Post-traumatic stress disorder – from traumatic neurosis to ICD-11: features of diagnosis and selection of therapy

Abstract

PTSD was determined as a stand-alone disorder about 50 years ago, and since then it is considered to be in the focus of attention of the mental health specialists. It’s main clinical features are the set of symptoms of re-experience of the traumatic event in here and now situation. They are defined to be the core symptoms for PTSD diagnostic. Clinical features and disorder course are the subject of wide prospective cohort studies with the use of the standardized psychometric instruments since the 80-s of the last century. In the new ICD-11 mental disorders classification, stress-associated disorders are defined as stand-alone rubric, the core PTSD symptoms are defined, the complex PTSD is proposed as a new diagnosis for the coding of persistent caused by prolonged psychotraumatic experience personality changes, the life-threatening diagnosis and intensive care unit experience were added to the list of PTSD triggers. The PTSD diagnosis is considered to be a challenging clinical task. The connection between symptoms manifestation and extreme traumatic experience should be established, one should take into consideration the existence of possible usually several weeks before symptoms manifestation latent period. It is useful to implement the recommended diagnostic instrument for the diagnosis verification and symptoms dynamic evaluation. The combination of pharmacotherapy and psychotherapy is recommended for PTSD treatment, individual approach should be used in case-management. In 2022 WFSBP Task Force on Treatment Guidelines for Anxiety, O and Post-Traumatic Stress Disorders have been published, there for the first-time cognitive behavior psychotherapy was determined as highly evidence based PTSD psychotherapeutic method of treatment. In March 2023 ministry of health of the Russian Federation has approved national PTSD clinical guidelines, where recommended medication list has been proposed taking into account the national clinical experience, in particular it includes a wide range of non-benzodiazepine anxiolytics. The article emphasizes the opportunities of their use and presents a clinical vignette where etifoxine is proposed as treatment of choice.