Cause Of Posttraumatic Stress Disorder Research Articles

Sertraline

Sertraline is a selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor (SSRI) that inhibits the serotonin transporter with only minor inhibition of the noradrenaline (norepinephrine) and dopamine transporters. It has recently shown efficacy in most, although not all, clinical trials in patients with post-traumatic stress disorder (PTSD). In 2 of 3 randomised, double-blind trials in civilian patients, once daily oral sertraline 50 to 200mg significantly reduced symptoms of PTSD compared with placebo over 12 weeks. Response rates were 53 and 60% for sertraline compared with 32 and 39% for placebo. The quality of life of patients receiving sertraline was significantly improved compared with those receiving placebo in I trial Post-hoc subgroup analysis of pooled results from the 2 trials showed that sertraline has significant efficacy in women with PTSD but efficacy in men was not clearly established. The efficacy of sertraline in combat-induced PTSD has not been clearly established. Sertraline has shown efficacy in 2 longer-term trials of 24 (nonblind, noncomparative) and 28 (double-blind, placebo-controlled) weeks' duration. Sertraline is generally well tolerated. Adverse events associated significantly more frequently with sertraline than placebo in clinical trials of patients with PTSD were insomnia, diarrhoea and nausea. Discontinuation of treatment occurred in approximately the same number of sertraline- and placebo-treated patients, Conclusions: Sertraline has demonstrated efficacy in the treatment of PTSD, particularly in female patients and in non-combat-induced PTSD, and is generally well tolerated. It appears to have a lower potential for drug interactions than other SSRIs, although direct comparisons are lacking. Sertraline is currently the only SSRI approved for the treatment of PTSD. As SSRIs are recommended as the first-line pharmacological agents when drug treatment is indicated in patients with PTSD. sertraline may be considered the present drug of choice for PTSD, particularly in females from the civilian population. Sertraline, a naphthylamine derivative, is a selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitor (SSRI) that has previously demonstrated efficacy in the treatment of patients with depression, panic disorder and obsessive-compulsive disorder, and more recently in the treatment of patients with post-traumatic stress disorder (PTSD). The causes of PTSD have yet to be established clearly. Nervous system pathways implicated in PTSD include the serotonergic and adrenergic systems, increased sympathetic nervous system activation and decreased corticotropin-releasing factor and ambient cortisol levels. Sertraline selectively inhibits the serotonin transporter with only minor inhibition of the noradrenaline (norepinephrine) and dopamine transporters, Sertraline showed no appreciable affinity for σ2, serotonergic 5-HT 1A , 5-HT 1B , 5-HT 2A , histaminergic H 1 , dopaminergic D 1 and D 2 , and muscarinic receptors, and α 2 -and β-adrenoceptors in vitro, In 1 study sertraline showed a moderate affinity for α-adrenoceptors, but under normal clinical conditions sertraline is unlikely to block these receptors as the sertraline concentration required to antagonise them is considerably more than that required to inhibit serotonin reuptake. Sertraline also has some affinity for σ 1 receptors, but the clinical implications of this have not yet been determined.

“Recovered-memory” therapy: Profession at a turning point

Six hundred Massachusetts-registered psychiatrists were surveyed for their opinions on items plausibly related to the production of false memories of childhood sexual abuse. One hundred fifty-four psychiatrists completed the written questionnaire. A majority of respondents (69%) endorsed the following statement: “The numbers of false accusations of childhood sexual abuse, appearing to emerge from the psychotherapy of adults, constitute a real problem needing public acknowledgment as such by the mental health professions.” Nevertheless, a substantial minority endorsed the following practices: 37% endorsed searching for childhood roots of presenting complaints; 36% endorsed validation (expressed belief) of the patient's memories as an essential part of therapy; 36% believed in appropriateness of affect as an indicator of truth in memories; 36% believed in the therapeutic value of abreaction; 26% would refer presumed survivors of abuse to specialists in incest recovery; 18% believed in ritual abuse as an important cause of posttraumatic stress disorder (PTSD) and dissociative disorders; 18% trusted symptom checklists as indicators of sexual abuse histories; and 15% believed that memory is a complete record of the individual's history. Small minorities (6% to 8%) endorsed these practices: using hypnosis to gain access to repressed memories of childhood abuse; patient confrontation of alleged abusers; and recommending the severing of contacts with skeptical family members. A factor analysis was performed, and it was found that self-designated specialists were more likely than nonspecialists to score toward the riskier pole of the four factors extracted.

Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma.

The study estimates the relative importance of specific types of traumas experienced in the community in terms of their prevalence and risk of leading to posttraumatic stress disorder (PTSD). A representative sample of 2181 persons in the Detroit area aged 18 to 45 years were interviewed by telephone to assess the lifetime history of traumatic events and PTSD, according to DSM-IV. Posttraumatic stress disorder was assessed with respect to a randomly selected trauma from the list of traumas reported by each respondent, using a modified version of the Diagnostic Interview Schedule, Version IV, and the World Health Organization Composite International Diagnostic Interview. The conditional risk of PTSD following exposure to trauma was 9.2%. The highest risk of PTSD was associated with assaultive violence (20.9%). The trauma most often reported as the precipitating event among persons with PTSD (31% of all PTSD cases) was sudden unexpected death of a loved one, an event experienced by 60% of the sample, and with a moderate risk of PTSD (14.3%). Women were at higher risk of PTSD than men, controlling for type of trauma. The risk of PTSD associated with a representative sample of traumas is less than previously estimated. Previous studies have overestimated the conditional risk of PTSD by focusing on the worst events the respondents had ever experienced. Although recent research has focused on combat, rape, and other assaultive violence as causes of PTSD, sudden unexpected death of a loved one is a far more important cause of PTSD in the community, accounting for nearly one third of PTSD cases.

Post-traumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures: A consecutive series of 30 cases of PTSD

Abstract 500 women volunteers took part in a study about the psychological stress associated with obstetric and gynaecological procedures. The sample was recruited by advertisements in local and national newspapers and in women's magazines and newsletters. Women completed a preliminary questionnaire on their experiences of obstetric and gynaecological procedures, their biographical data, and their feelings associated with the procedures both at the time and now. Out of the 500 subjects, over 100 women gave an history of an obstetric and for gynaecological procedure which was ‘very distressing’ or ‘terrifying’, which was ‘out of the ordinary’ and which occurred ‘more than one month previously’. These women were sent follow-up PTSD-I questionnaires and 30 of them fulfilled the DSM-111-R criteria for a diagnosis of post-traumatic stress disorder (PTSD). Significant differences between the 30 women with PTSD, and 30 respondents who rated their experiences from ‘very good’ to ‘slightly distressing’, were found on a range of findings, including feelings of powerlessness during the procedures, lack of information given to the patient, the experience of physical pain, a perceived unsympathetic attitude on the part of the examiner, and a lack of clearly-understood consent by the patient for the procedure. The results are discussed in relation to the literature on women's emotional reactions to the childbirth process and also to sexual violence and other causes of PTSD. The present findings suggest a cause of PTSD not previously described and challenge current medical working practices in the area of obstetrics and gynaecology.

Uncontrolled pain following physical injury as the core-trauma in post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a psychiatric diagnostic category characterized by “the development of characteristic symptoms following a psychologically traumatic event that is generally outside the range of usual human experience”. Research shows that the prevalence of PTSD among injured survivors of stressful events is higher than that of survivors without physical injury, thus suggesting that secondary Stressors (e.g., severe uncontrolled pain, a prolonged state of acute anxiety, uncertainty regarding the immediate future, loss of control, and inability to monitor contact with the environment) may play an important role in the formation of PTSD. However, pain has never been suggested or recognized as a direct cause of PTSD. We present the case of a patient who lost an eye under traumatic circumstances and was later diagnosed as suffering from PTSD. Upon evaluation in a psychophysiological laboratory, this patient's core-trauma was discovered to be 7 h of severe uncontrolled pain while waiting for surgery, rather than the moment when he lost his eye during military service. The case suggests that pain, although not “generally outside the range of usual human experience”, may be a strong enough Stressor in traumatic circumstances to cause the development of PTSD, thus highlighting the importance of prompt and adequate pain management in hospitalized survivors of traumatic injury.