Posttraumatic stress disorder: Diagnosis and epidemiology, comorbidity andsocial consequences, biology and treatment

Epidemiological studies clearly indicate that posttraumatic stress disorder (PTSD) is becoming a major health concern worldwide even if still poorly r ecognized and not well treated. PTSD commonly co-occurs with other psychiat ric 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 oc cupational, psychiatric, medical and psychosocial disability, and its conse quences are enormously costly, not only to the survivors and their families , but also to the health care system and society. Work impairment associate d with PTSD is very similar to the amount of work impairment associated wit h major depression. The pathophysiology of PTSD is multifactorial and invol ves dysregulation of the serotonergic as well as the noradrenergic system. A rational therapeutic approach should normalize the specific psychobiologi cal alterations associated with PTSD. This can be achieved through the use of antidepressant drugs, mainly of those that potentiate serotonergic mecha nisms. Recent double-blind placebo-controlled studies report the efficacy o f selective serotonin reuptake inhibitors. Several cognitive-behavioral and psychosocial treatments have also been reported to be efficacious and coul d be considered when treating PTSD patients. Copyright (C) 2001 S. Karger A G,Basel.