Source: Melton ST, Kirkwood CK.
Anxiety Disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells
BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7990166.
Accessed May 26, 2012.
- Anxiety disorder occurring as result of seeing or living
through dangerous event.
- Abnormalities in brain function
- Genetic and environmental factors likely involved.
- Chronic noradrenergic overactivity downregulates α2-adrenoreceptors
in patients with posttraumatic stress disorder (PTSD).
- Abnormalities of GABA inhibition may lead to increased response
to stress in patients with PTSD.
- 5-HT may increase anxiety in patients with PTSD.
- Hypersecretion of corticotropin-releasing factor but subnormal
levels of cortisol at time of trauma and chronically.
- Lower hippocampal volumes may be precursor for subsequent
development of PTSD.
- Estimated lifetime prevalence: 6.8% in United
- 8.2% of men and 20% of women exposed to
life-threatening traumatic event will develop PTSD.
- Genetic factors may influence vulnerability after traumatic
- Living through dangerous or traumatic event, for example:
- Sexual abuse
- Witnessing others get injured or killed
- History of emotional disorder or depression
- History of physical or sexual abuse
- Having little social support after traumatic event
- Exposure to traumatic event causes intense fear, helplessness,
- Reexperiencing symptoms
- Recurrent intrusive,
distressing memories of trauma
- Recurrent disturbing dreams of event
- Feeling that event is recurring (e.g., dissociative flashbacks)
- Physiologic reaction to reminders of trauma
- Avoidance symptoms
- Avoidance of conversations
- Avoidance of thoughts or feelings about trauma
- Avoidance of activities that are reminders of event
- Avoidance of people or places that arouse recollections of
- Inability to recall important aspect of trauma
- Estrangement from others
- Restricted affect
- Sense of foreshortened future (e.g., does not expect to have
- Hyperarousal symptoms
- Decreased concentration
- Easy to startle
- Irritability or anger outbursts
Means of Confirmation
- Must have at least 1 reexperiencing symptom, 3 signs or
symptoms of persistent avoidance of stimuli, and at least 2 symptoms
of increased arousal.
- Symptoms from each category must be present >1 month and cause
significant distress or impairment.
- PTSD can occur at any age; course variable.
- Acute: Duration of symptoms <3
- Chronic: Symptoms last for >3 months.
- Delayed onset: Symptoms begin at least 6 months post-event.
- Most persons with PTSD meet criteria for another mental disorder;
80% have concurrent depression, anxiety disorder, or substance
abuse or dependence.
- Decrease core symptoms, disability, and comorbidity.
- Improve quality of life and resilience to stress.
- Persons experiencing traumatic event should receive pharmacotherapy,
psychotherapy, or both if symptoms persist for 3–4 weeks
with social or occupational impairment.
- Psychotherapies include:
- Anxiety management
- Cognitive behavioral therapy (CBT)
- Group therapy
- Psychodynamic therapies
- Psychotherapy may be used in patients with mild symptoms,
those who prefer not to use medications, or in conjunction with
drugs in patients with severe symptoms.
- Figure 1: Algorithm for pharmacotherapy of PTSD
- Antidepressants (Table 1)
- First-line: Selective
serotonin reuptake inhibitors ...