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Biological approaches to the diagnosis and treatment of Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder appears to be associated with biological alterations in central noradrenergic activity, the hypothalamic-pituitary-adrenocortical axis, the endogenous opioid system, and the sleep cycle. This pattern of biologic abnormalities, which appears unique to PTSD, has practical implications for diagnosis and treatment. A biological approach may complement psychological diagnostic techniques. With regard to treatment, almost every type of psychotropic agent has reported efficacy in PTSD. However, very few double-blind therapeutic trials have been published. Successful pharmacotherapy appears to alleviate DSM-III-R intrusive recollections and hyperarousal but not avoidant symptoms. Current information suggests that drug treatment alone can rarely alleviate the suffering in PTSD. Medication appears to be most useful as an adjunct to psychotherapy. Finally, the neurobiological alterations associated with PTSD may make affected individuals more susceptible to alcohol, opiates, and other illicit drug use. This also has important implications for treatment.