A pharmacotherapeutic approach to the management of chronic posttraumatic stress disorder.
ABSTRACT Due to relatively recent and ongoing world events (eg, terrorist attacks, wars, and natural disasters), there has been a shift in attention from some of the more common psychiatric illnesses to one of the more elusive, namely, posttraumatic stress disorder (PTSD). PTSD is a severe, and often chronic, condition that can lead to significant morbidity and mortality. Although originally a condition seen primarily among war veterans, PTSD is now becoming more prevalent in the general community. PTSD often presents concurrently with other conditions, such as depression, bipolar, anxiety/panic disorders, and alcohol and drug abuse. Because of this, PTSD often goes unrecognized and is underdiagnosed in clinical practice. Thus, an opportunity for pharmacist intervention exists, both in the institution and in the community. With proper education and training, pharmacists can be efficient in screening for signs and symptoms of PTSD, triaging appropriate patients, and can play an integral role in managing the diverse array of drug therapy options for PTSD.
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ABSTRACT: Posttraumatic stress disorder (PTSD) is a fairly common psychiatric disorder that is associated with a lifetime prevalence of approximately 9% in the United States. In light of recent war and terrorist activity worldwide, it is likely that increased numbers of individuals will be exposed to severe or life-threatening trauma, and the incidence of PTSD may be even higher than previously indicated in epidemiologic studies. PTSD may develop after exposure to a traumatic event in which the individual experienced, witnessed, or was confronted by either actual or threatened loss of life or serious injury. Patients with PTSD often reexperience intrusive recollections of the event in ways that are highly distressing and may be described as reliving the memory. Not surprisingly, symptoms of avoidance are noted because individuals with PTSD often wish to escape recollections (thoughts, feelings, conversations, places) related to the trauma. Patients also experience symptoms of hyperarousal associated with difficulty concentrating or exaggerated startle response. Notably, individuals who develop PTSD represent only a subset of those exposed to trauma. It is of interest why certain individuals are at risk for development of PTSD after traumatic exposure, whereas others appear to be more resilient to the effects of trauma. Studies suggest that previous exposure to trauma and intensity of the response to acute trauma may affect the development of PTSD. In addition, however, neuroendocrine changes, such as lower cortisol levels, also may influence formation and processing of traumatic memories and may be associated with the underlying pathology of PTSD.The Journal of Clinical Psychiatry 02/2004; 65 Suppl 1:29-36. · 5.14 Impact Factor
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ABSTRACT: Posttraumatic stress disorder (PTSD) develops after exposure to events that are threatening and/or intensely distressing. Accumulating evidence suggests that intense psychological trauma can cause long-standing alterations in the neurobiological response to stress. These alterations translate into a number of symptoms commonly experienced by patients with PTSD. Current treatments for this disorder are only partially effective in managing the disease, and patients have to endure unpleasant symptoms associated with hyperarousal. As a result, they often withdraw from social interaction and increase the use of central nervous system depressants. Data suggest that biological dysregulation of the glutamatergic, amine neurotransmitter (noradrenergic and serotonergic), and neuroendocrine pathways plays a fundamental part in the pathology of PTSD and may cause brain structural as well as functional abnormalities. Knowledge of these pathologic changes in PTSD provides direction for the development of new treatments that will offer more comprehensive management of PTSD and enable patients to enjoy a much improved quality of life. This article reviews current knowledge regarding the psychobiology of PTSD and considers specific agents that are emerging as key modulators of this pathological process.The Journal of Clinical Psychiatry 02/2000; 61 Suppl 5:24-9; discussion 30-2. · 5.14 Impact Factor
Biological Psychiatry 06/2002; 52(10). · 9.47 Impact Factor