Quarantini Lucas C, Netto Liana R, Andrade-Nascimento Monica, Almeida Amanda Galvão-de, Sampaio Aline S, Miranda-Scippa Angela, Bressan Rodrigo A, Koenen Karestan C
Serviço Psiquiátrico, Hospital-Escola, Universidade Federal da Bahia, Salvador, BA, Brasil.
Braz J Psychiatry. 2009 Oct;31 Suppl 2:S66-76. doi: 10.1590/s1516-44462009000600005.
To review studies that have evaluated the comorbidity between posttraumatic stress disorder and mood disorders, as well as between posttraumatic stress disorder and other anxiety disorders.
We searched Medline for studies, published in English through April, 2009, using the following keywords: 'posttraumatic stress disorder', 'PTSD', 'mood disorder', 'major depressive disorder', 'major depression', 'bipolar disorder', 'dysthymia', 'anxiety disorder', 'generalized anxiety disorder', 'agoraphobia', 'obsessive-compulsive disorder', 'panic disorder', 'social phobia', and 'comorbidity'.
Major depression is one of the most frequent comorbid conditions in posttraumatic stress disorder individuals, but individuals with posttraumatic stress disorder are also more likely to present with bipolar disorder, other anxiety disorders and suicidal behaviors. These comorbid conditions are associated with greater clinical severity, functional impairment, and impaired quality of life in already compromised individuals with posttraumatic stress disorder. Depression symptoms also mediate the association between posttraumatic stress disorder and severity of pain among patients with chronic pain.
Available studies suggest that individuals with posttraumatic stress disorder are at increased risk of developing affective disorders compared with trauma-exposed individuals who do not develop posttraumatic stress disorder. Conversely, pre-existing affective disorders increase a person's vulnerability to the posttraumatic stress disorder--inducing effects of traumatic events. Also, common genetic vulnerabilities can help to explain these comorbidity patterns. However, because the studies addressing this issue are few in number, heterogeneous and based on a limited sample, more studies are needed in order to adequately evaluate these comorbidities, as well as their clinical and therapeutic implications.
回顾评估创伤后应激障碍与心境障碍之间以及创伤后应激障碍与其他焦虑障碍之间共病情况的研究。
我们检索了截至2009年4月以英文发表在Medline上的研究，使用了以下关键词：“创伤后应激障碍”、“PTSD”、“心境障碍”、“重度抑郁症”、“重度抑郁”、“双相情感障碍”、“恶劣心境”、“焦虑障碍”、“广泛性焦虑障碍”、“广场恐惧症”、“强迫症”、“惊恐障碍”、“社交恐惧症”以及“共病”。
重度抑郁是创伤后应激障碍个体中最常见的共病状况之一，但创伤后应激障碍个体也更有可能出现双相情感障碍、其他焦虑障碍和自杀行为。这些共病状况与创伤后应激障碍患者中已受损个体的更高临床严重程度、功能损害和生活质量受损相关。抑郁症状还介导了创伤后应激障碍与慢性疼痛患者疼痛严重程度之间的关联。
现有研究表明，与未患创伤后应激障碍的创伤暴露个体相比，创伤后应激障碍个体发生情感障碍的风险增加。相反，既往存在的情感障碍会增加个体对创伤事件诱发创伤后应激障碍效应的易感性。此外，共同的遗传易感性有助于解释这些共病模式。然而，由于针对该问题的研究数量较少、异质性较大且基于有限样本，因此需要更多研究来充分评估这些共病情况及其临床和治疗意义。
