin reuptake inhibitors (SSRIs) are currently the most widely researched agents with consistent, though modest, therapeutic effects. Other compounds, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) have also been found to be effective, although their use is limited due to side effects. PTSD is a psychobiological phenomenon in response to psychological trauma, which represents maladaptive neurobiological deregulation and psychological dysfunction, and awaits further recognition and research.

scholarly journals Posttraumatic stress disorder and the nature of trauma

2000 ◽  
Vol 2 (1) ◽  
pp. 7-22 ◽  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Mental Disorders ◽  
World War I ◽  
Vietnam War ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Motor Vehicle ◽  
Traumatic Event ◽  
Psychological Trauma ◽  
Vehicle Accidents

The role of psychological trauma (eg, rape, physical assaults, torture, motor vehicle accidents) as an etiological factor in mental disorders, anticipated as early as the 19th century by Janet, Freud, and Breuer, and more specifically during World War I and II by Kardiner, was "rediscovered" some 20 years ago in the wake of the psychological traumas inflicted by the Vietnam war and the discussion "in the open " of sexual abuse and rape by the women's liberation movement, 1980 marked a major turning point, with the incorporation of the diagnostic construct of posttraumatic stress disorder (PTSD) into the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and the definition of its main diagnostic criteria (reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, and symptoms of increased arousal). Initially described as resulting from a onetime severe traumatic incident, PTSD has now been shown to be triggered by chronic multiple traumas as well. This "state-of-the-art" article discusses past and current understanding of the disorder, with particular emphasis on the recent explosive developments in neuroimaging and other fields of the neurosciences that have highlighted the complex interrelationships between the psychological, psychiatric, biological, and neuroanatomical components of the disorder, and opened up entirely new therapeutic perspectives on how to help the victims of trauma overcome their past.

scholarly journals Therapeutic effects of two antidepressant agents in the treatment of posttraumatic stress disorder (PTSD)

2003 ◽  
Vol 3 (2) ◽  
pp. 12-16 ◽  
Author(s):  
Semra Čavaljuga ◽  
Ifeta Liačnin ◽  
Nedad Mulabegović ◽  
Dubravka Potkonjak
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Startle Reaction ◽  
Therapeutic Effects ◽  
Ptsd Symptoms ◽  
Fluoxetine Hydrochloride ◽  
Catastrophic Illness ◽  
Amitriptyline Hydrochloride

Posttraumatic stress disorder (PTSD) is a psychiatric disorder characterised by an acute emotional response to a traumatic event or situation involving severe environmental stress (natural disasters, wars, epidemics, rape, assaults, physical torture, catastrophic illness or accident), which may be identified in cognitive, affective or sensory motor activities. The objective was to perform a pilot clinical trial designed to compare the effects of older (tricyclic) and newer “second-generation” (selective inhibitors of serotonin uptake) antidepressants in the treatment of PTSD. A total of 20 hospitalised chronic military combat Bosnian veterans with PTSD symptoms were randomly assigned into two groups of 10 patients each. One group was treated with amitriptyline hydrochloride (AMYZOL®) 75 mg/day as a representative of older antidepressants and the other with fluoxetine hydrochloride 60 mg/day (OXETIN®) as a representative of newer antidepressants. Those drugs were administered by mouth two or three times-a-day in equally divided doses for at least 8 weeks. Favourable response was achieved in 70% of patients treated with amitriptyline hydrochloride and 60% of patients treated with fluoxetine hydrochloride. Amitriptyline hydrochloride was more effective in the treatment of acute PTSD symptoms (emotional numbing, startle reaction, nightmares, flashbacks, intrusive thoughts, vulnerability, poor impulse control or irritability and explosiveness). Fluoxetine hydrochloride showed a greater efficacy in the treatment of chronic PTSD symptoms (avoidance and numbing symptoms, hyperarousal, nightmares and a feeling of guilt).

WCA Recommendations for the Long-Term Treatment of Posttraumatic Stress Disorder

CNS Spectrums ◽  
2003 ◽  
Vol 8 (S1) ◽  
pp. 31-39 ◽  
Author(s):  
Dan J. Stein ◽  
Borwin Bandelow ◽  
Eric Hollander ◽  
David J. Nutt ◽  
Ahmed Okasha ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Term Treatment ◽  
Economic Consequences ◽  
Persistent Symptoms ◽  
Long Term Treatment

ABSTRACTPosttraumatic stress disorder (PTSD) is a common and disabling condition. In addition to combat-related PTSD, the disorder occurs in civilians exposed to severe traumatic events, with the community prevalence rate for the combined populations reaching as high as 12%. If left untreated, PTSD may continue for years after the stressor event, resulting in severe functional and emotional impairment and a dramatic reduction in quality of life, with negative economic consequences for both the sufferer and society as a whole. Although PTSD is often overlooked, diagnosis is relatively straight-forward once a triggering stressor event and the triad of persistent symptoms—reexperiencing the traumatic event, avoiding stimuli associated with the trauma, and hyperarousal—have been identified. However, comorbid conditions of anxiety and depression frequently hamper accurate diagnosis. Treatment for PTSD includes psychotherapy and pharmacotherapy. The latter includes selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase inhibitors. Only SSRls have been proven effective and safe in long-term randomized controlled trials. Current guidelines from the Expert Consensus Panel for PTSD recommend treatment of chronic PTSD for a minimum of 12–24 months.

scholarly journals Research on Posttraumatic Stress Disorder in the Context of the COVID-19 Pandemic: A Review of Methods and Implications in General Population Samples

2021 ◽  
Vol 5 ◽  
pp. 247054702110513
Author(s):  
Mathilde M. Husky ◽  
Robert H. Pietrzak ◽  
Brian P. Marx ◽  
Carolyn M. Mazure
Keyword(s):  
Posttraumatic Stress Disorder ◽  
General Population ◽  
Mental Disorders ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Health Planning ◽  
Self Report ◽  
Future Research ◽  
Snowball Sampling ◽  
Cross Sectional

Increasing concern about the mental health sequelae to the COVID-19 pandemic has prompted a surge in research and publications on the prevalence of posttraumatic stress disorder in general population samples in relation to the pandemic. We examined how posttraumatic stress disorder in the context of the COVID-19 pandemic has been studied to date and found three general themes: (1) assessment of posttraumatic stress disorder and posttraumatic stress disorder symptoms relied on self-report measures and often did not determine direct trauma exposure as required by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criterion A to diagnose posttraumatic stress disorder; (2) inadequate assessment of pre-existing mental disorders and co-occurring stress; and (3) the use of cross-sectional designs in most studies, often relying on snowball sampling strategies to conduct online surveys. Notwithstanding these methodological limitations, these studies have reported moderate to severe posttraumatic symptoms in 25.8% of the general population on average in relation to the pandemic (ranging from 4.6% to 55.3%). Opportunities for advancing future research that will inform public health planning are discussed.

PTSD treatment in light of DSM-5 and the “golden hours” concept

CNS Spectrums ◽  
2016 ◽  
Vol 21 (4) ◽  
pp. 279-282 ◽  
Author(s):  
Lior Carmi ◽  
Leah Fostick ◽  
Shimon Burshtein ◽  
Shlomit Cwikel-Hamzany ◽  
Joseph Zohar
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Mental Disorders ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Neural Mechanisms ◽  
Window Of Opportunity ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5

One of the main changes in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was the separation of Stress Related Disorders from the Anxiety chapter. This separation paves the way to examine the unique characteristics of posttraumatic stress disorder (PTSD) (ie, identifiable onset, memory processes, etc) and related neural mechanisms. The time that elapses between the traumatic event and the manifestation of the disorder may also be addressed as the “golden hours,” or the window of opportunity in which critical processes take place and relevant interventions may be administrated.

scholarly journals Pharmacological and Psychoactive Agents for Treatment Resistant Posttraumatic Stress Disorder

2021 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Stress Disorder ◽  
Treatment Resistance ◽  
Mood Stabilizers ◽  
Therapeutic Effects ◽  
Treatment Resistant ◽  
Pharmacological Agents ◽  
Number Of Patients

The Food and Drug Administration (FDA) approved two selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine for the treatment of posttraumatic stress disorder. Many patients do not respond to them and their side effects commonly occur before noticeable therapeutic effects, leading to their discontinuation. Other patients develop treatment resistance to the two approved SSRIs and are treated with other pharmacological agents. A sizable number of patients also do not respond to pharmacological agents and resort to the use of experimental psychoactive agents. This article reviews the definition of treatment resistant posttraumatic stress disorder, and summarizes the various pharmacological and psychoactive agents that have been used for treatment resistant posttraumatic stress disorder including various antidepressants, antipsychotics ,noradrenergic agents, anticonvulsants, mood stabilizers, anxiolytics, hypnotics ,antihistaminergic agents, naltrexone, buprenorphine, D-Cycloserine, neuropeptides, memantine, cannabinoids, 3,4-methylendioxymethamphetamine and ketamine.

scholarly journals 1067 Replicative and Non-Replicative Nightmares in the Development of Posttraumatic Stress Disorder

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A406-A406
Author(s):  
T Maeder ◽  
C Daffre ◽  
K I Oliver ◽  
N B Lasko ◽  
J Seo ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Traumatic Events ◽  
Sleep Onset ◽  
Psychological Trauma ◽  
Outcome Variable ◽  
Special Focus ◽  
Axis I

Abstract Introduction Nightmares are a frequent and disturbing symptom of posttraumatic stress disorder (PTSD). They are associated with sleep disruption and increased psychopathology. There is growing evidence that different types of nightmares may differ in their effects on psychopathology. Previous findings suggest that nightmares that are close replications of the experienced traumatic event might be especially important in the development of PTSD. This study investigated trauma-related (replicative) and non-trauma-related (non-replicative) nightmares as predictors of PTSD in a civilian sample. Methods Participants were recruited from the general public of the greater Boston area. The sample consisted of 108 participants who had experienced a psychological trauma in the past 2 years (e.g. sexual or physical assaults and accidents). The criteria for PTSD were met by 49% of participants. PTSD diagnosis was assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Non-Patient Edition. Participants received an Actiwatch 2 (Philips Respironics, Bend, OR) and a sleep diary for sleep measurements over an average of 14 consecutive nights. The diary included a prospective nightmare assessment and an item assessing the relatedness of each nightmare to traumatic events. Logistic regression analyses were performed with PTSD as the categorical outcome variable. Results Our analyses showed that replicative nightmares were the only statistically significant predictor of PTSD (OR = 1.2, p = .027), while controlling for age, sex, time since the traumatic event, and actigraphy total sleep time and minutes awake after sleep onset. All of these variables, including non-replicative nightmares, did not significantly predict PTSD in our analyses. Conclusion This study confirms and adds to the existing knowledge of nightmares and the importance of the degree to which they replicate the trauma in the development of PTSD. These findings underline the potential role of specific nightmare treatments after traumatic events, with a special focus on replicative nightmares. Support R01MH109638

scholarly journals Posttraumatic stress disorder as a diagnostic entity – clinical perspectives

2018 ◽  
Vol 20 (3) ◽  
pp. 161-168
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Psychological Trauma ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
The Third ◽  
Avoidance Behaviors ◽  
Clinical Presentations

Throughout history the consequences of psychological trauma and characteristic symptoms have involved clinical presentations that have had different names. Since the inclusion of the category of Posttraumatic Stress Disorder (PTSD) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) with the symptomatic triad of re-experiencing the traumatic event, avoidance behaviors, and hypervigilance, this entity has been a source of controversy. Indeed, some authors have denied its existence, even considering it a diagnostic invention. In this article we review, from the clinician's perspective, historical aspects as well as the development of the nosological classifications and the contributions from the neurosciences that allow the consideration of the full validity of this diagnosis as a form of psychobiological reaction to psychological trauma.

Psychological Intervention and Treatment for Posttraumatic Stress Disorder During Pregnancy: A Systematic Review and Call to Action

2020 ◽  
Author(s):  
Natalie R. Stevens ◽  
Michelle L. Miller ◽  
Ann‐Kathrin Puetz ◽  
Avelina C. Padin ◽  
Natasia Adams ◽  
...  
Keyword(s):  
Systematic Review ◽  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Psychological Intervention ◽  
Call To Action

scholarly journals Different Patterns of Mental Health Outcomes among Road Traffic Crash Survivors: A Prospective Cohort Study

2021 ◽  
Vol 18 (4) ◽  
pp. 1564
Author(s):  
Jelena Kovacevic ◽  
Ivica Fotez ◽  
Ivan Miskulin ◽  
Davor Lesic ◽  
Maja Miskulin ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Mental Disorders ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Road Traffic ◽  
Sociodemographic Factors ◽  
Road Traffic Crash ◽  
Traffic Crash ◽  
Factors Associated ◽  
Before And After

This study aimed to investigate factors associated with the symptoms of mental disorders following a road traffic crash (RTC). A prospective cohort of 200 people was followed for 6 months after experiencing an RTC. The cohort was comprised of uninjured survivors and injured victims with all levels of road traffic injury (RTI) severity. Multivariable logistic regression analyses were performed to evaluate the associations between the symptoms of depression, posttraumatic stress disorder and anxiety one and six months after the RTC, along with sociodemographic factors, health status before and after the RTC, factors related to the RTI and factors related to the RTC. The results showed associations of depression, anxiety, and posttraumatic stress disorder symptoms with sociodemographic factors, factors related to the health status before and after the RTC and factors related to the RTC. Factors related to the RTI showed associations only with depression and posttraumatic stress disorder symptoms. Identifying factors associated with mental disorders following an RTC is essential for establishing screening of vulnerable individuals at risk of poor mental health outcomes after an RTC. All RTC survivors, regardless of their RTI status, should be screened for factors associated with mental disorders in order to successfully prevent them.

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