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Treatment strategies for post‐traumatic stress disorder: need for brief and effective interventions

This issue of Acta Psychiatrica Scandinavica brings together three papers related to epidemiology and treatment of post-traumatic stress disorder (PTSD) (1-3). PTSD is a chronic and disabling anxiety disorder commonly seen after human-made traumas or natural disasters. The main characteristic of the diagnostic category is that, unlike most other diagnoses, a specific aetiological factor is held responsible: the diagnosis of PTSD requires the presence of a severely distressing event. Psychological trauma experienced by people in general population is surprisingly common. Sixtyone per cent of men and 51% of women in the general population report having experienced at least one traumatic experience that qualifies to be considered for PTSD (4). Such traumatic experiences are commonly followed by a multitude of psychological symptoms including anxiety, depression, substance abuse, suicide and post-traumatic stress symptoms. Although posttraumatic stress is common after severe psychological trauma, the symptoms in the majority of survivors remit shortly after the trauma and it is a minority who go on to have a chronic and disabling course. For those who do not recover, time does not seem to be a healer. In the study we conducted on the survivors of the 1999 earthquake in Turkey, for people who had experienced the earthquake at the epicentre, the PTSD rates remained essentially unchanged up to 2 years post-trauma (5, 6). The fact that many people still continue to show PTSD symptoms after the war trauma of Vietnam or even World War II reflects the chronic nature of the illness (7, 8). Identifying those at risk early on could mean a lot both to those people affected and to their families. Especially after natural disasters, where thousands of people may be affected, post-traumatic syndromes represent a serious health-care issue. Identifying risk groups would also be essential for preventive health-care measures to be taken by health authorities. Since all people exposed to a stressor do not develop the syndrome, other vulnerability factors have been put forward. Biological studies, which are clearly outlined in Hageman et al.’s paper in this issue (2), suggest that malfunctioning of opioid, glutamatergic, noradrenergic, serotonergic and neuroendocrine pathways may play a role in the etiology of PTSD. Drugs effective in the treatment of PTSD symptoms, especially SSRIs, provide further evidence for abnormalities in the abovementioned transmitter systems. Many epidemiological and phenomenological studies show that female gender is related to higher PTSD rates. Trauma characteristics also play a role: those who experience more severe trauma have higher PTSD rates. It is generally accepted that type of trauma is associated with PTSD rates. Man-made trauma generally results in higher rates compared to natural disasters. The paper which presents the psychological effects of a landslide in Sarno, Italy by Catapano et al (1) in this issue, however, shows that more than a quarter of survivors had PTSD 1 year after the event. The PTSD rates after earthquakes are also high (5, 9). Various treatment modalities are available for PTSD. Antidepressants have proved to be of value in treating traumatic stress symptoms. A detailed comparison of currently available pharmacological treatment options are given in Hageman et al.’s paper in this issue (2). Type of trauma, gender, baseline severity of PTSD and presence of depressive symptoms seem to affect treatment outcome. Brief early interventions developed for treatment of post-trauma psychological problems are few, and the validity of them are not universally accepted. CISD (critical incident stress debriefing) or psychological debriefing (PD) is developed for people who experience distressing events, including severe traumas. PD involves ‘a structured group activity, organized to review in detail the facts, thoughts, impressions and reactions following a critical incident’ (10). It has advantages, such as being This issue of Acta Psychiatrica Scandinavica also includes a short