Post-traumatic stress disorder (PTSD) is a devastating psychopathological consequence seen in some individuals who experience terrible traumatic events such as personal assaults, life-threatening accidents, sexual abuse or natural disasters etc. 1,2. The progression of PTSD is caused by characteristics of major traumatic events 3. In the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and International Classification of Diseases, 10th edition (ICD-10), PTSD was first defined as a diagnosable psychiatric disorder [1]. According to the DSM criteria, victim must have faced intense feeling of fear, or defenseless as the traumatic event happened 4. The symptoms must have lasted for more than one month and, significantly, resulted in clinically extreme anxiety, destruction of social, business-related, or other major areas of functioning 4. Should post-traumatic stress disorder exist for more than three months, it turns out that acute PTSD turns into chronic form 4. On the one hand, patients with psychiatric disorders are at higher risk to develop PTSD 5. Increasement of the assault of PTSD after exposure to trauma occurs by psychiatric disorders 6. Comorbidity of PTSD with other psychiatric disorders was also turned out 3. On the other hand, the affiliation of increased risk of PTSD with acute stress disorder is remarkable 7.
A variety of symptoms encountered in patients with PTSD are intrusive thoughts, memories and nightmares which remind the trauma, distressing, sleep disturbance, hypervigilance which means the body is always on guard, loss of concentration, feeling of sadness and loneliness 8. Persons with PTSD stay away from places, activities or anything which has potential to evoke memories of trauma 8. Symptoms of PTSD are generally encountered with prolonged onset beginning after six months 4. Insomnia, irritability, poor concentration, hypervigilance and exaggerated startle reactions are given as examples of the symptoms manifested by individuals with PTSD 9. As expected, after exposure to a stressful traumatic event, an individual will have experienced symptoms of avoidance which refers to the avoidance of reminders of the incident including places, persons and thoughts linked up with the event 1. During the first month of a traumatic event, individuals tend to face symptoms of the acute stress disorder 1. The social lives or careers of patients with PTSD are affected by the plethora of symptoms of the disorder in a such way that hyperarousal and nightmares the patients experienced result in lowered concentration, with worsening work performance and professional connections 1,10,11.
Research maintained that both stress-activated central and peripheral processes are modified by PTSD, with being classified as a multisystem disorder 1. Variety of factors with distinct effects level including complicacy of genetic, developmental and psychological risk factors, psychiatric comorbidity, the age at which a person’s exposure to the event, and impact and frequency of the traumatic incident, leads to heterogeneity of PTSD among the patients 1. The main nervous system involved in the pathophysiology of PTSD consists of abnormal fear learning, dysfunctional threat detection, emotional regulation, and contextual processing. Development of fear responses, avoidance of trauma reminders, and defective emotional regulations in PTSD are effectuated by the formation of abnormalities in the interconnected nervous system 1.
Finally, Diagnosis of PTSD is easy provided having knowledge or suspicion of the clinician that person must have been exposed to a traumatic incident 1. Determination of the existence and intensity of PTSD is performed by asking several questions by clinicians 1. Two FDA approved medications, namely sertraline and paroxetine that are selective serotonin reuptake inhibitors, are utilized for the treatment of PTSD 1. Psychotherapy is another option for the management of the PTSD.
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- Hori H, Kim Y. Inflammation and post-traumatic stress disorder. Psychiatry Clin Neurosci. Published online 2019. doi:10.1111/pcn.12820
- Hapke U, Schumann A, Rumpf HJ, John U, Meyer C. Post-traumatic stress disorder: The role of trauma, pre-existing psychiatric disorders, and gender. Eur Arch Psychiatry Clin Neurosci. Published online 2006. doi:10.1007/s00406-006-0654-6
- Bisson JI. Post-traumatic stress disorder. Br Med J. Published online 2007. doi:10.1136/bmj.39162.538553.80
- Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. Published online 2000. doi:10.1037/0022-006X.68.5.748
- Bromet E, Sonnega A, Kessler RC. Risk factors for dsm-iii-r posttraumatic stress disorder: Findings from the national comorbidity survey. Am J Epidemiol. Published online 1998. doi:10.1093/oxfordjournals.aje.a009457
- Harvey AG, Bryant RA. The relationship between acute stress disorder and posttraumatic stress disorder: A prospective evaluation of motor vehicle accident survivors. J Consult Clin Psychol. Published online 1998. doi:10.1037/0022-006X.66.3.507
- Cooper R. Diagnostic and statistical manual of mental disorders (DSM). Knowl Organ. Published online 2017. doi:10.5771/0943-7444-2017-8-668
- North CS, Nixon SJ, Shariat S, et al. Psychiatric disorders among survivors of the Oklahoma City bombing. J Am Med Assoc. Published online 1999. doi:10.1001/jama.282.8.755
- Te F, Bp L, Jn E, Wj B, Sk K, Prevalence KR. American Psychiatric Association. 1. Diagnostic and Statistical Manual of Mental Disorders. 4th Edn. Text Revision.; 2000.
- Munro S, Thomas KL, Abu-Shaar M. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013. Nature. Published online 1993.
- Lang S, Kroll A, Lipinski SJ, et al. Context conditioning and extinction in humans: Differential contribution of the hippocampus, amygdala and prefrontal cortex. Eur J Neurosci. Published online 2009. doi:10.1111/j.1460-9568.2009.06624.x
- Rougemont-Bücking A, Linnman C, Zeffiro TA, et al. Altered processing of contextual information during fear extinction in PTSD: An fMRI study. CNS Neurosci Ther. Published online 2011. doi:10.1111/j.1755-5949.2010.00152.x
- Fanselow MS, LeDoux JE. Why we think plasticity underlying pavlovian fear conditioning occurs in the basolateral amygdala. Neuron. Published online 1999. doi:10.1016/S0896-6273(00)80775-8
- Seeley WW, Menon V, Schatzberg AF, et al. Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci. Published online 2007. doi:10.1523/JNEUROSCI.5587-06.2007
Figure References:
- Shalev A, Liberzon I, Marmar C. Post-Traumatic Stress Disorder. N Engl J Med. 2017 Jun 22;376(25):2459-2469. doi: 10.1056/NEJMra1612499. PMID: 28636846
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