Review of somatic symptoms in post-traumatic stress disorder
Review of somatic symptoms in post-traumatic stress disorder
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DOI：
10.3109/09540261.2012.736367
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发表时间：
2013-02-01
影响因子：
2.8
通讯作者：
Gupta, Madhulika A.
中科院分区：
文献类型：
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作者：
Gupta, Madhulika A.
创伤后应激障碍(PTSD)与以下两个方面有关：(1)“不明原因”或“医学上无法解释”的躯体症状，如不明原因的头晕、耳鸣和视力模糊，以及可归类为躯体形式障碍(DSM-IV-TR)的症状；(2)在各种研究中，以心血管、呼吸系统、肌肉骨骼、神经和胃肠道疾病、糖尿病、慢性疼痛、睡眠障碍和其他免疫调节障碍为主的一系列疾病。在各种研究中，经常报告的创伤后应激障碍的医学并存包括心血管疾病，特别是高血压，以及免疫介导的疾病。创伤后应激障碍与边缘不稳定和下丘脑-垂体-肾上腺和交感-肾上腺髓质轴的改变有关，影响神经内分泌和免疫功能，对中枢神经系统产生影响，导致假性神经症状和睡眠觉醒调节障碍，并导致自主神经系统失调。过度警惕是创伤后应激障碍的一个主要特征，当患者处于部分睡眠和部分清醒状态时，可导致“局部睡眠”或区域唤醒状态，并在部分意识状态下表现为复杂的运动和/或语言行为。关于标准创伤后应激障碍治疗(药物，CBT)对创伤后应激障碍相关躯体症状的影响的研究很少，报告了不明确和自主调节的躯体症状、自我报告的身体健康问题和一些慢性疼痛综合征的严重程度的减轻。
Post-traumatic stress disorder (PTSD) is associated with both (1) 'ill-defined' or 'medically unexplained' somatic syndromes, e. g. unexplained dizziness, tinnitus and blurry vision, and syndromes that can be classified as somatoform disorders (DSM-IV-TR); and (2) a range of medical conditions, with a preponderance of cardiovascular, respiratory, musculoskeletal, neurological, and gastrointestinal disorders, diabetes, chronic pain, sleep disorders and other immune-mediated disorders in various studies. Frequently reported medical co-morbidities with PTSD across various studies include cardiovascular disease, especially hypertension, and immune-mediated disorders. PTSD is associated with limbic instability and alterations in both the hypothalamic-pituitary-adrenal and sympatho-adrenal medullary axes, which affect neuroendocrine and immune functions, have central nervous system effects resulting in pseudo-neurological symptoms and disorders of sleep wake regulation, and result in autonomic nervous system dysregulation. Hypervigilance, a central feature of PTSD, can lead to 'local sleep' or regional arousal states, when the patient is partially asleep and partially awake, and manifests as complex motor and/or verbal behaviours in a partially conscious state. The few studies of the effects of standard PTSD treatments (medications, CBT) on PTSD-associated somatic syndromes report a reduction in the severity of ill-defined and autonomically mediated somatic symptoms, self-reported physical health problems, and some chronic pain syndromes.