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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/8\\\/31\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/8\\\/31\u0022}],\u0022ac\u0022:{\u0022spmdc;14\\\/8\\\/31\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;14\\\/8\\\/31\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPosttraumatic stress disorder (PTSD) was officially designated as a disorder in the \u003Cem\u003EDiagnostic and Statistical Manual of Mental Disorders (DSM)\u003C\/em\u003E in 1980. This article provides a review of the epidemiology and psychological trauma associated with PTSD, as well as an update on the psychotherapy, pharmacotherapy, and complimentary and alternatives approaches to treat PTSD.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAnxiety Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychopharmacology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPsychiatry \u0026amp; Psychology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPosttraumatic stress disorder (PTSD) was officially designated as a disorder in the \u003Cem\u003EDiagnostic and Statistical Manual of Mental Disorders (DSM)\u003C\/em\u003E in 1980, said Charles C. Engel, MD, MPH, Senior Health Scientist, RAND Corporation, Arlington, Virginia, USA, in a review of the epidemiology and psychological trauma associated with PTSD. The criteria to diagnose PTSD have been further refined, most recently in \u003Cem\u003EDSM-5\u003C\/em\u003E in 2013 (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15865\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15865\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15865\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-3\u0022 class=\u0022first-child\u0022\u003E\n               \u003Cem\u003EDSM-5\u003C\/em\u003E Criteria to Diagnose PTSD\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-4\u0022\u003EPTSD comorbidities including depressive disorders, anxiety disorders (panic, generalized anxiety, phobias), substance abuse, somatic symptoms, mild traumatic brain injury, and fibromyalgia are common and affect an estimated 88% of men and 79% of women in their lifetime [Kessler RC et al. \u003Cem\u003EArch Gen Psychiatry\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPaula P. Schnurr, PhD, National Center for PTSD in the Department of Veterans Affairs and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA, provided an update on psychotherapy treatment for PTSD. Psychotherapy may be more effective than medication, according to a recent meta-analysis [Watts BV et al. \u003Cem\u003EJ Clin Psychiatry\u003C\/em\u003E 2013]. The delivery of treatment varies, and there are at least 7 clinical practice guidelines recommending treatment for PTSD. The Department of Veterans Affairs and Department of Defense Clinical Practice Guideline for Management of Posttraumatic Stress is used for veterans and military personnel. Using it as a framework, Dr. Schnurr recommended 5 principles to guide the choice of treatment (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15867\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15867\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15867\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EKeystones to Guide the Choice of Psychotherapy for Treatment of PTSD\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EA recent randomized controlled trial with 121 patients provided evidence that an intensive 1-week regimen of cognitive therapy produced results equivalent to 12 weeks of cognitive therapy, and both were superior to 12 weeks of supportive therapy [Ehlers A et al. \u003Cem\u003EAm J Psych\u003C\/em\u003E 2014]. A randomized, placebo-controlled trial of 67 patients with PTSD showed D-cycloserine (DCS) in addition to exposure therapy was effective only in a subgroup [de Kleine RA et al. \u003Cem\u003EBiol Psychiatry\u003C\/em\u003E 2012]. Another randomized controlled trial (RCT) reported negative effects of DCS on exposure therapy; the authors suggested that in some cases, the compound may cause traumatic memories to be intensively reconsolidated to the detriment of the patient [Litz BT et al. \u003Cem\u003EJ Psych Res\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Schnurr stated that evidence-based psychotherapy works for most PTSD patients, including veterans, and the benefits can persist for years.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EJohn H. Krystal, MD, Yale University School of Medicine, New Haven, Connecticut, USA, discussed the pharmacotherapy of PTSD. Anti-depressants have been the predominant class of drugs used in PTSD since the 1980s [Frank JB et al. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 1988].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ESelective serotonin reuptake inhibitors (SSRIs) approved by the US Food and Drug Administration for treatment of PTSD are sertraline and paroxetine. The norepinephrine reuptake inhibitor desipramine provided benefits in a 12-week study [Petrakis IL et al. \u003Cem\u003ENeuropsychopharmacology\u003C\/em\u003E 2012]. Norepinephrine targets adrenergic receptors, which are involved in the \u201cfight or flight\u201d response and learning. Antiadrenergic drugs including prazosin, clonidine, and propranolol have shown some evidence of benefit in PTSD studies, but definitive evidence of their efficacy is lacking. Other antidepressants block serotonin-2 receptors; trazodone has been the most commonly prescribed medication for PTSD in US veterans (despite the absence of placebo-controlled trials), and pilot studies of nefazodone have been positive.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ESecond-generation antipsychotics with prazosin-like and trazodone-like activity, as well as drugs that target the dopamine receptor D2 include risperidone, olanzepine, quetiapine, ziprasidone, clozapine, and aripiprazole. Benefits obtained with risperidone have not been compellingly different from placebo, and adverse effects including somnolence, weight gain, and decreased libido have been documented. Still, risperidone maybe beneficial for paranoia and psychosis and maybe warranted for those with less severe PTSD who are being treated with fewer medications. Quetiapine is the most commonly prescribed second-generation antipsychotic; preliminary data have been encouraging, with daytime sedation and weight gain being adverse concerns.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EBenzodiazepines enhance the effects of the gamma-aminobutyric acid neurotransmitter. The resulting easing of depression-related symptoms made benzodiazepines a popular prescription for PTSD. However, use is declining because of concerns about its abuse and limited evidence-based efficacy [Hermos JA et al. \u003Cem\u003EJ Trauma Stress\u003C\/em\u003E 2007; Lund BC et al. \u003Cem\u003EJ Clin Psychiatry\u003C\/em\u003E 2012]. A GABA receptor-targeted drug that has shown more promise is S-zopiclone; a double-blind, placebo-controlled RCT demonstrated its effectiveness in improving sleep and lessening PTSD symptoms [Pollack MH et al. \u003Cem\u003EJ Clin Psychiatry\u003C\/em\u003E 2011]. Other GABA modulators being assessed for PTSD pharmacotherapy are tiagabine, valproate, and topriamate.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003ED-cycloserine may have potential in fear extinction through its targeted activity at the N-methyl-D-aspartate (NMDA) receptor, which is crucial in memory retention. Finally, the antidepressant action of ketamine was recently demonstrated [Berman RM et al. \u003Cem\u003EBiol Psychiatry\u003C\/em\u003E 2000], and benefits appear to extend to PTSD treatment [Feder A et al. \u003Cem\u003EJAMA Psychiatry\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EDavid M. Benedek MD, Uniformed Services University, Bethesda, Maryland, USA, reviewed complimentary and alternatives approaches to treat PTSD. Complimentary approaches are used in conventional care. Alternative approaches are used in lieu of standard care, and can become complimentary as evidence for their efficacy accumulates. These approaches are currently the final step in a multistep hierarchy of treatment that begins with psychotherapy (cognitive-based therapy, relaxation techniques, imagery rehearsal therapy, hypnosis, group therapy, brief psychodynamic therapy) and, if necessary, progresses to include pharmacotherapy. The National Center of Complementary and Alternative Medicine (NCCAM) classification of complementary and alternative approaches are summarized in \u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15869\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15869\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15869\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n            \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003ENCCAM Classifications of Complementary and Alternative Approaches\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-16\u0022\u003EComplementary and alternative approaches, such as acupuncture, are reportedly used by about 40% of PTSD sufferers, mainly to improve mental health. The claimed benefits are currently more anecdotal than evidence-based; as of 2011, only 7 RCTs had been conducted (1 for body-oriented therapy and 6 for mind-body therapy). Evidence is relatively more solid for acupuncture, with its effect on the somatosensory cortex indicated. While relaxation therapy and yoga have health-related benefits, the evidence for their specific benefit in PTSD remains scant.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/8\/31.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp8pp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp8pp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}