Posttraumatic stress disorder and stress-related disorders.

Posttraumatic stress disorder (PTSD) is a prevalent anxiety disorder. Symptoms present shortly after an exposure to a traumatic event, abate with time in the majority of those who initially express them, and leave a significant minority with chronic PTSD. PTSD may be treated with pharmacotherapy or psychotherapy. Treatment of the early expressions of the disorder constitutes a separate domain of theory and research. Treatment of chronic PTSD often stabilizes the condition but rarely produces stable remission. This article reviews the empirical evidence on the treatment of acute and chronic PTSD, outlines similarities and differences between PTSD and other Axis I disorders, evaluates new therapeutic approaches, and discusses the implications of current knowledge for the forthcoming DSM-V.

[1]  J. Davidson,et al.  Post-traumatic stress disorder: an evaluation of existing pharmacotherapies and new strategies , 2007, Expert opinion on pharmacotherapy.

[2]  S. Wessely,et al.  Brief psychological interventions ("debriefing") for trauma-related symptoms and the prevention of post traumatic stress disorder. , 2000, The Cochrane database of systematic reviews.

[3]  R. Newcombe,et al.  Early cognitive–behavioural therapy for post-traumatic stress symptoms after physical injury , 2004, British Journal of Psychiatry.

[4]  B. Rothbaum,et al.  A prospective examination of post‐traumatic stress disorder in rape victims , 1992 .

[5]  B. McEwen Allostasis and Allostatic Load: Implications for Neuropsychopharmacology , 2000, Neuropsychopharmacology.

[6]  Matt J. Gray,et al.  Early intervention for trauma in adults: A framework for first aid and secondary prevention. , 2004 .

[7]  B. Rothbaum,et al.  Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. , 2001, Archives of general psychiatry.

[8]  C. Brewin,et al.  Promoting Mental Health Following the London Bombings: A Screen and Treat Approach , 2008, Journal of traumatic stress.

[9]  Sandro Galea,et al.  Was there unmet mental health need after the September 11, 2001 terrorist attacks? , 2006, Social Psychiatry and Psychiatric Epidemiology.

[10]  J. Reitsma,et al.  Treatment of acute posttraumatic stress disorder with brief cognitive behavioral therapy: a randomized controlled trial. , 2007, The American journal of psychiatry.

[11]  E. Foa,et al.  Effective treatments for PTSD : practice guidelines from the International Society for Traumatic Stress Studies , 2009 .

[12]  R. Yehuda,et al.  International handbook of human response to trauma , 2000 .

[13]  F. E. Wagner,et al.  Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study , 2006, Psychological Medicine.

[14]  Terence M Keane,et al.  The Criterion A problem revisited: controversies and challenges in defining and measuring psychological trauma. , 2007, Journal of traumatic stress.

[15]  E. Bizzi,et al.  The Cognitive Neurosciences , 1996 .

[16]  J. Bisson,et al.  Psychological treatment of post-traumatic stress disorder (PTSD). , 2007, The Cochrane database of systematic reviews.

[17]  R. Bryant,et al.  The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder. , 2005, Journal of consulting and clinical psychology.

[18]  Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. , 2002 .

[19]  Lynda A. King,et al.  Confirmatory Factor Analysis of the Clinician-Administered PTSD Scale: Evidence for the Dimensionality of Posttraumatic Stress Disorder. , 1998 .

[20]  Stuart Turner,et al.  Psychological treatments for chronic post-traumatic stress disorder , 2007, British Journal of Psychiatry.

[21]  E. Foa,et al.  Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. , 1995, Journal of consulting and clinical psychology.

[22]  A. Shalev,et al.  Predictors of chronic post-traumatic stress disorder , 1999, British Journal of Psychiatry.

[23]  Charles W Hoge,et al.  Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. , 2006, JAMA.

[24]  R. Kessler,et al.  Posttraumatic stress disorder: the burden to the individual and to society. , 2000, The Journal of clinical psychiatry.

[25]  Steven Taylor,et al.  Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. , 2003, Journal of consulting and clinical psychology.

[26]  C. Brewin,et al.  Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. , 2000, Journal of consulting and clinical psychology.

[27]  B. Rothbaum,et al.  Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. , 2001, The Journal of clinical psychiatry.

[28]  B. Rothbaum,et al.  Prolonged Exposure versus Eye Movement Desensitization and Reprocessing (EMDR) for PTSD rape victims. , 2005, Journal of traumatic stress.

[29]  A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. , 2002 .

[30]  R. Rosenheck,et al.  Pharmacotherapy of PTSD in the U.S. Department of Veterans Affairs: diagnostic- and symptom-guided drug selection. , 2008, The Journal of clinical psychiatry.

[31]  D. Stein,et al.  Pharmacotherapy for post traumatic stress disorder (PTSD). , 2006, The Cochrane database of systematic reviews.

[32]  E. Foa,et al.  Dissemination of exposure therapy in the treatment of posttraumatic stress disorder. , 2006, Journal of traumatic stress.

[33]  B. Niles,et al.  Obstacles to Assessment of PTSD in Longitudinal Research , 2000 .

[34]  J. A. Boer,et al.  Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology , 2005, Journal of psychopharmacology.

[35]  C. Becker,et al.  A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD. , 2004, Behaviour research and therapy.

[36]  R. Bryant,et al.  Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques. , 1999, The American journal of psychiatry.

[37]  A. Gloster,et al.  Posttraumatic stress disorder: diagnostic and epidemiological perspectives. , 2009, CNS spectrums.

[38]  Charles W Hoge,et al.  Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. , 2007, JAMA.

[39]  R. Bryant,et al.  Cognitive behaviour therapy of acute stress disorder: a four-year follow-up. , 2003, Behaviour research and therapy.

[40]  H. Wittchen,et al.  Traumatic events and post‐traumatic stress disorder in the community: prevalence,risk factors and comorbidity , 2000, Acta psychiatrica Scandinavica.

[41]  M. Stein,et al.  Pharmacotherapy to prevent PTSD: Results from a randomized controlled proof-of-concept trial in physically injured patients. , 2007, Journal of traumatic stress.

[42]  B. Rothbaum,et al.  Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. , 2000, JAMA.

[43]  R. Clark,et al.  Prescribing patterns for patients with posttraumatic stress disorder. , 2003, Psychiatric services.

[44]  S. Southwick,et al.  Developing an Agenda for Translational Studies of Resilience and Vulnerability Following Trauma Exposure , 2006, Annals of the New York Academy of Sciences.

[45]  A. Hale,et al.  Valproate in the treatment of PTSD: systematic review and meta analysis , 2007, Current medical research and opinion.

[46]  M. A. Mills,et al.  Trauma and stress response among Hurricane Katrina evacuees. , 2007, American journal of public health.

[47]  Leonardo Franklin Fontenelle,et al.  Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: A systematic review , 2009, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[48]  R. Yehuda,et al.  Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis. , 1995, The American journal of psychiatry.

[49]  K. Lovell,et al.  Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: a controlled study. , 1998, Archives of general psychiatry.

[50]  K. Felmingham,et al.  Treatment of acute stress disorder: a randomized controlled trial. , 2008, Archives of general psychiatry.

[51]  A. Serretti,et al.  The atypical antipsychotics olanzapine and risperidone in the treatment of posttraumatic stress disorder: a meta-analysis of randomized, double-blind, placebo-controlled clinical trials , 2008, International clinical psychopharmacology.

[52]  Charles R. Marmar,et al.  Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjus , 1990 .

[53]  B. Roozendaal,et al.  Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study , 2004, Biological Psychiatry.

[54]  R. Bradley,et al.  A multidimensional meta-analysis of psychotherapy for PTSD. , 2005, The American journal of psychiatry.

[55]  J. Elhai,et al.  Diagnostic alterations for post-traumatic stress disorder: examining data from the National Comorbidity Survey Replication and National Survey of Adolescents , 2009, Psychological Medicine.

[56]  A. Papa,et al.  A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. , 2007, The American journal of psychiatry.

[57]  N. Breslau,et al.  Troublesome memories: reflections on the future. , 2007, Journal of Anxiety Disorders.

[58]  L. Weisæth Acute posttraumatic stress: nonacceptance of early intervention. , 2001 .

[59]  N. Tarrier,et al.  A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. , 1999, Journal of consulting and clinical psychology.

[60]  M. Basoglu,et al.  A randomized controlled study of single-session behavioural treatment of earthquake-related post-traumatic stress disorder using an earthquake simulator , 2006, Psychological Medicine.

[61]  Dan J Stein,et al.  The Cape Town consensus on posttraumatic stress disorder: introduction. , 2009, CNS Spectrums.

[62]  R. Yehuda,et al.  Paroxetine in the treatment of chronic posttraumatic stress disorder: results of a placebo-controlled, flexible-dosage trial. , 2001, The Journal of clinical psychiatry.

[63]  G. Ironson,et al.  Comparison of two treatments for traumatic stress: a community-based study of EMDR and prolonged exposure. , 2002, Journal of clinical psychology.

[64]  M. K. Freeman,et al.  Prazosin for treatment of nightmares related to posttraumatic stress disorder. , 2008, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[65]  R. McNally Psychiatric Casualties of War , 2006, Science.

[66]  S Rose,et al.  Psychological debriefing for preventing post traumatic stress disorder (PTSD). , 2002, The Cochrane database of systematic reviews.

[67]  P. Schnurr,et al.  Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: results from a department of veterans affairs cooperative study. , 2003, Archives of general psychiatry.

[68]  A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. , 1999 .

[69]  Stéphane Bouchard,et al.  Effectiveness of Cognitive Behavioural Therapy Administered by Videoconference for Posttraumatic Stress Disorder , 2009, Cognitive behaviour therapy.

[70]  W. Katon,et al.  Collaborative interventions for physically injured trauma survivors: a pilot randomized effectiveness trial. , 2001, General hospital psychiatry.

[71]  S. Orr,et al.  Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. , 1987, Archives of general psychiatry.

[72]  R. Post,et al.  Sensitization and kindling: Implications for the evolving neural substrates of post-traumatic stress disorder. , 1995 .

[73]  R. Pitman,et al.  Reevaluating the association between emergency department heart rate and the development of posttraumatic stress disorder: A public health approach , 2005, Biological Psychiatry.

[74]  Terry L. Schell,et al.  All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress. , 2004, Journal of abnormal psychology.

[75]  Albert A. Rizzo,et al.  VR PTSD Exposure Therapy Results with Active Duty OIF/OEF Combatants , 2009, MMVR.

[76]  E. Echeburúa,et al.  Treatment of acute posttraumatic stress disorder in rape victims: An experimental study , 1996 .

[77]  B. Raphael,et al.  Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Post-Traumatic Stress Disorder , 2007, The Australian and New Zealand journal of psychiatry.

[78]  L. Kirmayer,et al.  Understanding trauma : integrating, biological, clinical, and cultural perspectives , 2007 .

[79]  Ann Hackmann,et al.  A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. , 2003, Archives of general psychiatry.

[80]  A. Shalev,et al.  Gender Differences in Responses to Traumatic Events: A Prospective Study , 2002, Journal of traumatic stress.

[81]  E. Foa,et al.  An evaluation of three brief programs for facilitating recovery after assault. , 2006, Journal of traumatic stress.

[82]  A. Boals,et al.  PTSD symptoms and dominant emotional response to a traumatic event: an examination of DSM-IV Criterion A2 , 2010, Anxiety, stress, and coping.

[83]  C. Hoge,et al.  Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. , 2004, U.S. Army Medical Department journal.

[84]  L. Deutsch,et al.  Pilot controlled trial of D-serine for the treatment of post-traumatic stress disorder. , 2009, The international journal of neuropsychopharmacology.

[85]  Hans-Jürgen Möller,et al.  World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision , 2002, The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry.

[86]  B. Dohrenwend,et al.  The Psychological Risks of Vietnam for U.S. Veterans: A Revisit with New Data and Methods , 2006, Science.

[87]  A. Arntz,et al.  Prolonged exposure in patients with chronic PTSD: predictors of treatment outcome and dropout. , 2002, Behaviour research and therapy.

[88]  D. Brom,et al.  Victims of traffic accidents: incidence and prevention of post-traumatic stress disorder. , 1993, Journal of clinical psychology.

[89]  P. Resick,et al.  Cognitive Processing Therapy for Rape Victims: A Treatment Manual , 1993 .

[90]  E. Brown,et al.  Fluoxetine v. placebo in prevention of relapse in post-traumatic stress disorder , 2002, British Journal of Psychiatry.

[91]  S. Spence,et al.  The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder. , 1999, Journal of anxiety disorders.

[92]  O. D. Leon Neurobiological and clinical consequences of stress , 1997 .

[93]  S. Antelman,et al.  Time‐dependent sensitization as the cornerstone for a new approach to pharmacotherapy: Drugs as foreign/stressful stimuli , 1988 .

[94]  B. Rothbaum,et al.  Prolonged Exposure Therapy for PTSD : Emotional Processing of Traumatic Experiences Therapist Guide , 2007 .

[95]  M. Oldham,et al.  Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. , 2001, The American journal of psychiatry.

[96]  C. Alberini,et al.  Preclinical Assessment for Selectively Disrupting a Traumatic Memory via Postretrieval Inhibition of Glucocorticoid Receptors , 2009, Biological Psychiatry.

[97]  F. Hu,et al.  Physiologic responses to sudden, loud tones in monozygotic twins discordant for combat exposure: association with posttraumatic stress disorder. , 2003, Archives of general psychiatry.

[98]  J. H. Kamphuis,et al.  Treating Acute Stress Disorder and Posttraumatic Stress Disorder with Cognitive Behavioral Therapy or Structured Writing Therapy: A Randomized Controlled Trial , 2008, Psychotherapy and Psychosomatics.

[99]  W. Katon,et al.  A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors. , 2004, Archives of general psychiatry.

[100]  R. Bryant Early predictors of posttraumatic stress disorder , 2003, Biological Psychiatry.

[101]  J. H. Kamphuis,et al.  Post-trauma debriefing : the road too frequently travelled , 2022 .

[102]  M. Stein,et al.  Adjunctive olanzapine for SSRI-resistant combat-related PTSD: a double-blind, placebo-controlled study. , 2002, The American journal of psychiatry.

[103]  A. Harvey,et al.  Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling. , 1998, Journal of consulting and clinical psychology.

[104]  T. Heir,et al.  Longitudinal changes in recalled perceived life threat after a natural disaster , 2009, British Journal of Psychiatry.

[105]  A. Ehlers,et al.  Psychological debriefing for road traffic accident victims , 2000, British Journal of Psychiatry.

[106]  Joseph E LeDoux,et al.  Indelibility of Subcortical Emotional Memories , 1989, Journal of Cognitive Neuroscience.

[107]  R. Kessler,et al.  Posttraumatic stress disorder in the National Comorbidity Survey. , 1995, Archives of general psychiatry.

[108]  Robert J. Ursano,et al.  Posttraumatic stress disorder and depression in battle-injured soldiers. , 2006, The American journal of psychiatry.

[109]  C. A. Vandevere,et al.  The effectiveness of risperidone on acute stress symptoms in adult burn patients: a preliminary retrospective pilot study. , 2001, The Journal of burn care & rehabilitation.

[110]  S. Orr,et al.  A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder. , 1998, Archives of general psychiatry.

[111]  S. Rauch,et al.  Fear extinction in rats: Implications for human brain imaging and anxiety disorders , 2006, Biological Psychology.

[112]  J. Kenardy,et al.  Systematic review and meta-analysis of multiple-session early interventions following traumatic events. , 2009, The American journal of psychiatry.

[113]  M. Bauer,et al.  What is a "mood stabilizer"? An evidence-based response. , 2004, The American journal of psychiatry.

[114]  S. Orr,et al.  Prospective study of posttraumatic stress disorder and depression following trauma. , 1998, The American journal of psychiatry.

[115]  E. Brown,et al.  Failed Efficacy of Fluoxetine in the Treatment of Posttraumatic Stress Disorder: Results of a Fixed-Dose, Placebo-Controlled Study , 2007, Journal of clinical psychopharmacology.

[116]  R. Kessler,et al.  Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. , 1998, Archives of general psychiatry.

[117]  A. Shalev,et al.  Longitudinal Studies of PTSD: Overview of Findings and Methods , 2006, CNS Spectrums.

[118]  B. Rothbaum,et al.  Exposure therapy for posttraumatic stress disorder. , 2002, American journal of psychotherapy.

[119]  Jasper A. J. Smits,et al.  DISORDERS : A META-ANALYSIS OF RANDOMIZED PLACEBO-CONTROLLED TRIALS , 2008 .

[120]  L. Cahill,et al.  Pilot study of secondary prevention of posttraumatic stress disorder with propranolol , 2002, Biological Psychiatry.

[121]  E. Foa Psychosocial therapy for posttraumatic stress disorder. , 2006, The Journal of clinical psychiatry.

[122]  B. Frueh,et al.  Delayed-onset post-traumatic stress disorder among war veterans in primary care clinics , 2009, British Journal of Psychiatry.

[123]  O. Bonne,et al.  Treatment of recent trauma survivors with benzodiazepines: a prospective study. , 1996, The Journal of clinical psychiatry.

[124]  C. Brewin,et al.  A randomized controlled trial of individual psychological debriefing for victims of violent crime , 1999, Psychological Medicine.

[125]  S. Orr,et al.  Auditory startle response in trauma survivors with posttraumatic stress disorder: a prospective study. , 2000, The American journal of psychiatry.

[126]  Brett T. Litz,et al.  Early intervention for trauma and traumatic loss , 2004 .

[127]  E. Peskind,et al.  A Parallel Group Placebo Controlled Study of Prazosin for Trauma Nightmares and Sleep Disturbance in Combat Veterans with Post-Traumatic Stress Disorder , 2007, Biological Psychiatry.