Posttraumatic Stress Disorder

Posttraumatic Stress Disorder

March 2000 – Vol 2 – No. 1

Editorial

Dear Colleagues,

Although the main features of posttraumatic stress disorder (PTSD) were identified as early as the first half of the 20th century in victims of psychological trauma of the two world wars—albeit under different names, such as shell shock or war neurosis—it is a relative newcomer in the history of psychiatry as a diagnostic entity, having only made its way into the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. This explains why so many key issues, such as prevalence, pathogenesis, mechanisms, and treatment, remain unresolved to this day. Some of these are pointed out below, but the reader will surely be able to think of more: • The prevalence of PTSD in the general population—hence the number of people liable to benefit from treatment—is debated.The chances of escaping war trauma are reasonably fair in countries spared open conflicts or civil war, but criminal violence, rape, child abuse, and traffic or industrial accidents are constant threats almost everywhere, explaining why some community-based studies show prevalence figures as high as 15%. • PTSD should be distinguished from the acute stress reaction immediately following traumatization, as some patients will spontaneously recover. Does this mean that, given a strong enough stressor, nobody is immune to PTSD, or are some persons in effect more vulnerable to the disorder? • What of the paradox that trauma caused by an exogenous stressor elicits neurochemical stigmata in the brain just like an endogenous disorder, and that the resulting symptoms respond to biological treatment? • What of the possible integration of PTSD into a broader diagnostic framework, in view of the resemblance between PTSD and other disorders characterized by paroxysms of anxiety? Can the beneficial effect of antidepressant drug treatment be taken as confirmation of the similarities between PTSD and panic attacks, social phobias, generalized anxiety, and obsessive-compulsive disorder? Turning to matters of more immediate practical concern, the mainstay of the management of PTSD currently consists in the association of cognitive and behavioral psychotherapy and antidepressant drug treatment. However, despite evidence that antidepressants are effective, many patients evolve toward chronicity. Double-blind studies with antidepressants in this indication are comparatively scarce in the literature. Studies with monoamine oxidase inhibitors and tricyclics are now old, and recent ones, complying with current methodological standards, mostly concern specific serotonin reuptake inhibitors. Drug trials are fraught with various problems, paramount among which are duration—which must be typically up to 12 weeks—and the filtering out of the effects of potential drug candidates on comorbid depression. Sertraline was the first compound approved for use in PTSD by the US FDA’s Psychopharmacologic Drug Advisory Committee, in October 1999, even though studies failed to demonstrate its efficacy in all general population samples or in the context of combat-induced PTSD.Thus, the challenge remains to discover new drugs for the treatment of both PTSD-specific symptoms and other acute anxiety disorders. Dialogues in Clinical Neuroscience is now entering its second year, and we are excited at the encouraging response expressed so far by our readers. It is our sincere hope that you should contribute to the further development of the journal, and we look forward to receiving your criticisms, questions, comments, letters, and articles.

Sincerely yours,

Jean-Paul MACHER, MD / Marc-Antoine CROCQ, MD

State of the art

Posttraumatic stress disorder and the nature of trauma
Bessel van der Kolk, MD

Basic research

Neurobiological findings in posttraumatic stress disorder: a review
Kumar Vedantham, MD; Alain Brunet, PhD; Thomas C. Neylan, MD; Daniel S. Weiss, PhD; Charles R. Mannar, MD

Ethical aspects of research on psychological trauma
Dan J. Stein, MB; Allen Herman, MD, PhD; Debra Kaminer, MA; Solomon Rataemane, MB; Soraya Seedat, MB; Ronald C. Kessler, PhD; David Williams, PhD, MPH

Pharmacological aspects

Update on the epidemiology, diagnosis, and treatment of posttraumatic stress disorder
Joseph Zohar, MD; Daniella Amital, MD; Heidi D. Cropp, BA; Gadi Cohen-Rappaport, MD; Yaffa Zinger, MSc; Yehuda Sasson, MD

Posters & images in neuroscience

An overview of the Peritraumatic Distress Scale
Alain Brunet, Phd; Daniel S. Weiss, PhD; Thomas J. Metzler, MA; Suzanne R. Best, PhD; Jeffrey Fagan, PhD; Kumar Vedantham, MD; Charles R. Marmar, MD

Clinical research

From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology
Marc-Antoine Crocq, MD; Louis Crocq, MD

Lifelong posttraumatic stress disorder: evidence from aging Holocaust survivors
Yoram Barak, MD; Henry Szor, MD

After the MV Estonia ferry disaster A Swedish nationwide survey of the relatives of the MV Estonia victims
Kristina Brandänge, MD; J. Petter Gustavsson, PhD

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, MD