I n   t h i s   i s s u e . . . Marc-Antoine Crocq, MD Posttraumatic stress disorder and the nature of trauma Bessel Van der Kolk on pages 7 to 22 An alternative title for this brilliant “state of the art” article might have been  “A  Century  of  Posttraumatic  Stress  Disorder.”  Bessel  van  der Kolk expertly recounts a hundred years of evolving concepts, from the first  stirrings  of  the  understanding  of  psychological  trauma,  with Charcot, Janet, Freud, and Breuer, past the fledgling diagnostic entity of  “war  neuroses,”  with  Kardiner,  to  the  full-blown  diagnostic  con- struct of PTSD as defined in DSM-III and beyond. The emphasis given to   the   recent   input   of   the   psychobiology   of   trauma,   hormonal responses, neuroimaging, and psychopharmacology confirms that our “vision” of PTSD is a never-ending process… Neurobiological findings in posttraumatic stress disorder: a review Kumar Vedantham, Alain Brunet, Thomas C. Neylan, Daniel S. Weiss, Charles R. Marmar on pages 23 to 29 This comprehensive review article takes us through the maze of the truly  mindboggling  developments  that  have  transformed  the  under- standing of PTSD in recent years. Particularly important are the find- ings   concerning   noradrenergic   axis   function,   neuroendrocrine responses,  and  neuroanatomic  changes  that  occur  in  PTSD.  A  clear view of the biological consequences of this disorder is of paramount interest, if only because it is a prerequisite for discovering better treat- ments. Ethical aspects of research on psychological trauma Dan  J.  Stein, Allen  Herman,  Debra  Kaminer,  Solomon  Rataemane, Soraya Seedat, Ronald C. Kessler, David Williams on pages 31 to 36 Ethics—the sine qua non of psychiatric research—is never absent from the  numerous  consensus  conferences  that  have  been  organized  in recent years. The nature of trauma and the propensity for victims to reexperience it pose critical questions in terms of therapeutic strate- gies and the need for clinical research in this field. The recent changes in  South  Africa  gave  psychiatrists  a  concrete  opportunity  to  explore these issues. Stein and colleagues’ trailblazing experience is a model for further developments. Update on the epidemiology, diagnosis, and treatment of posttraumatic stress disorder Joseph   Zohar,   Daniella  Amital,   Heidi   D.   Cropp,   Gadi   Cohen- Rappaport, Yaffa Zinger, Yehuda Sasson on pages 37 to 43 In  this  update,  the  authors  attribute  the  continuing  underdiagnosis and undertreatment of PTSD to lack of awareness of the prevalence of the disorder. After recalling the high frequency of traumatic events in the general population and the main diagnostic features of PTSD, the authors look at current therapeutic strategies, stressing the benefits of a combined and psychopharmacological approach in view of the psy- chobiological features of the disorder. From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology Marc-Antoine Crocq, Louis Crocq on pages 47 to 55 The twentieth century will go down in history as a century of aston- ishing technical prowess, but also as the century of wars. Sadly, the many conflicts of the past hundred years have offered an unequalled study   ground   for   the   psychological   consequences   of   trauma. Interspersed with historical and literary sidelights from biblical times to the present day, this article explains how the steady rise of violence in so many countries and cultures has meant that psychotraumatology has  now  escaped  from  the  confines  of  military  psychiatry,  and  that PTSD is being increasingly diagnosed in civilian populations. Lifelong posttraumatic stress disorder: evidence from aging Holocaust survivors Yoram Barak, Henry Szor on pages 57 to 62 The horrors of the Second World War, particularly those perpetrated by the Nazis, have surpassed anything humanity has had the misfor- tune to experience. After more than fifty years, the consequences of the unclosed psychological wounds of one of the worst traumas ever inflicted on human beings continue to haunt survivors even into old age. This is made plain by the findings of a study carried out in elder- ly Holocaust survivors, which led the authors to the poignant conclu- sion that, for many, “memory is a lifelong burden.” After the MV Estonia ferry disaster. A Swedish nation- wide survey of the relatives of the MV Estonia victims Kristina Brandänge, J. Petter Gustavsson on pages 63 to 69 Major disasters, such as the sinking of the Estonia ferry in the Baltic sea six years ago, exemplify how difficult it is for health authorities to prepare  adequate  contingency  plans.  This  disaster,  like  others  of  its type, was compounded by the fact that the victims included not only the survivors themselves, but also their relatives. The experience of the Ersta  Clinic  in  Stockholm  reported  in  this  article  gives  a  first-hand account of the problems encountered by Swedish psychiatrists as they set out to help survivors and relatives cope with the aftermath of the catastrophe. A social interaction model for war traumatization. Self-processes and postwar recovery in Bosnia in subjects with PTSD and other psychological disorders Willi Heinz Butollo on pages 71 to 81 The war in Bosnia lays claim to the dubious honor of concluding this “century of wars.” This article describes the multiple forms of trauma and ensuing psychological disorders, including PTSD, suffered by Bos- nian soldiers and civilians, and which exacted a particularly tragic toll on children. From his experience in the field, the author draws up the outlines of a social interaction model for war traumatization, centered on the concept of loss of interpersonal trust, and shows how such a model may help in developing more effective therapeutic strategies. 5
Vol 2 n° 1 - Posttraumatic Stress Disorder
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