Post-traumatic Stress Disorder E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: WPA Series in Evidence and Experience in Psychiatry
• Sprache: Englisch

Seitenzahl: 545

Veröffentlichungsjahr: 2011

Beschreibung

Despite the growing interest in the role of psychological trauma in the genesis of psychiatric disorders, few volumes have addressed these issues from a multidisciplinary and international perspective. Given the complexity of reslience and posttraumatic disorder, and given ongoing trauma and violence in many parts of the world, it is crucial to apply such perspectives to review existing knowledge in the field and provide directions for future research.

This book has a broad scope. A key focus is PTSD, because of its clinical and health importance, its obvious link with trauma, and its interest for many clinicians and researchers. However, the book also examines resilience and a range of mental health consequences of trauma, because it has become increasingly clear that not all individuals react to trauma in the same way. It is important for mental health professionals to be aware of the broad range of potential responses to trauma, as well as of relevant evidence-based treatments.

The book includes chapters that address a wide range of topics on trauma-related disorders, including nosology and classification, epidemiology, neurobiology, pharmacotherapy, and psychotherapy. Each chapter comprises a critical review of the existing literature, aimed at being useful for the practitioner. This is followed by selected commentaries from other authorities on the topic, representing diverse geographical locations and points of view, who refine some of the perspectives offered in the review, provide alternative views, or suggest important areas of future work.

Leseprobe

Table of Contents

Series Page

World Psychiatric Association Evidence and Experience in Psychiatry Series

Current Science and Clinical Practice Series

Other recent World Psychiatric Association titles

Title Page

Copyright

Preface

References

List of Contributors

Chapter 1: PTSD and Related Disorders

Introduction

Historical Antecedents

PTSD: DSM-IV-TR Diagnostic Criteria

Acute Stress Disorder

Adjustment Disorders

Partial/Subsyndromal PTSD

DESNOS/Complex PTSD

Subtypes of PTSD

Cross-Cultural Factors

Developmental Issues

Conclusion

References

Commentary 1.1: Walking the Line in Defining PTSD: Comprehensiveness Versus Core Features

Commentary 1.2: Trauma-Related Disorders in the Clinical and Legal Settings

Introduction

Are We Missing PTSD in the Clinical Setting?

Does PTSD Adequately Cover Trauma-Related Disorders in the Forensic Setting?

Conclusion

Commentary 1.3: Redefining PTSD in DSM-5: Conundrums and Potentially Unintended Risks

References

Chapter 2: Epidemiology of PTSD

Introduction

Trauma Exposure and PTSD in the General Population

Sociodemographic Risk Factors

Psychiatric Comorbidity

Course of PTSD

Acute Stress Disorder

Conclusion

References

Commentary 2.1: Challenges and Future Horizons in Epidemiological Research into PTSD

Introduction

Challenges

Future Horizons

Conclusion

Commentary 2.2: Preventing Mental Ill-Health Following Trauma

Commentary 2.3: PTSD Epidemiology with Particular Reference to Gender

Introduction

Prevalence

Gender, Refugee Status and PTSD

Access to Care

Conclusion

References

Chapter 3: Neurobiology of PTSD

Introduction

Fear Conditioning and Extinction

Neuroendocrine Modulation of Conditioned Stress Responses

Genetic Contributions to the Risk of Developing PTSD

Epigenetic Contributions to the Risk of Developing PTSD

Structural and Functional Neuroanatomy

Conclusion

Acknowledgement

References

Commentary 3.1: Translational Theory-Driven Hypotheses and Testing Are Enhancing Our Understanding of PTSD and its Treatment

Commentary 3.2: Precipitating and Design Approaches to PTSD

Introduction

From Fear Conditioning to Emotion Regulation

The Value of True Prospective Studies

Conclusion

References

Chapter 4: Pharmacotherapy of PTSD

Introduction

Development

Assessing the Evidence

Key Issues

Conclusion

References

Commentary 4.1: Critical View of the Pharmacological Treatment of Trauma

Commentary 4.2: Shortcomings and Future Directions of the Pharmacotherapy of PTSD

Commentary 4.3: Dire Need for New PTSD Pharmacotherapeutics

References

Chapter 5: Psychological Interventions for Trauma Exposure and PTSD

Introduction

Historical Overview

Major Psychological Interventions

Summary of the Evidence

Clinical Guidelines

Comorbidity

Trauma-Focused Therapy Contraindications

Conclusion

References

Commentary 5.1: Psychological Interventions for PTSD in Children

Commentary 5.2: Challenges in the Dissemination and Implementation of Exposure-Based CBT for the Treatment of Hispanics with PTSD

Commentary 5.3: What Else Do We Need to Know about Evidence-Based Psychological Interventions for PTSD?

Commentary 5.4: Another Perspective on Exposure Therapy for PTSD

References

Chapter 6: (Disaster) Public Mental Health

Introduction

Scope of the Chapter

Core Concepts and Definitions

Phase 1. Assessment: Pre-Programme and Cyclical

Phase 2. Selection Criteria Defining Priorities for Mental Health and Psychosocial Interventions

Phase 3. Interventions: A Multimodal, Multisectoral and Multilevel Model

Conclusion

References

Commentary 6.1: An Excellent Model for Low- and Middle-Income Countries

Commentary 6.2: Disaster Mental Health and Public Health: An Integrative Approach to Recovery

Introduction

Paradigm Shifts in Preventive Aspects of Disaster Mental Health

Conclusion

Commentary 6.3: Transcultural Aspects of Response to Disasters

Commentary 6.4: Disaster Public Health: Health Needs, Psychological First Aid and Cultural Awareness

References

Index

World Psychiatric Association Evidence and Experience in Psychiatry Series

Series Editor: Helen Herrman, WPA Secretary for Publications, University of Melbourne, Australia

Depressive Disorders, 3e

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Substance Abuse Disorders

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The Mental Health of Children and Adolescents: an area of global neglect

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Approaches to Practice and Research

Religion and Psychiatry: beyond boundaries

Edited by Peter J Verhagen, Herman M van Praag, Juan José López-Ibor, John Cox, Driss Moussaoui

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Psychiatric Diagnosis: challenges and prospects

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Recovery in Mental Health: reshaping scientific and clinical responsibilities

By Michaela Amering and Margit Schmolke

ISBN: 9780470997963

Handbook of Service User Involvement in Mental Health Research

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ISBN: 9780470997956

Psychiatrists and Traditional Healers: unwitting partners in global mental health

Edited by Mario Incayawar, Ronald Wintrob and Lise Bouchard,

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Depression and Comorbidity

Depression and Diabetes

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Depression and Heart Disease

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Library of Congress Cataloging-in-Publication Data

Post-traumatic stress disorder / [edited by] Dan Stein, Matthew Friedman, and Carlos Blanco.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-68897-7 (cloth)

1. Post-traumatic stress disorder. I. Stein, Dan J. II. Friedman, Matthew J. III. Blanco, Carlos, 1962-

[DNLM: 1. Stress Disorders, Post-Traumatic. WM 172]

RC552.P67P6616 2011

616.85′21–dc23

2011014924

A catalogue record for this book is available from the British Library.

This book is published in the following electronic format: ePDF 9781119998488; Wiley Online Library: 9781119998471; ePub 9781119971481; Mobi 9781119971498

Preface

Post-traumatic stress disorder (PTSD) is arguably the most controversial of all the psychiatric diagnoses. There are disagreements about the qualifying events that count as sufficiently traumatic to precipitate PTSD, disagreements about the nature of the typical symptoms that follow exposure to trauma, disagreements about how best to prevent and treat PTSD, and disagreements about what kind of compensation is owed to people with PTSD by society.

At the same time, there have been major advances in our understanding of many aspects of PTSD. The diagnostic classifications of both the World Health Organization (WHO) and the American Psychiatric Association (APA) include the same broad symptom categories (e.g. re-experiencing, avoidance/numbing and arousal) and emphasise that exposure to extremely stressful events can produce profound alterations in cognitions, emotions and behaviour that may persist for decades or a lifetime.

There is also a growing appreciation of the public health burden of PTSD. Trauma continues to be a pervasive aspect of life in the 21st century, in high-, middle- and low-income countries [1]. Furthermore, PTSD and other trauma-related disorders are highly prevalent and disabling, are often associated with other psychiatric and medical disorders, and lead to significant costs for society [2, 3].

We are gradually advancing our scientific understanding of how exposure to traumatic events can produce neurobiological and psychological alterations which, if untreated, may persist indefinitely [4]. Furthermore, although there is not complete consensus across different clinical guidelines [5], there is general agreement that cognitive behaviour therapy and certain medications are the most effective clinical approaches for PTSD.

Many challenges remain. Fundamental information on the psychobiology of PTSD must be translated into effective, evidence-based clinical interventions. The development and testing of additional evidence-based treatments, especially treatments that are culturally sensitive and effective in more traditional ethnocultural settings, is required [6]. A further challenge is to move beyond the traditional clinic to the public health arena, where the focus must shift to resilience, prevention and selective interventions for populations at risk following disasters or mass violence [7].

The World Psychiatric Association (WPA) Evidence & Experience series provides a useful opportunity to work towards an evidence-based and integrative approach to different psychiatric conditions. In this volume, expert clinicians and researchers from around the world rigorously synthesise the data on PTSD, and provide balanced and judicious approaches to the controversies and challenges noted above. The chapters cover many aspects of PTSD, ranging from work on epidemiology and nosology, through research on psychobiology, to work on pharmacotherapy, psychotherapy and community approaches to intervention. Commentaries on each chapter, again from authors around the globe, provide additional depth.

Taken together, this work documents the many advances in empirical work on PTSD, negotiates a middle path through the theoretical controversies and provides clinicians and policy-makers with a practical approach to clinical and community interventions. Given that the field has learned much in recent decades about the kinds of trauma that are typically associated with PTSD, about the natural course of symptoms in response to such traumas, about optimal ways to evaluate and measure such symptoms, and about the best pharmacotherapeutic, psychotherapeutic and community approaches to the prevention and management of PTSD, we believe that this volume is timely. We hope that it will be useful to a broad range of readers.

We thank the many individuals who contributed to this volume, particularly the chapter authors. We also thank Joan Marsh of Wiley-Blackwell, Helen Herrman and Mario Maj of the WPA, and Marianne Kastrup, for their guidance and support; their vision and enthusiasm were pivotal in ensuring the initiation and progress of the volume. We wish to dedicate it to those individuals who have shared their symptoms and histories with us, teaching us the clinical aspects of PTSD and providing inspiring models of courage and resilience in the face of immense adversity.

Dan J. Stein, Carlos Blanco, Matthew J. Friedman

References

1. Green, B.L., Friedman, M.J., de Jong, J. et al. (2003) Trauma Interventions in War and Peace: Prevention, Practice, and Policy, Kluwer Academic/Plenum, Amsterdam.

2. Watson, P.J., Gibson, L. and Ruzek, J.I. (2007) Public health interventions following disasters and mass violence, in Handbook of PTSD: Science and Practice (eds M.J. Friedman, T.M. Keane and P.A. Resick), Guilford Press, New York, pp. 521–539.

3. Blumenfield, M. and Ursano, R.J. (2008) Intervention and Resilience after Mass Trauma, Cambridge University Press, Cambridge, UK.

4. Friedman, M.J., Keane, T.M. and Resick, P.A. (2007) Handbook of PTSD: Science and Practice, Guilford Press, New York.

5. Forbes, D., Creamer, M.C., Bisson, J.I. et al. (2010) A guide to guidelines for the treatment of PTSD and related conditions. Journal of Traumatic Stress, 23, 537–552.

6. Marsella, A.J, Johnson, J.L., Watson, P. and Gryczynski, J. (2008) Ethnocultural Perspectives on Disaster and Trauma: Foundations, Issues and Applications, Springer, New York.

7. Friedman, M.J. (2005). Every crisis is an opportunity. CNS Spectrums, 10, 96–98.

List of Contributors

Dean Ajdukovic

Department of Psychology, University of Zagreb, Zagreb, Croatia

David M. Benedek

Department of Psychiatry and Neuroscience; Department of Psychiatry; Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Lucy Berliner

Harborview Center for Sexual Assault & Traumatic Stress, School of Social Work, University of Washington, Seattle, WA, USA

Carlos Blanco

Department of Psychiatry, Columbia University, New York, NY, USA

Chris R. Brewin

Clinical Educational and Health Psychology, University College London, London, UK

Richard A. Bryant

University of New South Wales, Sydney, Australia

Abdulrahman M. El-Sayed

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

Matthew J. Friedman

Department of Psychiatry and of Pharmacology & Toxicology, Dartmouth Medical School; National Center for Posttraumatic Stress Disorder, US Department of Veterans Affairs, Hanover, NH, USA

Sandro Galea

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

Asaf Gilboa

The Rotman Research Institute, Baycrest Centre, Toronto, ON, Canada

Matthew N. Goldenberg

Department of Psychiatry; Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Derrick Hamaoka

Department of Psychiatry; Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Brian H. Harvey

Division of Pharmacology, Unit for Drug Research and Development, School of Pharmacy, North-West University (Potchefstroom campus), Potchefstroom, South Africa

Helen Herrman

Centre for Youth Mental Health, University of Melbourne, Victoria, Australia

Jonathan C. Ipser

Department of Psychiatry, University of Cape Town, Cape Town, South Africa

Joop de Jong

Department of Psychiatry, VU University Amsterdam, The Netherlands; Boston University, USA; Rhodes University, South Africa

Elie G. Karam

Department of Psychiatry and Clinical Psychology; Balamand University Medical School and St Georges Hospital University Medical Center; Institute for Development Research Advocacy and Applied Care (IDRAAC); Medical Institute for Neuropsychological Disorders (MIND), Beirut, Lebanon

Marianne Kastrup

Videnscenter for Transkulturel Psykiatri, Psykiatrisk Center København, Strandboulevarden, Denmark

Rafael Kichic

Anxiety Clinic, Institute of Cognitive Neurology (INECO) and Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina

Channaveerachari Naveen Kumar

Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India

Karina Lovell

The School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK

Suresh Bada Math

Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India

Alexander C. McFarlane

Department of Psychiatry, University of Adelaide Node, Centre for Military and Veterans' Health, University of Adelaide, Adelaide, Australia

Marcelo F. Mello

Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil

Maria Christine Nirmala

Lead Knowledge Management, Private Multinational Company, Bangalore, India

Tarek A. Okasha

Department of Psychiatry, Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Beth Patterson

Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

Ann M. Rasmusson

Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System; Boston University School of Medicine, Boston, MA, USA

María L. Reyes-Rabanillo

Psychiatry Service, Veterans Affairs Caribbean Healthcare System, San Juan, Puerto Rico

Barbara Olasov Rothbaum

Department of Psychiatry, Trauma and Anxiety Recovery Program, Emory University School of Medicine, Atlanta, GA, USA

Arieh Y. Shalev

Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel

Dan J. Stein

Department of Psychiatry, University of Cape Town, Cape Town, South Africa; Mount Sinai School of Medicine, New York, NY, USA

Murray B. Stein

Department of Psychiatry and Family and Preventive Medicine, University of California San Diego, CA, USA

Robert J. Ursano

Department of Psychiatry and Neuroscience; Department of Psychiatry; Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Michael Van Ameringen

Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

Chapter 1

PTSD and Related Disorders

Matthew J. Friedman

Department of Psychiatry and of Pharmacology & Toxicology,

Dartmouth Medical School; National Center for Posttraumatic Stress Disorder,

US Department of Veterans Affairs, Hanover, NH, USA

Introduction

Of the many diagnoses in the Diagnostic and Statistical Manual IV-TR (DSM-IV-TR) [1], very few invoke an aetiology in their diagnostic criteria: (i) organic mental disorders (e.g. caused by a neurological abnormality); (ii) substance-use disorders (e.g. caused by psychoactive chemical agents); (iii) post-traumatic stress disorder (PTSD); (iv) acute stress disorder (ASD); and (v) adjustment disorders (ADs) [2] – the latter three are all caused by exposure to a stressful environmental event that exceeds the coping capacity of the affected individual. The presumed causal relationship between the stressor and PTSD, ASD and AD is complicated and controversial, as will be discussed below. Controversy notwithstanding, acceptance of this causal relationship, initially in the DSM-III [3], has equipped practitioners and scientists with a conceptual tool that has profoundly influenced clinical practice over the past 30 years.

PTSD is primarily a disorder of reactivity rather than of an altered baseline state as in major depressive disorder or general anxiety disorder. Its psychopathology is characteristically expressed during interactions with the interpersonal or physical environment. People with PTSD are consumed by concerns about personal safety. They persistently scan the environment for threatening stimuli. When in doubt, they are more likely to assume that danger is present and will react accordingly. The avoidance and hyperarousal symptoms described below can be understood within this context. The primacy of traumatic over other memories (e.g. the reexperiencing symptoms) can also be understood as a pathological exaggeration of an adaptive human response to remember as much as possible about dangerous encounters in order to avoid similar threats in the future.

The sustained anxiety about potential threats to life and limb, pervasive and uncontrollable sense of danger, and maladaptive preoccupation with concerns about personal safety and the safety of one's family can be explicated in terms of psychological models such as classic Pavlovian fear conditioning, two-factor theory or emotional processing theory [4–6]. The traumatic (unconditioned) stimulus (the rape, assault, disaster, etc.) automatically evokes the post-traumatic (unconditioned) emotional response (fear, helplessness and/or horror). The intensity of this emotional reaction provokes avoidance or protective behaviours that reduce the emotional impact of the stimulus. Conditioned stimuli, reminders of such traumatic events (e.g. seeing someone who resembles the original assailant, confronting war-zone reminders, exposure to high winds or torrential downpours reminiscent of a hurricane, etc.), evoke similar conditioned responses manifested as fear-induced avoidance and protective behaviours.