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Chapter 21 - Posttraumatic Stress Disorder

An Update on Diagnosis, Etiology, and Treatment

Published online by Cambridge University Press:  02 January 2025

By
John M. Bouras
Edited by
Marsal Sanches  and
Jair C. Soares
Marsal Sanches
Affiliation:
McGovern Medical School, Texas
Jair C. Soares
Affiliation:
McGovern Medical School, Texas
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Summary

This chapter provides a review for post-traumatic stress disorder (PTSD). It starts by presenting the epidemiological data as well as the risk factors in the development of PTSD. It then defines the diagnosis of PTSD, by using both DSM-5 and ICD-11 criteria, and provides a clinical approach on how to clarify differential diagnoses and comorbidities. It then reviews the pathophysiology and pathogenesis of PTSD by looking at neuroanatomic, neuroendocrine, neurochemical, and genetic changes in brain neural networks. It concludes by presenting the current evidence-based options for the treatment and management of PTSD that include psychotherapy and pharmacotherapy.

Keywords

Post-Traumatic Stress DisorderPathophysiologyTraumaAnxiety
Type
Chapter
Information
Fundamentals of Clinical Psychiatry
A Practical Handbook
 , pp. 212 - 220
Publisher: Cambridge University Press
Print publication year: 2025

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References

World Health Organization. What Is Stress? 2023. www.who.int/news-room/questions-and-answers/item/stress#:~:text=Stress%20can%20be%20defined%20as,experiences%20stress%20to%20some%20degree (accessed September 7, 2023).Google Scholar
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., et al. Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8 (2017) 1353383. https://doi.org/10.1080/20008198.2017.1353383.CrossRefGoogle ScholarPubMed
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E., Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62 (2005) 593–602. https://doi.org/10.1001/archpsyc.62.6.593.CrossRefGoogle ScholarPubMed
Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E., Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62 (2005) 617–627. https://doi.org/10.1001/archpsyc.62.6.617.CrossRefGoogle ScholarPubMed
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B., Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52 (1995) 1048–1060. https://doi.org/10.1001/archpsyc.1995.03950240066012.CrossRefGoogle ScholarPubMed
Brewin, C. R., Andrews, B., & Valentine, J. D., Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68 (2000) 748–766. https://doi.org/10.1037//0022-006x.68.5.748.CrossRefGoogle ScholarPubMed
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S., Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Bulletin, 129 (2003) 52–73. https://doi.org/10.1037/0033-2909.129.1.52.CrossRefGoogle ScholarPubMed
Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C., Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 62 (2005) 603–613. https://doi.org/10.1001/archpsyc.62.6.603.CrossRefGoogle ScholarPubMed
Myers, C. S., A Contribution to the Study of Shell Shock.: Being an Account of Three Cases of Loss of Memory, Vision, Smell, and Taste, Admitted into the Duchess of Westminster’s War Hospital, Le Touquet. The Lancet, 185 (1915) 316–320. https://doi.org/10.1016/S0140–6736(00)52916-X.CrossRefGoogle Scholar
Daly, R. J., Samuel Pepys and post-traumatic stress disorder. The British Journal of Psychiatry: The Journal of Mental Science, 143 (1983) 64–68. https://doi.org/10.1192/bjp.143.1.64.CrossRefGoogle ScholarPubMed
Kendell, R. E., Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised (DSM-III-R). American Journal of Psychiatry, 145 (1988) 1301–1302. https://doi.org/10.1176/ajp.145.10.1301.CrossRefGoogle Scholar
Diagnostic and Statistical Manual of Mental Disorders. DSM Library (n.d.). https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787 (accessed September 7, 2023).Google Scholar
ICD-11 for Mortality and Morbidity Statistics. (n.d.). https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/2070699808 (accessed September 7, 2023).Google Scholar
Koenigs, M. & Grafman, J., Post-traumatic stress disorder: the role of medial prefrontal cortex and amygdala. The Neuroscientist, 15 (2009) 540–548. https://doi.org/10.1177/1073858409333072.CrossRefGoogle ScholarPubMed
van Rooij, S. J. H., Kennis, M., Sjouwerman, R., et al. Smaller hippocampal volume as a vulnerability factor for the persistence of post-traumatic stress disorder. Psychological Medicine, 45 (2015) 2737–2746. https://doi.org/10.1017/S0033291715000707.CrossRefGoogle ScholarPubMed
Bremner, J. D., Randall, P., Scott, T. M., Bronen, R. A., Seibyl, J. P., Southwick, S. M., Delaney, R. C., McCarthy, G., Charney, D. S., & Innis, R. B., MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. The American Journal of Psychiatry, 152 (1995) 973–981.Google ScholarPubMed
Sherin, J. E. & Nemeroff, C. B., Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience, 13 (2011) 263–278.CrossRefGoogle ScholarPubMed
Ressler, K. J. & Nemeroff, C. B., Role of serotonergic and noradrenergic systems in the pathophysiology of depression and anxiety disorders. Depression and Anxiety, 12 Suppl 1 (2000) 2–19. https://doi.org/10.1002/1520-6394(2000)12:1+<2::AID-DA2>3.0.CO;2-4.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Rasmusson, A. M., Hauger, R. L., Morgan, C. A., Bremner, J. D., Charney, D. S., & Southwick, S. M., Low baseline and yohimbine-stimulated plasma neuropeptide Y (NPY) levels in combat-related PTSD. Biological Psychiatry, 47 (2000) 526–539. https://doi.org/10.1016/s0006–3223(99)00185-7.CrossRefGoogle ScholarPubMed
Souza, R. R., Noble, L. J., & McIntyre, C. K., Using the single prolonged stress model to examine the pathophysiology of PTSD. Frontiers in Pharmacology, 8 (2017) 615.CrossRefGoogle ScholarPubMed
Togay, B. & El-Mallakh, R. S., Posttraumatic stress disorder: from pathophysiology to pharmacology. Current Psychiatry, 19 (2020) 33–39. www.mdedge.com/psychiatry/article/221338/ptsd/posttraumatic-stress-disorder-pathophysiology-pharmacology (accessed September 7, 2023).Google Scholar
Rose, S. C., Bisson, J., Churchill, R., & Wessely, S., Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews (2002). https://doi.org/10.1002/14651858.CD000560.CrossRefGoogle Scholar
Sijbrandij, M., Olff, M., Reitsma, J. B., Carlier, I. V. E., & Gersons, B. P. R., Emotional or educational debriefing after psychological trauma: randomised controlled trial. The British Journal of Psychiatry: The Journal of Mental Science, 189 (2006) 150–155. https://doi.org/10.1192/bjp.bp.105.021121.CrossRefGoogle ScholarPubMed
Morganstein, J. C., Wynn, G. H., & West, J. C., Post-traumatic stress disorder: update on diagnosis and treatment. BJPsych Advances, 27 (2021) 184–186. https://doi.org/10.1192/bja.2021.13.CrossRefGoogle Scholar
Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C., & Mayou, R., A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Archives of General Psychiatry, 60 (2003) 1024–1032. https://doi.org/10.1001/archpsyc.60.10.1024.CrossRefGoogle Scholar
Bisson, J. I., Shepherd, J. P., Joy, D., Probert, R., & Newcombe, R. G., Early cognitive-behavioural therapy for post-traumatic stress symptoms after physical injury: randomised controlled trial. The British Journal of Psychiatry: The Journal of Mental Science, 184 (2004) 63–69. https://doi.org/10.1192/bjp.184.1.63.CrossRefGoogle ScholarPubMed
Stenmark, H., Catani, C., Neuner, F., Elbert, T., & Holen, A., Treating PTSD in refugees and asylum seekers within the general health care system: a randomized controlled multicenter study. Behaviour Research and Therapy, 51 (2013) 641–647. https://doi.org/10.1016/j.brat.2013.07.002.CrossRefGoogle ScholarPubMed
Sloan, D. M., Marx, B. P., Resick, P. A., Young-McCaughan, S., Dondanville, K. A., Mintz, J., Litz, B. T., & Peterson, A. L., Study design comparing written exposure therapy to cognitive processing therapy for PTSD among military service members: a noninferiority trial. Contemporary Clinical Trials Communications, 17 (2019) 100507. https://doi.org/10.1016/j.conctc.2019.100507.CrossRefGoogle ScholarPubMed
Bisson, J. I., Berliner, L., Cloitre, M., Forbes, D., Jensen, T. K., Lewis, C., Monson, C. M., Olff, M., Pilling, S., Riggs, D. S., Roberts, N. P., & Shapiro, F., The International Society for Traumatic Stress Studies new guidelines for the prevention and treatment of posttraumatic stress disorder: methodology and development process. Journal of Traumatic Stress, 32 (2019) 475–483. https://doi.org/10.1002/jts.22421.CrossRefGoogle ScholarPubMed
Schrader, C. & Ross, A., A review of PTSD and current treatment strategies. Missouri Medicine, 118 (2021) 546–551.Google ScholarPubMed
Morganstein, J. C., Wynn, G. H., & West, J. C., Post-traumatic stress disorder: update on diagnosis and treatment. BJPsych Advances, 27 (2021) 184–186. https://doi.org/10.1192/bja.2021.13.CrossRefGoogle Scholar
Hoskins, M., Pearce, J., Bethell, A., Dankova, L., Barbui, C., Tol, W. A., van Ommeren, M., de Jong, J., Seedat, S., Chen, H., & Bisson, J. I., Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. The British Journal of Psychiatry, 206 (2015) 93–100. https://doi.org/10.1192/bjp.bp.114.148551.CrossRefGoogle ScholarPubMed
Brady, K., Pearlstein, T., Asnis, G. M., Baker, D., Rothbaum, B., Sikes, C. R., & Farfel, G. M., Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA, 283 (2000) 1837–1844. https://doi.org/10.1001/jama.283.14.1837.CrossRefGoogle ScholarPubMed
Davidson, J. R. T., Landerman, L. R., Farfel, G. M., & Clary, C. M., Characterizing the effects of sertraline in post-traumatic stress disorder. Psychological Medicine, 32 (2002) 661–670. https://doi.org/10.1017/s0033291702005469.CrossRefGoogle ScholarPubMed
Villarreal, G., Hamner, M. B., Cañive, J. M., Robert, S., Calais, L. A., Durklaski, V., Zhai, Y., & Qualls, C., Efficacy of quetiapine monotherapy in posttraumatic stress disorder: a randomized, placebo-controlled trial. The American Journal of Psychiatry, 173 (2016) 1205–1212. https://doi.org/10.1176/appi.ajp.2016.15070967.CrossRefGoogle ScholarPubMed
Krystal, J. H., Rosenheck, R. A., Cramer, J. A., Vessicchio, J. C., Jones, K. M., Vertrees, J. E., Horney, R. A., Huang, G. D., Stock, C., & Veterans Affairs Cooperative Study No. 504 Group, Adjunctive risperidone treatment for antidepressant-resistant symptoms of chronic military service-related PTSD: a randomized trial. JAMA, 306 (2011) 493–502. https://doi.org/10.1001/jama.2011.1080.CrossRefGoogle ScholarPubMed
Philipp-Muller, A. E., Stephenson, C. J., Moghimi, E., Shirazi, A. H., Milev, R., Vazquez, G., Reshetukha, T., & Alavi, N., Combining ketamine and psychotherapy for the treatment of posttraumatic stress disorder: a systematic review and meta-analysis. The Journal of Clinical Psychiatry, 84 (2023) 22br14564. https://doi.org/10.4088/JCP.22br14564.CrossRefGoogle ScholarPubMed
Kozel, F. A., Motes, M. A., Didehbani, N., DeLaRosa, B., Bass, C., Schraufnagel, C. D., Jones, P., Morgan, C. R., Spence, J. S., Kraut, M. A., & Hart, J., Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: a randomized clinical trial. Journal of Affective Disorders, 229 (2018) 506–514. https://doi.org/10.1016/j.jad.2017.12.046.CrossRefGoogle ScholarPubMed

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