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 Research & Giving News Article  As we approach the one-year anniversary of the world trade center attacks, the National Alliance for Research on Schizophrenia and Depression (NARSAD) would like to provide the latest information on post-traumatic stress disorder (PTSD), based on scientific research. PTSD is an illness caused by exposure to a real-life traumatic event. Earlier this year, Jack Gorman, MD, presented a fascinating discussion on PTSD at a Scientific Symposium in New York City sponsored by NARSAD. Dr. Gorman, who has received Distinguished Investigator grants from NARSAD, is Lieber Professor and Vice-Chair for Research of the Department of Psychiatry at the College of Physicians and Surgeons at Columbia University. Defining PTSD At the symposium, Dr. Gorman noted that the medical community has a great deal of information on why people get PTSD, who gets it, what happens in the brain and how it can be treated. "It has to be the kind of event in which a person has reason to believe that he or she may either be killed or seriously physically harmed, or witnesses other people either being killed or seriously physically harmed," he said. Three specific groups of symptoms occur in individuals who develop PTSD. The first, and perhaps most important, is the persistent re-experiencing of the event. Individuals may have terrible nightmares. Or during the day they may feel as if they are back in the middle of the traumatic event. The second symptom is the avoidance of stimuli that remind one of the event and a numbing of general responsiveness. For example, some people who were in the vicinity of the World Trade Center on September 11 may refuse to go anywhere near lower Manhattan. The numbing of response is also a very serious symptom in which people with PTSD say they don't feel things with the same emotional intensity that they experienced before the traumatic event. For example, they don't feel that they can laugh at funny stories or cry while watching a sad movie. Finally, people with PTSD are in a state of chronic hyperarousal, which means their autonomic nervous system is in a state of high alert. Symptoms include trouble sleeping, outbursts of anger and difficulty concentrating. Their startle response is so intense they may jump out of their seat at the slightest provocation. An estimated eight percent of Americans suffer from PTSD at some time in their lives, and it is more common in women than it is in men. However, the true prevalence is probably not known because many cases go unreported, according to Dr. Gorman. A diagnosis of PTSD is made only if an individual continues to have symptoms one month after the traumatic event has occurred. Up until then, symptoms are considered an acute stress response, because many individuals do not go on to develop a persistent psychiatric disturbance. People with PTSD are highly prone to other psychiatric illnesses, such as major depression. Although women have a higher incidence of PTSD, men with the disorder are more likely to abuse alcohol. And PTSD is a major risk factor for suicide. People with PTSD may suffer with symptoms for many years before ultimately committing suicide. Risk Factors for PTSD Different traumatic events have different risk for causing PTSD. For example, the chance of developing post-traumatic stress disorder after witnessing a terrible, traumatic event is only about 15 percent. However, if an individual is the victim of child abuse or sexual assault, these events are likely to produce PTSD at the rate of 40 to 50 percent. Approximately one-third of people exposed to a qualifying traumatic event will actually develop PTSD. It depends largely on the specific event. The majority of people who have PTSD will get over it without any intervention. About 25 percent of people who still have PTSD one month after the event will continue to have it chronically. These are the people who suffer the most and are most in need of treatment, according to Dr. Gorman. Unfortunately, it's very difficult to predict who will develop PTSD and who will get better. "Therefore, in general we recommend that all of these individuals get some form of treatment," Dr. Gorman said. "I want to also stress that post-traumatic stress disorder is not the only psychiatric illness that an individual can get if they've been exposed to a trauma. Some people will get depressed, others will develop panic disorder, others will develop alcoholism." Why do some people end up with PTSD while others do not? An individual who is with a group is less likely to develop PTSD than someone who is alone when exposed to a traumatic event. "We think the risk of developing PTSD from the World Trade Center disaster will be slightly lower than it might otherwise have been, because clearly it was a large group of individuals exposed to the same traumatic event," Dr. Gorman said. Another reason has to do with what happens to the individual after the trauma, particularly the level of social support. The tremendous outpouring of sympathy, help and support for the victims of the World Trade Center attacks may also have helped to lower the risk for PTSD. Other predisposing factors to developing PTSD include pre-existing psychological problems, a past history of psychiatric illness and a family history of psychiatric illness or of PTSD. Genetic vulnerabilities are also thought to play a role. How the Brain Regulates the Fear Response Dr. Gorman discussed three parts of the brain believed to be involved in post-traumatic stress disorder. The first is a very small part of the brain known as the amygdala which is deep in the medial temporal lobe. The amygdala is a part of the brain that mediates the expression of fearful behaviors. A good deal of evidence suggests that active coping strategies lead to a much lower risk for post-traumatic stress disorder. "Following an acute stressful event, it is much more important to get a person mobilized than it is to have them talk about what happened over and over again," said Dr. Gorman. People with anxiety disorders, and those with PTSD, in particular, seem to have difficulty activating higher parts of the brain, one of which is known as the anterior cingulate. People with PTSD do not seem capable of reasoning through the meaningfulness of the stimuli before them because they can't engage those higher parts of the brain. "Different types of psychotherapies may be critical in helping people to be able to use these parts of the brain to overtake the amygdala. And we know that these parts of the brain in general inhibit the ability of the amygdala to produce the fear response," said Dr. Gorman. The third part of the brain involved in PTSD is the hippocampus, which is important for a variety of emotional responses and for emotional memory. There is evidence that stress hormones like cortisol have a damaging effect on this part of the brain. Studies suggest that post-traumatic stress disorder patients have reduced volume of the hippocampus. Treating PTSD Knowing which parts of the brain are involved in PTSD enables researchers to develop treatment interventions targeting these brain regions. Treatment for post-traumatic stress disorder includes medication and psychotherapies. Of the medications, many different drugs have been shown to work, but only two are now approved by the FDA to treat PTSD, both in the class of SSRI antidepressants. One is sertraline, for which the brand name is Zoloft. The other is paroxetine, or Paxil. The other treatment option is exposure therapy, currently considered the leading psychotherapy for PTSD by most experts. This therapy essentially involves exposing the person to what he was frightened of and training him to see it in a realistic way and to have a normal emotional response. This therapy is not offered until a month or two has passed since the traumatic even. Researchers are still trying to determine the best way to treat individual patients suffering from PTSD. "We can say two things with great confidence at this point: One, that anyone with post-traumatic stress disorder has a very good chance of getting better, should not ignore it and should get help," said Dr. Gorman. "And secondly, with the developments in modern neuroscience, we are going to learn a lot more about post-traumatic stress disorder in the very near future." |
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