Treatments of Posttraumatic Stress Disorder in Civilian Populations.
Treatments of Posttraumatic Stress Disorder in Civilian Populations.
复制标题
平民创伤后应激障碍的治疗。
DOI：
10.1007/s11920-019-0994-3
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发表时间：
2019
影响因子：
6.7
通讯作者：
Javanbakht,Arash
中科院分区：
文献类型：
--
作者：
Grasser,LanaRuvolo;Javanbakht,Arash
创伤后应激障碍是一种慢性、异质性障碍，有多种心理治疗、药物治疗和新兴治疗方案可供选择。大多数疗效研究关注的是高加索男性军人，这可能是并非所有患者对治疗都有长期积极结果的原因。此外，治疗对症状群的影响一直被忽视。这项工作回顾了创伤后应激障碍及其症状群的治疗，专门在平民人群中，这在历史上一直在文献中被低估。暴露疗法站在成功治疗PTSD的前沿，提供了比药物治疗更具成本效益的解决方案；然而，难民和患有共病抑郁症的患者可能不会体验到如此强烈的益处。对于暴露疗法和其他形式的心理治疗，非劣效性研究指出，互联网提供的和基于远程医疗的方法有望覆盖那些可能无法获得面对面护理的人群。ssri类药物是治疗PTSD最广泛使用的药物；观察到适度的初始益处，但长期保留和结果可能通过辅助治疗而增强。同样，难民是一个受益较少的群体。研究已经开始探索个体症状群的治疗效果，目前可用的治疗方式最有利于过度觉醒。回避、干扰、消极的想法和信念以及分离是需要更多研究的症状，以便有针对性地进行干预。创伤后应激障碍的治疗已经发展到(1)包括同等比例的男性和女性，以及专门针对女性的队列；(2)在网上和不同的文化背景下探索新的治疗方法；(3)目前的临床试验表明，对药物的关注较少。除了在更多不同种族人群中进行进一步的疗效和安全性研究外，还需要研究针对创伤后应激障碍特定症状群的最佳治疗方法。这项研究将推动精确治疗，这样的研究开始指向病理和变化的潜在机制。
Purpose of ReviewPosttraumatic stress disorder is a chronic, heterogeneous disorder for which a multitude of psychotherapies, pharmaceuticals, and immerging treatment programs are available. Majority of efficacy studies focus on Caucasian male military populations, which may be a reason why not all patients respond to treatment with long-term positive outcomes. Additionally, effects of treatment on symptom clusters have been neglected. This work reviews treatment of PTSD and its symptom clusters exclusively in civilian populations, which have been historically under-examined in the literature.Recent FindingsExposure therapy stands at the forefront of successful PTSD treatment and offers a more cost-effective solution to pharmacotherapy; however, refugees and patients with comorbid depression may not experience such strong benefits. For exposure therapy and other forms of psychotherapy, non-inferiority studies point to promise of internet-delivered and telemedicine-based methods for reaching populations that may not have access to in-person care.SSRIs are the most widely used pharmaceutical treatment for PTSD; moderate initial benefits are observed yet long-term retention and outcomes may be enhanced by adjunct treatment. Again, refugees are a group that experiences lesser benefit. Research has begun to explore efficacy of treatments for individual symptom clusters, with hyperarousal benefiting most from currently available modalities. Avoidance, intrusion, negative thoughts and beliefs, and dissociation are symptoms requiring more research for focused interventions.SummaryTreatment of PTSD has evolved to (1) include equivalent proportions of men and women, along with focused female-exclusive cohorts; (2) explore novel methods of treatment online and in various cultural contexts; and (3) less focus on medication as evidenced by current clinical trials. In addition to further efficacy and safety studies in more diverse ethnic populations, work is needed to examine what therapies are best for targeting specific symptom clusters of PTSD. This research will drive precision treatment, and such research is beginning to point towards underlying mechanisms of pathology and change.