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Posttraumatic Stress Disorder: Diagnosis and Epidemiology, Comorbidity and Social Consequences, Biology and TreatmentBrunello N.a,b · Davidson J.R.T.c · Deahl M.d · Kessler R.C.e · Mendlewicz J.f · Racagni G.b,g · Shalev A.Y.h · Zohar J.i
aDepartment of Pharmaceutical Sciences, University of Modena and Reggio Emilia, Modena, bCenter of Neuropharmacology, University of Milan, Italy; cDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C., USA; dSt Bartholomew’s and the Royal London School of Medicine and Dentistry, London, UK; eDepartment of Health Care Policy, Harvard Medical School, Boston, Mass., USA; fDepartment of Psychiatry, Erasme Hospital, University of Brussels, Belgium; gI.R.C.C.S. Centro San Giovanni di Dio-Fatebenefratelli, Brescia, Italy; hDepartment of Psychiatry, Hadassah University Hospital, Center of Traumatic Stress, Jerusalem, and iThe Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Hashomer, Israel
Epidemiological studies clearly indicate that posttraumatic stress disorder (PTSD) is becoming a major health concern worldwide even if still poorly recognized and not well treated. PTSD commonly co-occurs with other psychiatric disorders, and several symptoms overlap with major depressive disorders, anxiety disorders and substance abuse; this may contribute to diagnostic confusion and underdiagnosis. This anxiety disorder provokes significant occupational, psychiatric, medical and psychosocial disability, and its consequences are enormously costly, not only to the survivors and their families, but also to the health care system and society. Work impairment associated with PTSD is very similar to the amount of work impairment associated with major depression. The pathophysiology of PTSD is multifactorial and involves dysregulation of the serotonergic as well as the noradrenergic system. A rational therapeutic approach should normalize the specific psychobiological alterations associated with PTSD. This can be achieved through the use of antidepressant drugs, mainly of those that potentiate serotonergic mechanisms. Recent double-blind placebo-controlled studies report the efficacy of selective serotonin reuptake inhibitors. Several cognitive-behavioral and psychosocial treatments have also been reported to be efficacious and could be considered when treating PTSD patients.
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