Posttraumatic Stress Disorder: Diagnosis and Epidemiology, Comorbidity and Social Consequences, Biology and Treatment

Abstract

Epidemiological studies clearly indicate that posttraumatic stress disorder (PTSD) is becoming a major health concern worldwide even if still poorly recognized and not well treated. PTSD commonly co-occurs with other psychiatric disorders, and several symptoms overlap with major depressive disorders, anxiety disorders and substance abuse; this may contribute to diagnostic confusion and underdiagnosis. This anxiety disorder provokes significant occupational, psychiatric, medical and psychosocial disability, and its consequences are enormously costly, not only to the survivors and their families, but also to the health care system and society. Work impairment associated with PTSD is very similar to the amount of work impairment associated with major depression. The pathophysiology of PTSD is multifactorial and involves dysregulation of the serotonergic as well as the noradrenergic system. A rational therapeutic approach should normalize the specific psychobiological alterations associated with PTSD. This can be achieved through the use of antidepressant drugs, mainly of those that potentiate serotonergic mechanisms. Recent double-blind placebo-controlled studies report the efficacy of selective serotonin reuptake inhibitors. Several cognitive-behavioral and psychosocial treatments have also been reported to be efficacious and could be considered when treating PTSD patients.

Alcohol use in New York after the terrorist attacks: A study of the effects of psychological trauma on drinking behavior

“…Recognition of a multi-factorial PTSD model is consistent with the observation that both pharmacotherapy and cognitive-behavioral psychotherapy are reported effective in treating PTSD (Ballenger et al, 2000;Brunello et al, 2001;van der Kolk et al, 1996). In the case of pharmacotherapy, the pathophysiology of PTSD, in part, appears to involve the serotonergic and the noradrenergic systems, hence, drugs known to potentiate these mechanisms have been effective (Brunello et al, 2001).…”

Leukocyte glucocorticoid receptor expression and immunoregulation in veterans with and without post-traumatic stress disorder

“…Data from epidemiological surveys indicate that the vast majority of individuals with PTSD meet criteria for at least one other psychiatric disorder. 53,54 The most common comorbid diagnoses are depressive disorder, substance use disorders and other anxiety disorders. As substance disorders are known to influence neurobiology significantly, we have excluded this group.…”

Post-traumatic stress disorder following disasters: a systematic review

“…Research suggests that there are certain geographical areas where large populations are consistently exposed to large-scale traumatic events such as wars, organized violence, terrorism, and natural disasters. Therefore, the overall exposure to trauma worldwide may exceed rates previously reported in the USA (Kessler, 2000;Brunello et al 2001). …”