Cahill Shawn P, Pontoski Kristin, D'Olio Carla M
Dr. Cahill is Assistant Professor of Psychology in Psychiatry and Ms. Pontoski and Ms. D'Olio are Research Assistants-All three are from the University of Pennsylvania, Philadelphia, Pennsylvania.
Psychiatry (Edgmont). 2005 Sep;2(9):34-46.
Posttraumatic stress disorder is a common and often chronic and disabling anxiety disorder that can develop after exposure to highly stressful events characterized by actual or threatened harm to the self or others. This is the second of two invited articles summarizing the nature and treatment of PTSD and the associated condition of acute stress disorder (ASD). The present article reviews evidence for the efficacy of psychological and pharmacological treatments for PTSD and ASD. In summary, cognitive behavior therapy (CBT) has been found efficacious in the treatment of chronic PTSD as well as the treatment of ASD/prevention of PTSD. The selective serotonin reuptake inhibitors, sertraline, paroxetine, and fluoxetine, have been found efficacious in the treatment of chronic PTSD, with sertraline and paroxetine receiving the FDA indication for this condition. There is less evidence for efficacious medications in the treatment of ASD/prevention of PTSD. At present, hydrocortisone and propranolol show the greatest promise. Limitations of these treatments, including dropout and a significant number of patients showing no or only partial response, are discussed as well as issues related to selecting among efficacious treatments.
创伤后应激障碍是一种常见的、通常为慢性且致残的焦虑症，可在暴露于以对自己或他人实际的或威胁性的伤害为特征的高度应激事件后发生。这是两篇特邀文章中的第二篇，总结了创伤后应激障碍的性质和治疗以及相关的急性应激障碍（ASD）状况。本文综述了心理治疗和药物治疗对创伤后应激障碍和急性应激障碍疗效的证据。总之，认知行为疗法（CBT）已被证明在治疗慢性创伤后应激障碍以及治疗急性应激障碍/预防创伤后应激障碍方面有效。选择性5-羟色胺再摄取抑制剂舍曲林、帕罗西汀和氟西汀已被证明在治疗慢性创伤后应激障碍方面有效，舍曲林和帕罗西汀获得了美国食品药品监督管理局（FDA）针对这种情况的适应症。在治疗急性应激障碍/预防创伤后应激障碍方面，有效药物的证据较少。目前，氢化可的松和普萘洛尔显示出最大的前景。还讨论了这些治疗方法的局限性，包括脱落率以及大量患者无反应或仅部分有反应的情况，以及在有效治疗方法中进行选择的相关问题。
