Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Curr Psychiatry Rep. 2019 Feb 8;21(2):11. doi: 10.1007/s11920-019-0994-3.
Posttraumatic stress disorder is a chronic, heterogeneous disorder for which a multitude of psychotherapies, pharmaceuticals, and immerging treatment programs are available. Majority of efficacy studies focus on Caucasian male military populations, which may be a reason why not all patients respond to treatment with long-term positive outcomes. Additionally, effects of treatment on symptom clusters have been neglected. This work reviews treatment of PTSD and its symptom clusters exclusively in civilian populations, which have been historically under-examined in the literature.
Exposure therapy stands at the forefront of successful PTSD treatment and offers a more cost-effective solution to pharmacotherapy; however, refugees and patients with comorbid depression may not experience such strong benefits. For exposure therapy and other forms of psychotherapy, non-inferiority studies point to promise of internet-delivered and telemedicine-based methods for reaching populations that may not have access to in-person care. SSRIs are the most widely used pharmaceutical treatment for PTSD; moderate initial benefits are observed yet long-term retention and outcomes may be enhanced by adjunct treatment. Again, refugees are a group that experiences lesser benefit. Research has begun to explore efficacy of treatments for individual symptom clusters, with hyperarousal benefiting most from currently available modalities. Avoidance, intrusion, negative thoughts and beliefs, and dissociation are symptoms requiring more research for focused interventions. Treatment of PTSD has evolved to (1) include equivalent proportions of men and women, along with focused female-exclusive cohorts; (2) explore novel methods of treatment online and in various cultural contexts; and (3) less focus on medication as evidenced by current clinical trials. In addition to further efficacy and safety studies in more diverse ethnic populations, work is needed to examine what therapies are best for targeting specific symptom clusters of PTSD. This research will drive precision treatment, and such research is beginning to point towards underlying mechanisms of pathology and change.
创伤后应激障碍是一种慢性、异质障碍，有多种心理疗法、药物和新兴治疗方案可供选择。大多数疗效研究都集中在白种男性军人人群，这可能是为什么并非所有患者都能对治疗产生长期积极结果的原因之一。此外，治疗对症状群的影响也被忽视了。这项工作专门综述了创伤后应激障碍及其症状群在平民人群中的治疗情况，而这些人群在文献中历来被忽视。
暴露疗法是成功治疗创伤后应激障碍的前沿方法，为药物治疗提供了更具成本效益的解决方案；然而，难民和伴有抑郁共病的患者可能无法从中获得如此强烈的益处。对于暴露疗法和其他形式的心理疗法，非劣效性研究表明，通过互联网提供和远程医疗为可能无法获得面对面护理的人群提供服务具有很大的前景。SSRIs 是治疗 PTSD 最广泛使用的药物；观察到中度的初始益处，但通过附加治疗可以增强长期保留和结果。同样，难民是受益较少的群体。研究已经开始探索针对个体症状群的治疗效果，目前可用的方法对过度警觉最有效。回避、侵入、消极的想法和信念以及分离是需要更多研究的症状，以便进行针对性干预。创伤后应激障碍的治疗已经发展到：（1）纳入同等比例的男性和女性，以及专注于女性的特定队列；（2）探索在线和各种文化背景下的新型治疗方法；（3）目前的临床试验表明，对药物的关注减少。除了在更多样化的种族人群中进行进一步的疗效和安全性研究外，还需要研究哪种疗法最适合针对创伤后应激障碍的特定症状群。这项研究将推动精准治疗，并且这种研究已经开始指向创伤后应激障碍的病理和变化的潜在机制。
