-
Clinical Psychology Review Nov 2018Posttraumatic stress disorder (PTSD) is associated with impairments in relationship functioning. Beyond the abundance of research that has demonstrated this basic link,... (Review)
Review
Posttraumatic stress disorder (PTSD) is associated with impairments in relationship functioning. Beyond the abundance of research that has demonstrated this basic link, more recent research has begun to explore possible mediators and moderators of this association. The present paper reviews and synthesizes existing literature in the context of an overarching organizational framework of potential ways in which PTSD impacts relationship functioning. The framework organizes findings in terms of specific elements of PTSD and comorbid conditions, mediators (factors that are posited to explain or account for the association), and moderators (factors that are posited to alter the strength of the association). Specific symptoms of PTSD, comorbid symptoms, and many of the potential mediators explored have extensive overlap, raising questions of possible tautology and redundancy in findings. Some findings suggest that non-specific symptoms, such as depression or anger, account for more variance in relationship impairments than trauma-specific symptoms, such as re-experiencing. Moderators, which are characterized as individual, relational, or environmental in nature, have been the subject of far less research in comparison to other factors. Recommendations for future research and clinical implications of the findings reviewed are also presented.
Topics: Adult; Humans; Interpersonal Relations; Spouses; Stress Disorders, Post-Traumatic
PubMed: 30205286
DOI: 10.1016/j.cpr.2018.08.003 -
Journal of Child Psychology and... May 2019Important advances in understanding traumatic stress reactions in children and young people have been made in recent years. The aim of this review was to synthesise... (Review)
Review
Important advances in understanding traumatic stress reactions in children and young people have been made in recent years. The aim of this review was to synthesise selected recent research findings, with a focus on their relevance to clinical practice. We therefore address: findings on the epidemiology of trauma exposure and Posttraumatic Stress Disorder (PTSD); recent changes to diagnostic classification; implications for screening and assessment of traumatic stress reactions; and treatment outcome studies including interventions for acute and chronic PTSD, dissemination of effective treatments into community settings, and early interventions. We conclude with recommendations for clinical practice and suggestions for future areas of research.
Topics: Adolescent; Child; Cognitive Behavioral Therapy; Humans; Psychological Trauma; Stress Disorders, Post-Traumatic
PubMed: 30350312
DOI: 10.1111/jcpp.12983 -
Critical Care Clinics Jul 2017This article focuses on a psychiatric morbidity in critical illness survivors, posttraumatic stress disorder (PTSD). We present a case in the second person, because it... (Review)
Review
This article focuses on a psychiatric morbidity in critical illness survivors, posttraumatic stress disorder (PTSD). We present a case in the second person, because it is helpful to imagine what being critically ill can be like from the perspective of a patient without medical training. One-fifth of critical illness survivors have clinically relevant PTSD symptoms in the year after intensive care, and markers of risk include prior psychiatric illness, benzodiazepine administration in the intensive care unit (ICU), and early post-ICU memories of frightening, nightmare-like experiences during intensive care. ICU diaries are a low-tech, low-cost interventions that can supplement psychiatric care.
Topics: Critical Care; Critical Illness; Dreams; Humans; Intensive Care Units; Stress Disorders, Post-Traumatic; Survivors
PubMed: 28601139
DOI: 10.1016/j.ccc.2017.03.006 -
The American Journal of Psychiatry Nov 2021
Topics: Humans; Resilience, Psychological; Stress Disorders, Post-Traumatic
PubMed: 34734744
DOI: 10.1176/appi.ajp.2021.21090890 -
Der Nervenarzt Nov 2022The term "complex posttraumatic stress disorder" (cPTSD) appeared in the scientific literature 30 years ago and has now been included in a diagnostic catalogue for the...
The term "complex posttraumatic stress disorder" (cPTSD) appeared in the scientific literature 30 years ago and has now been included in a diagnostic catalogue for the first time, namely in the International Statistical Classification of Diseases and Related Health Problems 11 (ICD-11) which was officially published at the beginning of 2022. This usually severely debilitating disorder often poses great challenges to treating physicians and psychotherapists in everyday clinical practice. Due to the much-debated overlap of cPTSD with borderline personality disorder (BPD), which is very high in cases of comorbidity of BPD and PTSD, cPTSD became embroiled in scientific discussions about the raison d'être of BPD in the new dimensional concept of personality disorders (PD) in the ICD-11. In addition to a detailed explanation of the diagnostic criteria of cPTSD and their differentiation from other mental disorders, particularly from PTSD, BPD and dissociative disorders, this article summarizes the historical development of the concept of cPTSD to date and the currently available treatment options. The same criteria apply to cPTSD in childhood and adolescence as in adulthood, but there are some special features that are not addressed in this article.
Topics: Adult; Adolescent; Humans; Stress Disorders, Post-Traumatic; Dissociative Disorders; International Classification of Diseases; Borderline Personality Disorder; Comorbidity
PubMed: 36251027
DOI: 10.1007/s00115-022-01400-4 -
Progress in Neuro-psychopharmacology &... Mar 2019Posttraumatic stress disorder (PTSD) is prevalent, disabling, and frequently becomes chronic. Despite this, only two selective serotonergic reuptake inhibitors have been... (Review)
Review
Posttraumatic stress disorder (PTSD) is prevalent, disabling, and frequently becomes chronic. Despite this, only two selective serotonergic reuptake inhibitors have been approved to date for its treatment by the United States Food and Drug Administration, and treatment results are often disappointing, with a remission rate of <30%. Certain neuroendocrinological systems are currently gaining attention with respect to their use for PTSD prevention and treatment as standalone options or medication-enhanced psychotherapy due to their involvement in physiological stress reactions, memory consolidation and extinction, cognitive appraisal to stress, and attachment and resilient coping strategies, which are important in the pathogenesis of PTSD. The hypothalamic-pituitary-adrenal axis system takes the most important role in stress reactions. Hydrocortisone has been studied for the prevention of PTSD, and some meta-analyses have suggested its possible efficacy; furthermore, it has been considered both as monotherapy and as an augmentation to psychotherapy in PTSD patients, with some positive results. Glucocorticoid receptor antagonists and corticotropin-releasing factor type 1 antagonists have also been considered for clinical use in PTSD treatment. Additionally, other neuroendocrinological systems have been studied in PTSD including the use of oxytocin for PTSD prevention and augmentation to psychotherapy, allopregnanolone, and neuropeptide Y (NPY) for PTSD treatment. For now, however, these studies offer only limited evidence of efficacy, thus it is prudent to study this issue more vigorously.
Topics: Animals; Humans; Neurosecretory Systems; Psychotropic Drugs; Stress Disorders, Post-Traumatic
PubMed: 30502374
DOI: 10.1016/j.pnpbp.2018.11.021 -
Sleep Medicine Clinics Mar 2015The purpose of this article is to provide a brief overview of sleep in the context of posttraumatic stress disorder (PTSD) and focus on the treatment of the most common... (Review)
Review
The purpose of this article is to provide a brief overview of sleep in the context of posttraumatic stress disorder (PTSD) and focus on the treatment of the most common sleep disorders encountered by patients with PTSD: insomnia and nightmares. The effects of the standard treatments for PTSD are discussed along with a review of available treatments for insomnia and nightmares. Particular emphasis is placed on nonpharmacologic treatments for these sleep disorders and how they may be adapted for delivery to patients with PTSD.
Topics: Humans; Sleep Wake Disorders; Stress Disorders, Post-Traumatic
PubMed: 26055672
DOI: 10.1016/j.jsmc.2014.11.010 -
International Journal of Psychiatry in... Mar 2021Snakebite is a major public health problem among impoverished rural populations causing considerable morbidity and mortality in West Africa. Despite the huge burden of...
BACKGROUND
Snakebite is a major public health problem among impoverished rural populations causing considerable morbidity and mortality in West Africa. Despite the huge burden of snakebite in this region, psycho-social impairment following snakebite has not been evaluated. In this study, we assessed for features of posttraumatic stress disorder and psycho-social impairment among rural snakebite victims in Northeastern Nigeria.
METHODS
Individuals with previous snakebite managed in our facility, defined as exposed to snakebite, and their matched relatives not exposed to snakebite were invited to participate in the study following community mobilization. A retrospective cohort study was conducted evaluating the presence of psycho-social functioning, posttraumatic stress disorder, quality of life, social disability, cognitive impairment, and psychological morbidity using standard tools administered by the investigators, trained nurses, and community health workers.
RESULTS
The prevalence of features of posttraumatic stress disorder among those exposed to snakebite compared to those not exposed to snakebite was 43% and 28%, respectively (risk ratio = 1.53; 95% confidence interval: 1.04-2.24; p = 0.024). Subjects exposed to snakebite had significantly poorer quality of life score in the psychological and social domains (p < 0.05). Other psycho-social complications associated with snakebite were impaired family/school functioning and psychological morbidity. No difference in cognitive functioning was observed between the two groups.
CONCLUSIONS
Snakebite is complicated by features of posttraumatic stress disorder, poor quality of life, and psycho-social impairments in northeastern Nigeria. Detection, monitoring, and appropriate management interventions should be provided and made more accessible to snakebite victims to ameliorate mental and psychological impairment.
Topics: Humans; Nigeria; Quality of Life; Retrospective Studies; Snake Bites; Stress Disorders, Post-Traumatic
PubMed: 32216497
DOI: 10.1177/0091217420913400 -
Neuroscience Letters May 2017Posttraumatic stress disorder (PTSD) is a psychiatric disorder that develops in some individuals in the aftermath of exposure to traumatic events, such as actual or... (Review)
Review
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that develops in some individuals in the aftermath of exposure to traumatic events, such as actual or threatened death, serious injury or sexual assault. It has been hypothesized that dysregulations in a number of specific neurocircuits, characterized by heightened responsivity of amygdala, dACC and insula, diminished responsivity of mPFC, impaired hippocampal function and deficits in cortical regions, underlie the development and expression of key PTSD symptoms. Here, we concisely describe three functional neural circuits implicated in PTSD pathophysiology and briefly review selected treatment strategies in the context of these neural circuits. We start with the commonly implicated neurocircuit model, namely, the fear learning and threat detection circuits, and then discuss the context processing circuitry, which plays an important role among others, in fear regulation. We then discuss the emotion regulation circuitry, which can further contribute to PTSD pathophysiology, and conclude with a discussion of the therapeutic approaches that might be targeting dysregulation in these circuits in PTSD patients. Specifically, we discuss how exposure-based treatments might be targeting fear learning circuits, and the pharmacological and brain-stimulation interventions aimed to augment these therapies. Finally, we discuss other pharmacological and cognitive therapeutic approaches that can augment or restore the function of the context processing and emotional regulation circuits.
Topics: Amygdala; Animals; Brain; Conditioning, Classical; Emotions; Fear; Hippocampus; Humans; Neural Pathways; Prefrontal Cortex; Stress Disorders, Post-Traumatic
PubMed: 27845239
DOI: 10.1016/j.neulet.2016.11.014 -
Biological Psychiatry Sep 2015Posttraumatic stress disorder (PTSD) is a stress-related psychiatric disorder that is thought to emerge from complex interactions among traumatic events and multiple... (Review)
Review
Posttraumatic stress disorder (PTSD) is a stress-related psychiatric disorder that is thought to emerge from complex interactions among traumatic events and multiple genetic factors. Epigenetic regulation lies at the heart of these interactions and mediates the lasting effects of the environment on gene regulation. An increasing body of evidence in human subjects with PTSD supports a role for epigenetic regulation of distinct genes and pathways in the pathogenesis of PTSD. The role of epigenetic regulation is further supported by studies examining fear conditioning in rodent models. Although this line of research offers an exciting outlook for future epigenetic research in PTSD, important limitations include the tissue specificity of epigenetic modifications, the phenomenologic definition of the disorder, and the challenge of translating molecular evidence across species. These limitations call for studies that combine data from postmortem human brain tissue and animal models, assess longitudinal epigenetic changes in living subjects, and examine dimensional phenotypes in addition to diagnoses. Moreover, examining the environmental, genetic, and epigenetic factors that promote resilience to trauma may lead to important advances in the field.
Topics: Animals; DNA Methylation; Epigenomics; Gene Expression Regulation; Humans; Stress Disorders, Post-Traumatic
PubMed: 25979620
DOI: 10.1016/j.biopsych.2015.04.003