Ellis Janet, Zaretsky Ari
Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):873-892. doi: 10.1212/CON.0000000000000610.
The goal of this article is to increase clinicians' understanding of posttraumatic stress disorder (PTSD) and improve skills in assessing risk for and diagnosing PTSD. The importance and sequelae of lifetime trauma burden are discussed, with reference to trends in prevention, early intervention, and treatment.
PTSD has different clinical phenotypes, which are reflected in the changes in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. PTSD is almost always complicated by comorbidity. Treatment requires a multimodal approach, usually including medication, different therapeutic techniques, and management of comorbidity. Interest is growing in the neurobiology of childhood survivors of trauma, intergenerational transmission of trauma, and long-term impact of trauma on physical health. Mitigation of the risk of PTSD pretrauma in the military and first responders is gaining momentum, given concerns about the cost and disability associated with PTSD. Interest is also growing in screening for PTSD in medical populations, with evidence of improved clinical outcomes. Preliminary research supports the treatment of PTSD with repetitive transcranial magnetic stimulation.
PTSD is a trauma-related disorder with features of fear and negative thinking about the trauma and the future. Untreated, it leads to ongoing disruption of life due to avoidance, impaired vocational and social functioning, and other symptoms, depending on the phenotype. Despite a theoretical understanding of underlying mechanisms, PTSD remains challenging to treat, although evidence exists for benefit of pharmacologic agents and trauma-focused therapies. A need still remains for treatments that are more effective and efficient, with faster onset.
本文旨在增进临床医生对创伤后应激障碍（PTSD）的理解，并提高评估PTSD风险和进行诊断的技能。文中讨论了终生创伤负担的重要性和后果，并提及预防、早期干预及治疗方面的趋势。
PTSD具有不同的临床表型，这在《精神疾病诊断与统计手册》第五版（DSM-5）标准的变化中有所体现。PTSD几乎总是伴有共病。治疗需要采用多模式方法，通常包括药物治疗、不同的治疗技术以及对共病的管理。对于创伤儿童幸存者的神经生物学、创伤的代际传递以及创伤对身体健康的长期影响，人们的兴趣日益浓厚。鉴于对PTSD相关成本和残疾问题的担忧，在军事人员和急救人员中减轻创伤前PTSD风险的工作正在兴起。在医疗人群中筛查PTSD的兴趣也在增加，有证据表明临床结局得到改善。初步研究支持采用重复经颅磁刺激治疗PTSD。
PTSD是一种与创伤相关的障碍，具有对创伤及未来的恐惧和消极思维特征。若不治疗，由于回避、职业和社会功能受损以及其他症状（取决于表型），会导致生活持续受到干扰。尽管对潜在机制有理论上的理解，但PTSD的治疗仍然具有挑战性，不过有证据表明药物治疗和以创伤为重点的疗法有益。仍然需要更有效、更高效且起效更快的治疗方法。
