Seedat Soraya, Stein Dan J, Carey Paul D
Department of Psychiatry, MRC Unit on Anxiety and Stress Disorders, University of Stellenbosch, Tygerberg, Cape Town, South Africa.
CNS Drugs. 2005;19(5):411-27. doi: 10.2165/00023210-200519050-00004.
Although women are exposed to proportionately fewer traumatic events in their lifetime than men, they have a higher lifetime risk of post-traumatic stress disorder (PTSD). In addition to gender-differential rates of rape and sexual assault, including greater exposure to intimate partner violence, the preponderance of PTSD in women may be attributable to factors other than trauma type, such as sensitisation of stress hormone systems in response to early adverse experiences, inherent neuroendocrine factors, subjective interpretation of the event, and peritraumatic dissociation. Women with PTSD arguably experience a greater symptom burden, longer course of illness and have worse quality-of-life outcomes than men. An expanding knowledge base of the psychobiological alterations in PTSD is providing stimulus for the development of improved pharmacological and psychosocial treatment options. Recent randomised controlled studies conducted in large samples of women with chronic PTSD indicate that: (i) SSRIs have efficacy on all three symptom clusters of PTSD and should be used as first-line pharmacotherapy; and (ii) cognitive behavioural strategies (e.g. prolonged exposure treatment and cognitive processing) are effective in sexually and non-sexually assaulted women. Studies also suggest that female gender may be associated with better response rates to pharmacotherapy. Emerging empirical data on the potential usefulness of antiadrenergic agents and preventive cognitive behavioural treatments in managing acute trauma reactions and stemming the emergence of PTSD are paving the way for further work in this area. However, additional innovative treatments are needed for traumatised women and for female children/adolescents presenting with acute stress reactions and PTSD.
尽管女性一生中遭受创伤性事件的比例低于男性，但她们患创伤后应激障碍（PTSD）的终生风险更高。除了强奸和性侵犯的性别差异发生率，包括更多地遭受亲密伴侣暴力外，女性中PTSD的高发可能归因于创伤类型以外的因素，如应激激素系统对早期不良经历的敏感性、内在神经内分泌因素、对事件的主观解释以及创伤期间的解离。与男性相比，患有PTSD的女性症状负担可能更重，病程更长，生活质量更差。PTSD心理生物学改变的知识基础不断扩大，为开发更好的药物和心理社会治疗方案提供了动力。最近对大量慢性PTSD女性样本进行的随机对照研究表明：（i）选择性5-羟色胺再摄取抑制剂（SSRI）对PTSD的所有三个症状群均有效，应作为一线药物治疗；（ii）认知行为策略（如延长暴露治疗和认知加工）对遭受性侵犯和非性侵犯的女性有效。研究还表明，女性性别可能与对药物治疗的更好反应率相关。关于抗肾上腺素能药物和预防性认知行为治疗在管理急性创伤反应和阻止PTSD出现方面潜在有用性的新实证数据，为该领域的进一步研究铺平了道路。然而，对于受创伤的女性以及出现急性应激反应和PTSD的女童/青少年，还需要更多创新治疗方法。
