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2002, Number 3

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Salud Mental 2002; 25 (3)

Trastorno por estrés postraumático: Una revisión del tema (Primera Parte)

Palacios L, Heinze G

Language: Spanish
References: 49
Page: 19-26
PDF size: 378.20 Kb.


ABSTRACT

Since early history, human beings have been closely exposed to several types of traumatic events. Although modern societies have developed a more acceptable kind of convivence, these traumatic events have become increasingly present in the everyday life of any individual in underdeveloped societies. This is due to extended problems, like a lower income per capita, which gives rise to such conducts as violent robbery, kidnapping, or murder. Similarly, family desintegration is a likely factor leading to the development of interfamily violence, and illegal substances traffic and abuse; even weather phenomena (e.g., “El Niño”) may trigger a higher incidence of PTSD given the suffering brought about by hurricanes or tornados.
At the Fourth Consensus Group International Meeting on Depression and Anxiety, held in Montecatini, Italy, in April 1999, PTSD was regarded as the main issue, because of its high prevalence, social impact, and financial burden on society. For these reasons, it represents an enormous public health problem in both underdeveloped and developed countries. During the last three decades, biological guidelines for PTSD have been studied and proposed, together with the development of new effective treatments.
Epidemiological studies allow us to calculate the rates of specific disorders and their impact on the community and health system. The prevalence of the exposure to traumatic events themselves is an important part of PTSD study. Recent epidemiological studies have shown that about 40 to 90% individuals from adult community samples have been exposed to a traumatic event. Prevalence life rates of PTSD vary from 5 to 15% in developed countries. Nowadays, 4 to 6% of the population presents PTSD symptoms, considering only the worst traumatic event (8, 9, 13, 20, 29, 32, 39).
In the last two decades, PTSD is an anxiety disorder which has called the attention in research and clinical areas due to several reasons. One of these is that the rates of violence have had a dramatic increase all over the world; another one is the identification of their subdiagnosis in several places.
However, not everyone who has been exposed to a traumatic event develops PTSD. Several risk factors increase the possibility of its expression and chronicity −for instance, to experience the event at early life stages, multiple traumatic events, their severity, gender experiencing the event, personal stress and behavior, or psychological problems history, comorbid psychopathology, parents’ PTSD history, or subsequent exposure to reactivant environmental events.
Likewise, risk factors can be classified according to the person involved and the traumatic event experienced (19, 22). In this sense, different studies have shown women have a higher risk than men to develop PTSD, in spite of men having an increased exposure to traumatic events (13, 20, 37). The psycho-biological development level is important when a traumatic event appears, since it has been demonstrated that age is a significative factor to develop PTSD: traumatic events in childhood have been associated with a higher risk of PTSD and more severe symptoms (10). The clinical course of PTSD is often chronic, with only 50% of the patients recovering within two years after the incident. Most of those unable to recover will still show symptoms 15 years later (32).
The situation in underdeveloped countries is particularly interesting, since traumatic events frequently associated with long wars, hunger, politic opression, and sectary violence seem to make PTSD more chronic and the profile of its symptoms more complex and disabling than in developed countries (21, 23, 38, 45, 46).
PTSD has a relevant impact on different areas of life, as is revealed for instance in its enormous social costs. Generally, individuals who suffer PTSD earn a lower income, present high scholar failure rates, and more interpersonal problems compared to the overall population. In addition, the age of onset of the mental disorders has a predictive value over educational, birth, marriage, and economic accomplishments (8, 23, 24, 27, 28, 30, 32).
A research conducted among the overall American population estimated that 38% of the individuals with PTSD received some form of treatment during a given year. The reason more commonly reported by the remaining 62% to refuse getting medical attention was that they did not think they had any problem at all (31). Often, the traumatic reaction adapts over several years and becomes part of the individual’s coping style. People at risk of PTSD commonly ask for medical help early, but do not do so in the psychiatric area. Finally, PTSD brings about less stigmatization compared to another psychiatric disorders, because their symptoms are considered as natural consequences of a severe traumatic event (32).
Apparently, the presence of psychiatric disorders other than PTSD is the rule rather than the exception. According to clinical and general populations studies, between 50- 90% of PTSD patients show comorbid psychiatric disorders (14-18, 33, 42, 43). PTSD is frequently associated with comorbid psychiatric disorders, such as High Depressive Disorder (HDD), Anguish Disorder (AD), Social Phobia (SP), Generalized Anxiety Disorder, Substance Use Disorder -mostly alcohol- (SUD), Personality Disorders (PD) (e.g., borderline, avoidance, antisocial), and Dissociative Disorders (4, 5, 9, 29, 32, 48).
In brief, the relevance of PTSD study becomes clear due to several aspects. Apparently, PTSD is more common than it is thought so. The life prevalence of PTSD among the general population is about 8 to 9%, and women have a higher risk to develop PTSD (22). Also, PTSD is more frequent after certain kinds of traumatic events (e.g., rape), not considering in this case the survivor’s gender (29).
This discussion is divided in two parts. In this first article we will analyze some general aspects like the introduction of this disorder in the American classification, together with its definition, epidemiology, clinic course, effect on the individual’s general functioning, and comorbidity with different psychiatric disorders.


REFERENCES

  1. AMERICAN PSYCHIATRIC ASSOCIATION: Diagnostic and Statistical Manual of Mental Disorders. Tercera edición; Washington, 1980.

  2. AMERICAN PSYCHIATRIC ASSOCIATION: Manual Diagnóstico y Estadístico de los Trastornos Mentales. Masson, cuarta edición, Washington, 1995.

  3. ATKINSON RM, SPARR LF, SHEFF AG: Diagnosis of posttraumatic stress disorder in Vietnam veterans: preliminary findings. Am J Psychiatry, 141:694-696, 1984.

  4. BALLENGER J, DAVIDSON J, LECRUBIER Y: Focus on posttraumatic stress disorder. J Clin Psychiatry, 61 (supl 5):3-12, 2000.

  5. BRADY K, KILLEEN T, BREWERTON T, LUCERINI S: Comorbidity of psychiatric disorders and posttraumatic stress disorder. J Clin Psychiatr y, 61 (supl 7):22-32, 2000.

  6. BREMNER J, SOUTHWICK S, DARNELI A y cols.: Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse. Am J Psychiatry, 153:369- 375, 1996.

  7. BRESLAU N, DAVIS GC, PETERSON EL y cols.: Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry, 54:81-87, 1997.

  8. BRESLAU N, KESSLER RC, CHICOAT HD, SCHULTZ LR, DAVIS GC, ANDRESKI P: Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry, 55:626-632, 1998.

  9. BRESLAU N, DAVIS GC, ANDRESKI P y cols.: Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry, 48:216-222, 1991.

  10. BRIERE J, WOO R, MCRAE B y cols.: Lifetime victimization history, demographics, clinical status in female psychiatric emergency room patients. J Nerv Ment Dis, 185:95-101,1997.

  11. BROMET E, SONNEGA A, KESSLER RC: Risk factors for DSM-III-R PTSD: findings from the National Comorbidity Survey. Am J Epidemiol, 147:343-361, 1998.

  12. CASHMAN LC, MOLNAR E, FOA B: Comorbidity of DSMIII- R Axis I and II disorders with acute and chronic posttraumatic stress disorder. Trabajo presentado en la 29 Convención Anual de la Association for the Advancement of Behavior Therapy. Washington, 1995.

  13. DAVIDSON JRT, HUGHES D, BLAZER D y cols.: Posttraumatic stress disorder in the community; an epidemiological study. Psychol Med, 21:1-19, 1991.

  14. DAVIDSON JRT, SWARTZ M, STORK M y cols.: A diagnostic and family study of posttraumatic stress disorder. Am J Psychiatry, 142:90-93, 1985.

  15. ENGDAHL B, DIKEL TN, EBERLY R y cols.: The comorbidity and course of psychiatric disorders in a community sample of former prisoners of war. Am J Psychiatry, 155:1740-1745, 1998.

  16. FREDDY JR, SHAW DL, JARRELL MP: Towards an understanding of the psychological impact of natural disaster: An application of the conservation resources stress model. J Trauma Stress, 5:441-454, 1992.

  17. GREEN BL, LINDY JD, GRACE MC y cols.: Multiple diagnosis in posttraumatic stress disorder: the role of war stressors. J Nerv Men Dis, 177:329-335, 1989.

  18. GREEN BL, LINDY JD, GRACE MC, LEONARD AC: Chronic posttraumatic stress disorder and diagnostic comorbidity in a disaster sample. J Nerv Men Dis, 180:760-766,1992.

  19. GREEN BL: Psychological research in traumatic stress: an update. J Trauma Stress, 7:341-362, 1994.

  20. HELZER JE, ROBINS LN, McEVOY L: Postraumatic stress disorder in the general population. N England J Med, 317:1630-1634, 1987.

  21. HERMAN JL: Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. J Trauma Stress, 5:377-391, 1992.

  22. HIDALGO R, DAVIDSON J: Posttraumatic stress disorder: Epidemiology and health related considerations. J Clin Psychiatry, 61 (supl 7):5-13, 2000.

  23. KESSLER RC: Posttraumatic stress disorder: The burden to the individual and to society. J Clin Psychiatry, 61 (supl 5):4-12, 2000.

  24. KESSLER RC, BERGLUND PA, FOSTER CL y cols.: Social consequences of psychiatric disorders, II: teenage parenthood. Am J Psychiatry, 154:1405-1411, 1997.

  25. KESSLER RC, BORGES B, WALTERS EE: Prevalence and risk factors of lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry, 56:617-626, 1999.

  26. KESSLER RC, DAVIS CG, KENDLER KS: Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychol Med, 27:1101- 1119, 1997.

  27. KESSLER RC, FOSTER CL, SAUNDERS WB y cols.: Social consequences of psychiatric disorders, I : educational attainment. Am J Psychiatry, 152: 1026-1032, 1995.

  28. KESSLER RC, FRANK RG: The impact of psychiatric disorders on work loss day. Psychol Med, 27:861-873, 1997.

  29. KESSLER RC, SONNEGA A, BROMET E y cols.: Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry, 52:1048-1060, 1995.

  30. KESSLER RC, WALTERS EE, FORTHOFER MS: The social consequences of psychiatric disorders, III: probability of marital stability. Am J Psychiatry, 155:1092- 1096, 1998.

  31. KESSLER RC, ZHAO S, KATZ SJ y cols.: Past year use of outpatient services for psychiatric problems in the National Comorbidity Survey. Am J Psychiatry, 156:115- 123, 1999.

  32. KORN M: New Insights into PTSD. XXII Congreso del Collegium Internationale Neuro-Psychopharmacologicum, MEDSCAPE. (www.http//medscape.com)

  33. LERER B, BLEICH A, KOTLER M y cols.: Posttraumatic stress disorder in Israeli combat veterans: Effect of phenelzine treatment. Arch Gen Psychiatry, 44:976- 981,1987.

  34. LEYBA CM, WAMPLER TP: Risperidone in PTSD [letter]. Psychiatry Serv, 49:245-246,1998.

  35. McFARLANE A: The phenomenology of posttraumatic stress disorders following a natural disaster. J Nerv Men Dis, 176:22-29, 1988.

  36. NISHIT P, MECHANIC MB, RESICK PA: Prior Interpersonal Trauma: The contribution to current PTSD symptoms in female rape victims. J Abnormal Psychol, 109(1):20-25, 2000.

  37. NORRIS FH: Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol, 60:409-418, 1992.

  38. PELCOVITZ D, van der KOLK BA, ROTH S y cols.: Development of a criteria set a structured Interview for Disorders of Extreme Stress (SIDES). J Trauma Stress, 10: 3-15, 1997.

  39. RESNICK HS, KILPATRICK DG; DANSKY BS y cols.: Prevalence of civilian trauma and posttraumatic stress disorder in the national sample of women. J Consult Clin Psychol, 61:984-991, 1993.

  40. SHALEV AY: Post traumatic stress disorder: diagnosis, history, and life course. En: Post-traumatic Stress Disorder Diagnosis, Management and Treatment. Nutt D, Davidson JRT, Zohar J (eds.), pp. 1-15. Martin Dunitz Ltd, 2000.

  41. SHAY J: Fluoxetine reduces explosiveness and elevates mood of Vietnam combat vets with PTSD. Trauma Stress, 5:97-101, 1992.

  42. SHORE JH, VOLLMER WM, TATUM EI: Community patterns of posttraumatic stress disorders. J Nerv Men Dis, 177:681-685, 1989.

  43. SIERLES FS, CHEN J, MCFARLAND RE y cols.: Posttraumatic stress disorder and concurrent psychiatric illness: a preliminary report. Am J Psychiatry, 140:1177- 1179, 1983.

  44. SILVA RR, ALPERT M, MUNOZ DM y cols.: Stress and vulnerability to posttraumatic stress disorder in children and adolescents. Am J Psychiatry, 157:1229-1235, 2000.

  45. SIMON RI: Chronic posttraumatic stress disorder: a review and check list of factors influencing prognosis. Harv Rev Psychiatry, 6:304-312, 1999.

  46. van der KOLK BA, PELCOVITZ D, ROTH S y cols.: Dissociation, somatization, and affect dysregulation: The complexity of adaptation to trauma. Am J Psychiatry, 153 (supl 7):83-93, 1996.

  47. VAN KAMPEN M, WATSON CG, TILLESKJOR C y cols.: The definition of posttraumatic stress disorder in alcoholic Vietnam veterans. Are the DSM-III diagnostic criteria necessary and sufficient? J Nerv Men Dis, 174:137- 144, 1986.

  48. YEHUDA R, WONG Ch: Etiology and biology of posttraumatic stress disorder: Implications for treatment. Psychiatric Clin North America, 8:109-134, 2001.

  49. ZLOTNICK C, WARSHAW M, SHEA MT y cols.: Chronicity in posttraumatic stress disorder (PTSD) and predictors of course of comorbid PTSD in patients with anxiety disorders. J Trauma Stress, 12:89-100, 1999.




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