Article

Traumatic Stress and Posttraumatic Stress Disorder in Youth: Recent Research Findings on Clinical Impact, Assessment, and Treatment

Department of Child and Adolescent Psychiatry, New York University, Brooklyn, New York. Electronic address: .
Journal of Adolescent Health (Impact Factor: 2.75). 02/2013; 52(2):137-143. DOI: 10.1016/j.jadohealth.2012.06.018
Source: PubMed

ABSTRACT Childhood trauma can have a profound effect on adolescent development, with a lifelong impact on physical and mental health and development. Through a review of current research on the impact of traumatic stress on adolescence, this article provides a framework for adolescent health professionals in pediatrics and primary care to understand and assess the sequelae of traumatic stress, as well as up-to-date recommendations for evidence-based treatment. We first review empirical evidence for critical windows of neurobiological impact of traumatic stress, and then we discuss the connection between these neurobiological effects and posttraumatic syndromes, including posttraumatic stress disorder, depression, aggressive behavior, and psychosis. This article concludes by considering the implications of this current research for clinical assessment and treatment in pediatric and primary care settings.

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    • "PTSD is characterized by reexperiencing the event, numbness of feelings/emotions, avoidance of stimuli associated with the event, and increased arousal (American Psychiatric Association [APA], 1994). Traumatic events and PTSD in childhood can have significant effects on adolescent development (Gerson & Rappaport, 2013) and lead to chronic mental disorders (Sack, Clarke, & Seeley, 1995). Even when full PTSD diagnostic criteria are not met, partial symptomatology may cause serious functional impairment (Stein, Walker, Hazen, & Forde, 1997) and have possible severe long-term consequences, especially because general and particularly mental health resources in most Sub-Saharan African countries are rather limited (Sathiyasusuman, 2011). "
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    ABSTRACT: Quality of life (QOL) tends to be lower among the homeless than the general population, and traumatic events experienced on the streets have a negative impact on QOL. Low-income countries face a high number of street youth, yet little research has been performed so far on QOL, trauma, and posttraumatic stress disorder (PTSD) among this group. This study aimed at examining the QOL of a sample of Ethiopian street youth within a rehabilitation program and at exploring whether the street youth have experienced traumatic events and show posttraumatic stress symptoms. We interviewed 84 street youths with the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and the Diagnostic Interview for Children and Adolescents (DICA). Mean QOL scores differed significantly between the groups assessed at the beginning and at the end of the program (Cohen's d = 0.48). Eighty-three percent of the Ethiopian street youths had experienced traumatic events, and 25.0% met criteria for PTSD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. QOL did not differ between those with and without PTSD symptoms. These findings show the high rate of traumatic events among Ethiopian street youth and the importance for rehabilitation programs that focus on improving QOL. The results of the study may have cultural limitations.ResumenLa calidad de vida (CDV) tiende a ser peor entre las personas sin hogar en comparación con la población general y los eventos traumáticos sufridos en la calle tienen un impacto negativo en la CDV. Los países de bajos ingresos enfrentan un alto número de juventud callejera, pero poca investigación se ha llevado a cabo en la CDV, trauma y TEPT en este grupo. Este estudio intentó examinar la CDV de una muestra de jóvenes callejeros etíopes que están en un programa de rehabilitación y explorar si los jóvenes callejeros han sufrido eventos traumáticos y si tienen síntomas de TEPT. Entrevistamos 84 jóvenes callejeros con el Cuestionario de Calidad de Vida de la Organización Mundial de la Salud (WHOQOL-BREF sigla en inglés) y la Entrevista Diagnóstica para Niños y Adolescentes (EDNA). El puntaje promedio de la CDV fue significativamente diferente entre los grupos evaluados al inicio y al final del programa (d de Cohen:0.48). Ochenta y tres por ciento de los jóvenes callejeros etíopes habían sufrido eventos traumáticos y 25% reunía los criterios DSM-IV para TEPT. La CDV no difería entre aquellos con y sin síntomas TEPT. Estos hallazgos muestran la alta tasa de eventos traumáticos entre los jóvenes callejeros etíopes y lo importante que es focalizar en mejorar la CDV en los programas de rehabilitación. Los resultados de este estudio pueden tener limitaciones culturales.Traditional and Simplified Chinese Abstracts by AsianSTSS標題:埃塞俄比亞街頭青年在一個復康中心中生活質量及其與創傷的關係。撮要:無家者比一般民眾有更低生活質量(QOL),而街頭創傷經歷對QOL有負面影響。低收入國家面對大量街頭青年問題,但少有研究他們的QOL、創傷和創傷後壓力症(PTSD)。本文在埃塞俄比亞一個復康中心街頭青年樣本中檢視他們的QOL,探究有否經歷創傷事件和表現創傷後壓力症狀。我們會見了84 名街青,並使用了世界衛生組織生活質量問卷(WHOQOL―BREF)和兒童及青少年診斷面見(DICA)。在計劃開始和終結時組別間QOL得分平均值未有明顯分別(Cohens d=0.48)。埃塞俄比亞街頭青年有83%經歷創傷事件,而25%符合DSM-IV的PTSD準則。有和沒有PTSD症狀組別並沒有QOL差異。本文發現埃塞俄比亞青年有較高創傷比率,所以針對改善QOL的復康計劃是重要的,但本研究可能有文化方面的限制。标题:埃塞俄比亚街头青年在一个复康中心中生活质量及其与创伤的关系。撮要:无家者比一般民众有更低生活质量(QOL),而街头创伤经历对QOL有负面影响。低收入国家面对大量街头青年问题,但少有研究他们的QOL、创伤和创伤后压力症(PTSD)。本文在埃塞俄比亚一个复康中心街头青年样本中检视他们的QOL,探究有否经历创伤事件和表现创伤后压力症状。我们会见了84 名街青,并使用了世界卫生组织生活质量问卷(WHOQOL―BREF)和儿童及青少年诊断面见(DICA)。在计划开始和终结时组别间QOL得分平均值未有明显分别(Cohens d=0.48)。埃塞俄比亚街头青年有83%经历创伤事件,而25%符合DSM-IV的PTSD准则。有和没有PTSD症状组别并没有QOL差异。本文发现埃塞俄比亚青年有较高创伤比率,所以针对改善QOL的复康计划是重要的,但本研究可能有文化方面的限制。
    Journal of Traumatic Stress 10/2014; 27(5). DOI:10.1002/jts.21953 · 2.72 Impact Factor
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    ABSTRACT: The search for endophenotypes that stand between genetics and disease has been applied to the diagnostic entity of Posttraumatic Stress Disorder (PTSD). Advances are being made in understanding the pathway to disorder in PTSD in terms of brain regions, neuronal networks, stress-related systems (e.g., the hypothalamic–pituitary–adrenal (HPA) axis), and their underlying genetic and neurogenetic bases. The latter are affected by gene–environmental interactions and epigenetic effects, and the environment and context reciprocally interrelate with them, as well. Therefore, a primary focus on (neuro)pathophysiological intermediates in the disease pathway, as appears emphasized in the research domain criteria (RDoC) approach to etiology of psychiatric disorder, and to which the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) subscribes, might detract from a more inclusive biopsychosocial approach that would be more applicable in the case of PTSD. The paper undertakes a comprehensive review of the recent literature in the areas of endophenotypes, neurogenetics, epigenetics, neural networks, HPA axis, neuronal networks, pathways, the PTSD five-factor model, allostasis, and the RDoC criteria for psychiatric diagnosis, and then returns to the topic of endophenotypes. Neuronal networks constitute one integrating area that could help in arriving at an appropriate model of PTSD endophenotype. Pathway analysis provides a rich field for discerning individual differences in PTSD development, more so than the static approach of using DSM-5 symptom criteria. A model of endophenotypes is presented, which considers these factors in relation to PTSD. The paper concludes with implications for the DSM-5, for practice and for court, especially that it would be premature to seek individual biomarkers of PTSD given the current state of knowledge, even if it is burgeoning.
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    Neurobiology of Learning and Memory 04/2014; 112. DOI:10.1016/j.nlm.2014.04.008 · 4.04 Impact Factor
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