Etiology of post traumatic stress disorder pdf

The definition and diagnostic criteria for PTSD remain complex and ambiguous to some extent, which may be attributed to the complicated nature of PTSD and insufficient research on it. The underlying mechanisms of PTSD involve changes in different levels of psychological and molecular modulations. Thus, research targeting the basic mechanisms of PTSD using standard clinical guidelines and controlled interference factors is needed. In terms of treatment, psychological and pharmacological interventions could relief PTSD symptoms to different degrees.

However, it is necessary to develop systemic treatment as well as symptom-specific therapeutic methods. Future research could focus on predictive factors and physiological indicators to determine effective prevention methods for PTSD, thereby reducing its prevalence and preventing more individuals and families from struggling with this disorder. Risk of post-traumatic stress disorder following traumatic events in a community sample.

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Long-term efficacy of psychotherapy for posttraumatic stress disorder: a meta-analysis of randomized controlled trials. Download references. Berardi, A. Ostacher, M. Management of Post-Traumatic Stress Disorder. De Berardis, D.

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Drug Investig. Johnson, M. Jetly, R. A recent meta-analysis further supports that bilateral stimulation eye movements are not the only potential form of bilateral stimulation used in EMDR impacts memory in ways that might facilitate PTSD treatment [ 68 ].

Other researchers have hypothesized, however, that the exposure-based components of EMDR are all that is required, and a review of dismantling studies has demonstrated that the EMDR protocol works just as well without the bilateral stimulation component [ 69 ]. Regardless of the validity of its theoretical underpinnings, EMDR has empirical support in that it consistently outperforms no-treatment controls and demonstrates similar outcomes to exposure- and cognitive-based psychotherapies for PTSD [ 41 , 70 ].

Although less frequently studied and supported in the more recent literature, relaxation-based psychotherapies are another type of psychotherapy for PTSD.

Relaxation skills are trained and practiced in sessions using techniques such as behavioral rehearsal and imagery, modeling, and role-play. Although psychotherapeutic interventions are the first and most supported option for the treatment of PTSD, there are several evidence-based pharmacological treatments available. In contrast to psychological interventions, pharmacotherapies can be provided in most clinical settings and require much less time and effort on the part of the patient e.

The foundation of pharmacological treatments is supported by a growing literature for the association between PTSD and dysregulations in neurotransmitter and neuroendocrine systems [ 77 , 78 , 79 , 80 ]. For the purposes of this review, we have focused on the current medication options with the most evidence, and therefore omitted older e. SSRIs have a broad effect on PTSD symptoms, including improvements in re-experiencing, avoidance, numbing, and hyper-arousal symptoms, and related quality of life improvements associated with the symptom reductions [ 81 ].

Other agents, such as fluvoxamine and citalopram, also have received support for the treatment of PTSD [ 86 , 87 ]. Interestingly, paroxetine also has been shown to potentially address cognitive deficits associated with PTSD, in addition to the clinical symptoms [ 88 ].

Longer trials of SSRIs 36 weeks have been associated with a higher percentage of treatment response compared to the standard week trials [ 89 ]. Unfortunately, independent of the duration of the trial, the discontinuation of SSRIs is associated with the relapse of PTSD symptoms [ 81 , 83 , 90 ]. In contrast, symptoms typically remain stable or continue to improve after completion of evidence-based psychotherapy for PTSD [ 91 ].

There are several other agents that have received support in the pharmacological treatment of PTSD. Two common examples are trazadone, an antidepressant serotonergic agent with a sedating side effect, and prazosin, an antiadrenergic agent that has been studied in the treatment of sleep and nightmares in PTSD.

Prazosin has received increased attention as of late after randomized clinical trials demonstrating its effectiveness for PTSD-related sleep disruptions and nightmares, as well as global functioning and PTSD symptoms [ 92 ]. While pharmacological treatments have shown some promise, more investigation and advancement in this area is needed.

One of the most important concerns with the sole use of pharmacotherapy for PTSD treatment is the evidence that discontinuing treatment can be associated with relapse [ 81 , 83 , 90 ].

Although relapse is relatively infrequent after one responds to an evidence-based psychotherapy for PTSD [ 91 ], a proportion of patients either drop out of therapy prematurely or do not respond to therapy [ 46 , 47 , 54 ]. It is therefore critical to continue to investigate new strategies to improve upon the available treatments for PTSD.

One novel line of research has investigated the potential to enhance mechanisms of learning during cognitive behavioral therapies such as those used for PTSD by administering medications that could facilitate fear extinction, for example, d -cycloserine, yohimbine, methylene blue, MDMA, and oxytocin [ 93 , 94 ].

However, pharmacological augmentation of learning mechanisms is still in its infancy and will require much further exploration before these strategies can be recommended as standard treatment techniques for PTSD.

Another line of cutting edge research involves priming the trauma memory through a reminder, and then preventing reconsolidation of the primed memory through pharmacological blockade [ 95 ]. Although some evidence suggests that this technique reduces emotional reactivity to the trauma memory [ 95 ], findings in this newer area of research are very preliminary and somewhat conflicted [ 39 ]. Innovative treatments outside the realms of psychotherapy and pharmacotherapy, such as neuronal feedback and brain stimulation techniques [ 96 ], are also being explored and may help reduce PTSD symptoms, particularly in treatment-resistant patients.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of NIDA, Department of Veterans Affairs, or the United States government. National Center for Biotechnology Information , U. Journal List J Clin Med v.

J Clin Med. Published online Nov Cynthia L. Lancaster , 1, 2 Jenni B. Teeters , 1, 2 Daniel F. Gros , 1, 2 and Sudie E. Lancaster 1 Ralph H. Jenni B. Teeters 1 Ralph H. Daniel F. Gros 1 Ralph H. Sudie E. Back 1 Ralph H. Author information Article notes Copyright and License information Disclaimer.

Received Oct 1; Accepted Nov This article has been cited by other articles in PMC. Abstract Posttraumatic stress disorder PTSD is a chronic psychological disorder that can develop after exposure to a traumatic event. Keywords: posttraumatic stress disorder, evidence based, empirically supported, assessment, psychotherapy, pharmacotherapy, prolonged exposure, cognitive processing therapy, eye movement desensitization and reprocessing, selective serotonin reuptake inhibitors.

Epidemiology PTSD develops after exposure to a potentially traumatic event. Clinical Characteristics In addition to a history of trauma exposure, PTSD is characterized by four clusters of symptoms: 1 re-experiencing symptoms e.

Table 1 Commonly used screening and self-report measures for trauma exposure and PTSD symptom severity. Open in a separate window. Initial Screening Several brief tools have been developed to screen for exposure to a Criterion A traumatic event, which allows for rapid identification of persons at-risk for PTSD. Diagnosis After initial screening, more advanced assessment procedures should be conducted to establish clinical diagnosis of PTSD based on the DSM-5 diagnostic criteria.

Symptom Severity and Treatment Tracking Once a PTSD diagnosis has been established, symptom frequency and severity are the next essential components to treatment planning and monitoring. Evidence-Based Treatments Is PTSD primarily a biological or psychological phenomenon, and relatedly, are psychosocial or pharmacological treatments more appropriate?

Cognitive-Based Therapies Over time, the field of psychotherapy has expanded to include cognitive-based treatment techniques in addition to exposure-based techniques. Eye Movement Desensitization and Reprocessing. Relaxation-Based Psychotherapies Although less frequently studied and supported in the more recent literature, relaxation-based psychotherapies are another type of psychotherapy for PTSD.

Evidence-Based Pharmacological Treatments Although psychotherapeutic interventions are the first and most supported option for the treatment of PTSD, there are several evidence-based pharmacological treatments available.

Conflicts of Interest There are no conflicts of interest to disclose. References 1. Kessler R. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Methods Psychiatr. American Psychiatric Association. Kilpatrick D. Bryant R. A review of acute stress disorder in DSM Depression Anxiety.

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