McFarlane Alexander Cowell, Lawrence-Wood Eleanor, Van Hooff Miranda, Malhi Gin S, Yehuda Rachel
Centre for Traumatic Stress Studies, The University of Adelaide, Level 2, 122 Frome Street, Adelaide, 5000, South Australia.
Department of Psychiatry, Sydney Medical School, The University of Sydney, Edward Ford Building (A27), Fisher Road, University of Sydney, New South Wales, 2006, Australia.
Curr Psychiatry Rep. 2017 Feb;19(2):10. doi: 10.1007/s11920-017-0761-2.
Despite the substantial body of neurobiological research, no specific drug target has been developed to treat PTSD and there are substantial limitations with the available interventions. We propose that advances are likely to depend on the development of better classification of the heterogeneity of PTSD using a staging approach of disease. A primary rationale for staging is to highlight the probability that distinct therapeutic approaches need to be utilised according to the degree of biological progression of the disorder. Prospective studies, particularly of military populations, provide substantial evidence about the emerging biological abnormalities that precede the full-blown disorder. These need to be targeted with tailored interventions to prevent disease progression. Equally, the neurobiology of chronic unremitting PTSD needs to be differentiated from the acute disorder which emerges across a spectrum of severity, and this range of presentations correspondingly needs to be addressed with differing therapeutic strategies. The staging approach also needs to take account of the range of somatic pathological outcomes that are being identified as a consequence of traumatic stress exposure. PTSD should be conceptualised as a systemic disorder underpinned a range of biological dysregulation, including metabolic and altered immune function, reflected in the increased rates of cardiovascular and autoimmune disease. The effectiveness of novel treatments needs to be judged across their effectiveness in addressing the spectrum of trauma-related pathology.
尽管有大量的神经生物学研究，但尚未开发出治疗创伤后应激障碍（PTSD）的特定药物靶点，现有干预措施也存在很大局限性。我们认为，进展可能取决于采用疾病分期方法对PTSD的异质性进行更好的分类。分期的一个主要理由是强调根据疾病生物学进展程度需要采用不同治疗方法的可能性。前瞻性研究，特别是针对军人的研究，提供了大量证据，证明在全面发作的疾病之前出现的新出现的生物学异常。需要针对这些异常采取量身定制的干预措施以预防疾病进展。同样，慢性持续性PTSD的神经生物学需要与急性PTSD区分开来，急性PTSD在不同严重程度范围内出现，相应地需要用不同的治疗策略来应对这一系列表现。分期方法还需要考虑到因创伤性应激暴露而被识别出的一系列躯体病理结果。PTSD应被视为一种全身性疾病，其基础是一系列生物失调，包括代谢和免疫功能改变，这反映在心血管疾病和自身免疫性疾病的发病率增加上。新疗法的有效性需要根据其在解决与创伤相关的一系列病理问题方面的有效性来判断。
