Posttraumatic stress disorder.
Posttraumatic stress disorder.
复制标题
DOI：
10.1212/01.con.0000466667.20403.b1
复制
发表时间：
2015-06-01
期刊：
影响因子：
--
通讯作者：
Jorge, Ricardo E
中科院分区：
文献类型：
--
作者：
Jorge, Ricardo E
审查目的：本文的目的是向读者更新创伤后应激障碍（PTSD）的当前定义和诊断评估，描述其临床特征，讨论其流行病学和病理生理学方面，并总结当前的治疗选择创伤后应激障碍（PTSD）。最近的发现：精神疾病诊断和统计手册第五版（DSM-5）的新命名法包括20种PTSD症状，分为四个症状领域：侵入性症状、主动回避、不安的情绪状态以及唤醒和反应性的改变。诊断性结构化访谈和严重程度量表已更新，以解决这一最新修订。人们还认识到，神经回路的中断可能解释创伤后应激障碍症状的起源，虽然重叠，可能是不同的这四个领域，一个事实，可能告知新的生物学基础的表型与预后和治疗的影响。在过去的几年中，一直积极研究不同的因素影响脆弱性和恢复力的压力，包括遗传和表观遗传变异的影响。在创伤后应激障碍患者中，受动物研究启发的范式已经研究了参与处理威胁性刺激的神经回路。这些研究表明，PTSD患者很难区分危险和安全线索，在安全线索存在的情况下也难以抑制恐惧。功能性磁共振成像（fMRI）研究表明，在这些患者中观察到的杏仁核激活增加是由腹内侧前额叶皮层的异常调制输入引起的。另一方面，大脑结构异常在海马体中被更一致地确定，延长暴露疗法和认知再加工是对其心理治疗效果进行更广泛验证的干预措施。药物治疗PTSD症状比安慰剂更有效，选择性5-羟色胺再摄取抑制剂（SSRIs）被认为是安全的初始选择。包括恐惧处理的药理学调节在内的组合策略的使用是一个活跃的research.SUMMARY领域：PTSD是一种常见的精神病理学状况，其终生患病率接近10%。在过去的几年里，在疾病的定义，阐明脆弱性和恢复力的神经生物学以及开发新的治疗方法方面取得了重大进展。
PURPOSE OF REVIEW: The objectives of this article are to update the reader on the current definition and diagnostic assessment of posttraumatic stress disorder (PTSD) and to describe its clinical characteristics, discuss its epidemiology and pathophysiologic aspects, as well as to summarize the current therapeutic options for PTSD.RECENT FINDINGS: The new nomenclature of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes 20 PTSD symptoms clustered into four symptomatic domains: intrusive symptoms, active avoidance, disturbed emotional states, and alterations of arousal and reactivity. Diagnostic structured interviews and severity scales have been updated in order to address this recent revision. It is also recognized that the neural circuits whose disruption might explain the genesis of PTSD symptoms, although overlapping, may be different between these four domains, a fact that may inform new biologically based phenotypes with prognostic and therapeutic implications.During the past years, there has been active research into the different factors influencing vulnerability and resilience to stress, including the effect of genetic and epigenetic variations. The neural circuits involved in the processing of threatening stimuli have been studied in patients with PTSD through paradigms inspired in animal research. These studies suggest that patients with PTSD have difficulty discriminating danger from safety cues and have problems suppressing fear in the presence of safety cues. Functional MRI (fMRI) studies suggest that the increased amygdala activation observed in these patients results from abnormal modulatory input from the ventromedial prefrontal cortex. Structural brain abnormalities, on the other hand, have been more consistently identified in the hippocampus.Prolonged exposure therapy and cognitive reprocessing are the interventions that have the more extensive validation of their psychotherapeutic efficacy. Medications are modestly more effective than placebo to treat PTSD symptoms, and selective serotonin reuptake inhibitors (SSRIs) are considered a safe initial choice. Use of combined strategies including pharmacologic modulation of fear processing is an area of active research.SUMMARY: PTSD is a frequent psychopathologic condition with a lifetime prevalence that is close to 10%. In the past few years, there have been significant advances in the definition of the disorder, in elucidating the neurobiology of vulnerability and resilience, and in developing new treatment alternatives.