The authors’ view is in agreement with the consensus that PTSD represents a special type of induced anxiety state with fairly stereotyped psychologic aspects, often with an accompanying depression and somatic symptoms. Separating it by highlighting the triggering event serves a useful nosologic purpose and draws attention to the need for acute treatment and subsequent support of individuals who have experienced a serious traumatic event such as rape or other violent attack and those returning from battle or after. An emerging notion is that sedatives or narcotics administered immediately after the inciting event may reduce the incidence and severity of PTSD, for example in battlefield conditions.
Selective serotonin reuptake inhibitors have been suggested for initial treatment but the other classes of antidepression drugs are also effective. Limiting anxiolytics such as benzodiazepines is recommended, but there are few data on which to make these judgments. A sympathetic physician is helpful in reassuring affected individuals and giving them perspectives to cope with the trauma and various cognitive-behavioral therapies and imagery have been useful but infrequently tested in a rigorous fashion. The review by Yehuda is informative on this subject and many of the comments above are taken from her summary.
The psychologic phenomenon of stress is closely allied to nervousness, fatigue, and anxiety and all of them are pervasive features of modern life. In general terms, stress has been defined as a feeling of self-doubt about being able to cope with some situation over a period of time. The term stress syndrome refers to perturbations of behavior and accompanying physiologic changes that are ascribable to environmental challenges of such intensity and duration as to overwhelm the individual’s adaptive capacity. The biologic effects of this phenomenon can be recognized in many species; chickens laying fewer eggs when moved to a new coop and cows giving less milk when put in a new barn, or monkeys going berserk when repeatedly frustrated by threats that they cannot control. Human beings forced to work under confined conditions and constant danger and cultural groups removed from their home and traditional way of life lose their coping skills and suffer anxiety and stress reactions.
Hans Selye, influenced by Pavlov’s concepts of stress, produced lesions in the visceral organs by exposing animals to life-threatening stressors combined with corticosteroids. Cardiac contraction-band necrosis and the shallow hemorrhagic gastrointestinal tract lesion (Cushing ulcer) are two examples of such catecholamine-mediated organ damage that is precipitated by acutely stressful circumstances. The dramatic syndrome of ballooning of the left ventricular apex, or takotsubo-like cardiomyopathy (so-named for the shape of the Japanese octopus trapping pot), is a manifestation of catecholamine excess caused by acute stress.
There is also equivocal epidemiologic evidence that chronic stress in individuals, captured in what has been termed the type A personality, raises the risk of cardiac disease, but the mechanism here, if it indeed exists, is likely to be through a physiologic intermediary such as systemic hypertension or perhaps inflammation that leads to atherosclerosis. Presumably, they have an increased output of “stress hormones” (cortisol and adrenaline).
Such psychologic disorders, bearing a direct relationship to environmental stressors, are among the most common occupational health problems. Stress syndromes are distinguished from anxiety disorders, in which the psychologic disturbance arises from within the individual and has no definite relationship to environmental stimuli. Whether certain individuals are by nature hyperresponsive to such stimuli is not known. The only therapeutic approach is to attempt to alter the patient’s perception of stress—for example, with psychotherapy and meditation exercises—and to remove him, if possible, from recognizable environmental stressors. (See “Editorial” in references.)