Posttraumatic stress disorder PTSD

Clinicians have more recently become more aware of elevated rates of posttraumatic stress disorder (PTSD) in both men and women with opioid dependence (Hien et al. 2000). A lifetime prevalence of PTSD of 20% in women and 11% in men was found in one sample of methadone maintenance patients (Villagomez et al. 1995). Patients often deny a PTSD history during initial assessment. They should be reassessed after they have had the opportunity to develop trust in their treating clinicians. 

Doblin, R., A clinical plan for MDMA (Ecstasy) in the treatment of posttraumatic stress disorder (PTSD) partnering with the FDA, J. Psychoactive Drugs 34(2), 185-94, 2002. 

Mental disorders, for example, multiple subtypes of anxiety, chronic fatigue syndrome, depression, sometimes together with chronic pain, posttraumatic stress disorders (PTSD), and schizophrenia... 

Posttraumatic stress disorder (PTSD) Paroxetine (immediate-release except Pexeva), sertraline. 

Anxiety represents a state of heightened vigilance and fear, but pathological anxiety can be distinguished from fear in that it is inappropriately evoked and may persist in the absence of real threat or danger. The study of conditioned fear has provided detailed information on the neural circuitry and intracellular mechanisms that are important to fear responses and their long-term retention. The description of neural circuitry and the mechanisms underlying disorders of fear memory such as posttraumatic stress disorder (PTSD) may also be relevant to other anxiety states that share common neural substrates. 

The effects of P-adrenergic blockade on the consolidation of traumatic memories has been an area of special interest for the treatment of posttraumatic stress disorder (PTSD), and recently the first randomized controlled study on the effects of propranolol in the prevention of PTSD was published. Pittmann and coworkers (2002) could demonstrate that propranolol may reduce PTSD... 

Posttraumatic stress disorder (PTSD) refers to a pattern of anxiety, distress, and avoidance following an event experienced as threatening and/or intensely distressing. This disorder has been reported to have behavioral (Zaidi and Foy, 1994) and neurobiological effects into adulthood (Charney and Bremner, 1999). Much of the developmental research on the condition derives from retrospective studies of adults. The many possible biases inherent in such research preclude the generation of firm conclusions on the developmental course of the condition. An important process in the study of PTSD will be to identify the developmental path of the disorder in the context of the prevalence of anxiety disorders in childhood (Costellot et ah, 1996 Pynoos et ah, 1999). 

Alcohol is one of the most commonly consumed drugs in the world and has been used by humans since the Stone Age. It is anxiolytic for this reason, it has been used not only for relaxation purposes but also by people with anxiety disorders to suppress their symptoms. Between 10% and 20% of agoraphobic patients are alcohol dependent. Thyrer et al. [1986] reported a 36% prevalence of alcoholism among socially phobic patients entering an anxiety disorders clinic, and [according to population studies] 20%-80% of people with posttraumatic stress disorder [PTSD] are dependent on alcohol. Sierles et al. [1983], in their study of Vietnam War veterans with PTSD, found that 64% were alcohol dependent. Since the Epidemiological Catchment Area study estimated the lifetime prevalence of PTSD to be 1% in the United States population, it is clear that self-medication with alcohol for anxiety symptoms will have a major influence on the development of alcohol dependency [Regier et al. 1990]. 

Posttraumatic stress disorder (PTSD) is another anxiety disorder that can be characterized by attacks of anxiety or panic, but it is notably different from panic disorder or social phobia in that the initial anxiety or panic attack is in response to a real threat (being raped, for example) and subsequent attacks are usually linked to memories, thoughts, or flashbacks of the original trauma. The lifetime incidence of PTSD is about 1%. Patients have disturbed sleep and frequent sleep complaints. Comorbidities with other psychiatric disorders, especially depression and drug and alcohol abuse, are the rule rather than the exception. The DSM-IV diagnostic criteria are given in Table 9—11. 

FIGURE 9-8. Shown here are the variety of therapeutic options for treating posttraumatic stress disorder (PTSD). Combination treatments for PTSD are very poorly documented but very frequently used. The PTSD combinations are similar to those for depression and for panic disorder. 

Noradrenergic model. This model suggests that the autonomic nervous system of anxious patients is hypersensitive and overreacts to various stimuli. The locus ceruleus may have a role in regulating anxiety, as it activates norepinephrine release and stimulates the sympathetic and parasympathetic nervous systems. Chronic noradrenergic overactivity down regulates 02-adrenoreceptors in patients with generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). Patients with social anxiety disorder (SAD) appear to have a hyperresponsive adrenocortical response to psychological stress. 

Psychoiogicai triage identifies those at greatest risk for psychiatric compiications. Crisis intervention and sociai support are key eiements of psychoiogicai first aid. Acute stress disorder (ASD) in the immediate aftermath increases risk for iafer posttraumatic stress disorder (PTSD). 

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