Journal of Angiotherapy
Angiogenesis, Inflammation & Therapeutics | Online ISSN  2207-872X
  1. You are here:
  2. Home
  3. Journals
  4. Biological Sciences
REVIEWS   (Open Access)
Contents Vol 3 (1)

Advances in Treating Posttraumatic Stress Disorder: Diagnostic Criteria, Molecular Mechanisms, and Therapeutic Approaches

Fahad Abdulaziz Altuwaijri 1*, Mohammed Salem Alshammari 1, ‏Khalid Mohammed Aljohani 1, ‏Abdullah Jalawi Aldakhil 1, ‏Mohammed Thamr Almutairi 1, ‏Raed Mohammed Alomair 1,  Mohammed Saleem  Alshammari 1, Sultan Safah A Alharbi 1, Maryam Saud Alsharif 1, Khalid Obid  Abdullah  Alruki 1, Mohammed Menwer Alruwaili 1, Saleh Helayyil Saleh Alharbi 1, Taleb Ghazi Thaar Aldalbahi 1, Hatim Bunaydir Bader AImutairi 1, Hassan Duairam Thawab Al-Shahrani 1, Saif Sultan Alsahli 1

+ Author Affiliations

Journal of Angiotherapy 3 (1) 1-10 https://doi.org/10.25163/angiotherapy.3110068

Submitted: 14 October 2019 Revised: 28 December 2019  Published: 30 December 2019 

Abstract

Background: Posttraumatic Stress Disorder (PTSD) is a debilitating condition that affects individuals exposed to traumatic events, with higher prevalence rates among military personnel. The disorder’s complexity, including the distinction between PTSD and complex PTSD (CPTSD), has led to evolving diagnostic criteria in both the DSM-5 and ICD-11. Advances in understanding PTSD have led to improved treatment strategies, but further research is needed to explore its underlying molecular, genetic, and neurobiological mechanisms. Methods: This review synthesizes current literature on PTSD, focusing on its diagnostic evolution, treatment options, and emerging research on its genetic and neurobiological foundations. Studies on PTSD in military populations were highlighted, emphasizing diagnostic frameworks, treatment modalities, and the role of healthcare providers, particularly nurses, in managing PTSD. A systematic analysis of genetic studies and neuroimaging findings was also included to understand the molecular underpinnings of PTSD. Results: The review found that PTSD’s diagnostic criteria have evolved to include more detailed distinctions between standard PTSD and CPTSD. Pharmacological treatments such as SSRIs and SNRIs, alongside psychological therapies like Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR), were identified as effective in alleviating symptoms. Emerging evidence points to genetic predispositions, immune system dysfunction, and neuroimaging findings, such as reduced hippocampal volume, as key factors in the development and persistence of PTSD. Conclusion: Despite substantial progress in the understanding and management of PTSD, further research is needed to explore the genetic, neurobiological, and molecular factors contributing to the disorder. Healthcare providers, especially nurses, play a crucial role in early detection, treatment facilitation, and advocacy, ensuring better outcomes for those affected by PTSD.

Keywords: PTSD, diagnostic criteria, molecular mechanisms, treatment approaches, therapeutic interventions

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596.744053

Anderle, R., Brown, D. C., & Cyran, E. (2011). Department of Defense. In African Studies Association Annual Meeting (pp. 340–342).

Bolzenius, J. D., Velez, C. S., Lewis, J. D., Bigler, E. D., Wade, B. S. C., Cooper, D. B., et al. (2018). Diffusion imaging findings in US service members with mild traumatic brain injury and posttraumatic stress disorder. Journal of Head Trauma Rehabilitation. https://doi.org/10.1097/HTR.0000000000000378

Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., et al. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review, 58, 1–15. https://doi.org/10.1016/j.cpr.2017.09.003

Briggs-Gowan, M. J., Carter, A. S., & Ford, J. D. (2012). Parsing the effects of violence exposure in early childhood: Modeling developmental pathways. Journal of Pediatric Psychology, 37(1), 11–22. https://doi.org/10.1093/jpepsy/jsr070

Bulger, R. E. (1992). The Institute of Medicine. Kennedy Institute of Ethics Journal, 2(1), 73–77. https://doi.org/10.1353/ken.1992.0013

Deahl, M., Srinivasan, M., Jones, N., Thomas, J., Neblett, C., & Jolly, A. (2000). Preventing psychological trauma in soldiers: The role of operational stress training and psychological debriefing. British Journal of Medical Psychology, 73(1), 77–85. https://doi.org/10.1348/000711200160693

Enlow, M. B., Blood, E., & Egeland, B. (2013). Sociodemographic risk, developmental competence, and PTSD symptoms in young children exposed to interpersonal trauma in early life. Journal of Trauma and Stress, 26(6), 686–694. https://doi.org/10.1002/jts.21864

Eraly, S. A., Nievergelt, C. M., Maihofer, A. X., Barkauskas, D. A., Biswas, N., Agorastos, A., et al. (2014). Assessment of plasma C-reactive protein as a biomarker of posttraumatic stress disorder risk. JAMA Psychiatry, 71(4), 423. https://doi.org/10.1001/jamapsychiatry.2013.4435

Evans, L., Cowlishaw, S., & Hopwood, M. (2009). Family functioning predicts outcomes for veterans in treatment for chronic posttraumatic stress disorder. Journal of Family Psychology, 23(4), 531–539. https://doi.org/10.1037/a0015975

Feussner, J. R., & Maklan, C. W. (1998). Department of Veterans Affairs. Medical Care, 36(3), 254–256. https://doi.org/10.1097/00005650-199803000-00006

Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The posttraumatic diagnostic scale. Psychological Assessment, 9(9), 445–451. https://doi.org/10.1037/1040-3590.9.4.445

Gnanavel, S., & Robert, R. S. (2013). Diagnostic and statistical manual of mental disorders (5th edition) and the impact of events scale-revised. Chest, 144(6), 1974–1975. https://doi.org/10.1378/chest.13-1563

Jaques, H. (2012). Introducing the national institute for health and clinical excellence. European Heart Journal, 33(17), 2111–2112. https://doi.org/10.1093/eurheartj/ehs241

Jonas, D. E., Cusack, K., Forneris, C. A., Wilkins, T. M., Sonis, J., Middleton, J. C., et al. (2013). Psychological and pharmacological treatments for adults with posttraumatic stress disorder (PTSD). Agency for Healthcare Research and Quality (AHRQ), 4(1), 1–760.

Kendell, R. E. (1980). Diagnostic and statistical manual of mental disorders, 3rd ed., revised (DSM-III-R). American Journal of Psychiatry, 145(10), 1301–1302. https://doi.org/10.1176/ajp.145.10.1301

Lebois, L. A., Wolff, J. D., & Ressler, K. J. (2016). Neuroimaging genetic approaches to posttraumatic stress disorder. Experimental Neurology, 284(Pt B), 141–152. https://doi.org/10.1016/j.expneurol.2016.02.011

Logue, M. W., Rooij, S. J. H. V., Dennis, E. L., Davis, S. L., Hayes, J. P., Stevens, J. S., et al. (2018). Smaller hippocampal volume in posttraumatic stress disorder: A multi-site ENIGMA-PGC study. Biological Psychiatry, 83(3), 244–253. https://doi.org/10.1016/j.biopsych.2017.07.015

Macera, C. A., Aralis, H. J., Highfill-McRoy, R., & Rauh, M. J. (2014). Posttraumatic stress disorder after combat zone deployment among navy and marine corps men and women. Journal of Women's Health (Larchmt), 23(6), 499–505. https://doi.org/10.1089/jwh.2013.4697

Macgregor, A. J., Tang, J. J., Dougherty, A. L., & Galarneau, M. R. (2013). Deployment-related injury and posttraumatic stress disorder in US military personnel. Injury, 44(11), 1458–1464. https://doi.org/10.1016/j.injury.2012.10.016

Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., Reed, G. M., Van Ommeren, M., et al. (2013). Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet, 381(9878), 1683–1685. https://doi.org/10.1016/S0140-6736(12)62192-5

McKinney, J. M., Hirsch, J. K., & Britton, P. C. (2017). PTSD symptoms and suicide risk in veterans: Serial indirect effects via depression and anger. Journal of Affective Disorders, 214, 100–107. https://doi.org/10.1016/j.jad.2017.03.046

Nash, W. P., & Litz, B. T. (2013). Moral injury: A mechanism for war-related psychological trauma in military family members. Clinical Child and Family Psychology Review, 16(4), 365–375. https://doi.org/10.1007/s10567-013-0149-1

Nazarov, A., Fikretoglu, D., Liu, A., Thompson, M., & Zamorski, M. A. (2018). Greater prevalence of post-traumatic stress disorder and depression in deployed Canadian Armed Forces personnel at risk for moral injury. Acta Psychiatrica Scandinavica, 137(4), 342–354. https://doi.org/10.1111/acps.12874

Neigh, G. N., & Ali, F. F. (2016). Co-morbidity of PTSD and immune system dysfunction: Opportunities for treatment. Current Opinion in Pharmacology, 29, 104–110. https://doi.org/10.1016/j.coph.2016.03.001

Newport, D. J., & Nemeroff, C. B. (2009). Neurobiology of posttraumatic stress disorder. Current Opinion in Neurobiology, 14(1 Suppl 1), 13. https://doi.org/10.1016/j.conb.2009.06.014

Olatunji, B. O., Ciesielski, B. G., & Tolin, D. F. (2010). Fear and loathing: A meta-analytic review of the specificity of anger in PTSD. Behavior Therapy, 41(1), 93–105. https://doi.org/10.1016/j.beth.2009.01.003

Passos, I. C., Vasconcelos-Moreno, M. P., Costa, L. G., Kunz, M., Brietzke, E., Quevedo, J., et al. (2015). Inflammatory markers in post-traumatic stress disorder: A systematic review, meta-analysis, and meta-regression. Lancet Psychiatry, 2(11), 1002. https://doi.org/10.1016/S2215-0366(15)00292-4

Reijnen, A., Rademaker, A. R., Vermetten, E., & Geuze, E. (2015). Prevalence of mental health symptoms in Dutch military personnel returning from deployment to Afghanistan: A 2-year longitudinal analysis. European Psychiatry, 30(2), 341–346. https://doi.org/10.1016/j.eurpsy.2014.12.003

Sandweiss, D. A., Slymen, D. J., Leardmann, C. A., Smith, B., White, M. R., Boyko, E. J., et al. (2011). Preinjury psychiatric status, injury severity, and postdeployment posttraumatic stress disorder. Archives of General Psychiatry, 68(5), 496–504. https://doi.org/10.1001/archgenpsychiatry.2011.48

Schnyder, U. (2008). International Society for Traumatic Stress Studies (ISTSS). Psychosomatik und Konsiliarpsychiatrie, 2(4), 261.

Seal, K. H., Bertenthal, D., Maguen, S., Gima, K., Chu, A., & Marmar, C. R. (2008). Getting beyond "Don't ask; don't tell": An evaluation of US veterans administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan. American Journal of Public Health, 98(4), 714–720. https://doi.org/10.2105/AJPH.2007.121410

Sijaric-Voloder, S., & Capin, D. (2008). Application of cognitive behavioral therapeutic techniques for prevention of psychological disorders in police officers. Health Medicine, 2(4), 288–292.

Skeffington, P. M., Rees, C. S., & Kane, R. (2013). The primary prevention of PTSD: A systematic review. Journal of Trauma & Dissociation, 14(4), 404–422. https://doi.org/10.1080/15299732.2013.765502

Sripada, R. K., Rauch, S. A., & Liberzon, I. (2016). Psychological mechanisms of PTSD and its treatment. Current Psychiatry Reports, 18(11), 99. https://doi.org/10.1007/s11920-016-0732-1

Street, A. E., Rosellini, A. J., Ursano, R. J., Heeringa, S. G., Hill, E. D., Monahan, J., et al. (2016). Developing a risk model to target high-risk preventive interventions for sexual assault victimization among female U.S. army soldiers. Clinical Psychological Science, 4(6), 939–956. https://doi.org/10.1177/2167702616632354

Sundin, J., Herrell, R. K., Hoge, C. W., Fear, N. T., Adler, A. B., Greenberg, N., et al. (2014). Mental health outcomes in US and UK military personnel returning from Iraq. British Journal of Psychiatry, 204(3), 200–207. https://doi.org/10.1192/bjp.bp.113.132616

White, J., Pearce, J., Morrison, S., Dunstan, F., Bisson, J. I., & Fone, D. L. (2015). Risk of post-traumatic stress disorder following traumatic events in a community sample. Epidemiology and Psychiatric Sciences, 24(3), 1–9. https://doi.org/10.1017/S2045796014000299

Wolmer, L., Hamiel, D., & Laor, N. (2011). Preventing children's posttraumatic stress after disaster with teacher-based intervention: A controlled study. Journal of the American Academy of Child & Adolescent Psychiatry, 50(4), 340–348.e1–2. https://doi.org/10.1016/j.jaac.2010.12.024

Zhang, K., Qu, S., Chang, S., Li, G., Cao, C., Fang, K., et al. (2017). An overview of posttraumatic stress disorder genetic studies by analyzing and integrating genetic data into genetic database PTSD gene. Neuroscience and Biobehavioral Reviews, 83, 647–656. https://doi.org/10.1016/j.neubiorev.2017.10.001

PDF
Abstract
Export Citation

View Dimensions


View Plumx


View Altmetric




Save
0
Citation
55
View

Share