Posttraumatic stress disorder (PTSD) develops in persons who experienced or witnessed events that involved actual or threatened death or injury or a threat to the physical integrity of self and others. There is also the possibility that persons who have killed, injured, or threatened other people may develop PTSD. Symptoms of PTSD include distressing recollections or dreams of the event, flashbacks, and stress at exposure to cues that resemble the trauma, diminished interest, insomnia, irritability, hypervigilance, depression, and anxiety. PTSD may occur with considerably delayed onset and may often become chronic.
PTSD often co-occurs with mood, anxiety, somatoform, or substance abuse disorders.
The lifetime prevalence of PTSD was estimated to be about 6.8% in the US population. Although a large number of people are involved in a threatening event, only a certain percentage develops PTSD. In a large random sample of American adults, 60.7% had been exposed to traumatic events; on average, 8.2% of men and 20.4% of women suffering from a comparable trauma develop PTSD - Post Traumatic Stress Disorder.
Lack of social support after the traumatic event contributes significantly to the maintenance of PTSD symptoms. Lower intelligence may increase the risk. Vulnerability or resilience to traumatic stress may be determined by disruptions of neurotransmitter systems (e.g., serotonin, norepinephrine, glutamate, gamma-aminobutyric acid, substance P, neuropeptide Y, and others) or abnormalities of the hypothalamic–pituitary–adrenal axis.
In general, PTSD is difficult to treat. Treatment modalities for PTSD include psychological and drug treatments, which have been evaluated by a number of expert committees, including the American Psychiatric Association , the UK National Institute of Clinical Excellence, the British Association for Psychopharmacology, the Australian National Center for PTSD, the US Institute of Medicine, the World Federation of Societies of Biological Psychiatry, and the Cape Town Consensus on Posttraumatic Stress Disorder. Cognitive behavioral therapy (CBT), the most common psychological treatment for PTSD.
In order to prevent the development of PTSD, “debriefing”, a therapeutic conversation with an individual who has just experienced a traumatic event, was attempted. However, several studies even showed a worsening in the debriefing groups.
Eye movement desensitization and reprocessing therapy (EMDR) is being used widely for patients with PTSD. In an EMDR session, the client is instructed to focus on an image of a traumatic memory. Then, the therapist moves his fingers to the end of the patient’s field of vision, while the patient moves her/his eyes following the therapist’s fingers. Some therapists use sounds, tapping, or tactile stimulations.
According to a guideline on psychopharmacological treatment for PTSD selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered first-line treatments for PTSD. Second-line drugs are amitriptyline, imipramine, mirtazapine, risperidone, and lamotrigine.
A German study of the Army Personnel
Outcome of the study
The complete treatment setting, including EMDR, CBT, medication, and other supportive strategies, was considered successful in 91 (77.8%) of the patients, according to the assessment of the treating therapists, while 22.2% were not considered as markedly improved. In 91 (77.8%) of the 117 cases, the patients reported that the psychological treatment had been successful, whereas in 81.3% of the 22 cases, drug treatment had been rated as successful.
Ninety-one (77.8%) of the patients were fit for service again after treatment, while 3 (2.6%) were fit with limitations, and 23 (19.6%) were unfit for work.
Borwin Bandelow, Auth
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