创伤后应激障碍的神经生物学研究进展

创伤后应激障碍(PTSD)是当机体遭受生命威胁或者强烈精神创伤后发生的精神疾病。近年来关于PTSD的机制研究主要包括HPA轴功能失调、神经递质水平异常、谷氨酸系统失衡以及其它相关蛋白表达异常。尽管目前关于PTSD的研究已经取得了较大成就,但其准确的神经生物学机制仍然有待于进一步的研究。     

创伤后应激障碍研究进展

多数研究发现,PTSD（创伤后应激障碍）伴有的皮质醇负反馈抑制垂体加强与其它靶组织（肾上腺、下丘脑）高反应性一致,低皮质醇和垂体反应性增加也与肾上腺分泌减少一致。     

龟鹿二仙胶对创伤后应激障碍大鼠行为学和HPA轴功能的影响

目的观察创伤后应激障碍(PTSD)大鼠下丘脑-垂体-肾上腺(HPA)轴功能和行为学的变化及龟鹿二仙胶对其的影响。方法采用单一延长应激(SPS)的方法建立大鼠PTSD模型,采用旷场实验、高架十字迷宫实验,检测大鼠自主活动及焦虑水平;应用地塞米松抑制实验,检测大鼠HPA轴快速负反馈功能;采用ELISA法检测血浆皮质酮(CORT)水平和促肾上腺皮质激素(ACTH)含量。结果PTSD模型大鼠d 8开始出现HPA轴快速负反馈功能增强,并持续到d 22。模型组大鼠d 8焦虑水平升高,持续到d29。此外,d 29还出现自主活动下降和血浆CORT水平升高。龟鹿二仙胶连续给药14 d后能明显抑制HPA轴负反馈功能的增强;连续给药21 d后能明显提高大鼠的自主活动能力,降低其焦虑水平和血浆CORT水平。结论龟鹿二仙胶能够改善PTSD大鼠的行为学异常,其作用机制可能与调节HPA轴的功能紊乱有关。     

治疗创伤后应激障碍的潜在靶点研究进度

创伤后应激障碍(PTSD)是指个体因受到威胁性、灾难性创伤事件的刺激后延迟出现并长期持续的精神障碍,目前对于该疾病尚缺乏针对性强、有效率高的治疗药物.PTSD与抑郁、焦虑、药物成瘾等其他精神类疾病共患病率达50％,给患病个体和社会带来了严重的影响.目前临床上使用的抗PTSD药物均为五羟色胺重摄取抑制剂,存在治疗效率不高...     

应激与抑郁症发病的相关性及新药研究进展

重度抑郁症是全球范围内最大的公共卫生难题之一,其具有反复性和周期性,可严重影响患者正常的工作能力和社会活动。应激是指外界刺激影响机体内环境稳态而引起的机体非特异性反应,长期的慢性应激通过激活并损伤下丘脑一垂体．肾上腺（HPA）轴及抑制海马神经元冉生诱发抑郁症。本文就应激、HPA轴在抑郁发病机制中的重要作用以及与该机制相关的抗抑郁药的研究进展进行综述。     

中缝背核5-HT在创伤后应激障碍发病机制中的研究

中缝背核是位于脑干正中缝两侧的中缝核细胞群中的一员,其存在多种神经递质和神经肽,参与多种生理活动。本文主要叙述中缝背核中的5-羟色胺及其相关的神经递质和神经肽在中缝背核神经精神调节中的主要作用机制,及在创伤后应激障碍发病机制中的作用。     

创伤后应激障碍的表现与干预治疗

<正>在现实生活中,人们难免会遭遇一些诸如地震、火灾、严重事故、被犯罪侵害等创伤性事件。当人们经历此类事件时,常常会出现严重的生理和心理上的问题,导致社会功能丧失,严重者甚至走向自杀,这便是创伤后应激障碍。由于创伤后应激障碍会带来延迟性、持续性的心身障碍,故应及时对创伤后应激障碍进行干预和治疗,以便尽早缓解症状,恢复     

Pharmacotherapy of post-traumatic stress disorder

In the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R and DSM-IV, the diagnosis of post-traumatic stress disorder (PTSD) requires the presence of three symptom clusters: re-experiencing, avoidance and hyperarousal. The selective serotonin reuptake inhibitors (SSRIs), in particular sertraline and paroxetine, have emerged as the treatment of choice for trauma victims experiencing these three symptom clusters. While not approved by the U.S. Food and Drug Administration, other pharmacological agents are often used, some for symptoms found in victims of early, chronic or extreme stress. Referred to as having type II trauma, complex PTSD, disorders of extreme stress and enduring personality change after catastrophic experience, these patients, with symptoms such as dissociation, somatization and self-injurious behavior, need to be recognized as suffering from a trauma-related disorder qualitatively different from that presently captured in the DSM-IV. In this paper we will refer to DSM-IV's construct as simple PTSD (sPTSD); to complex PTSD/disorders of extreme stress as cPTSD/DES; and to both as PTSD. We will review existing evidence for the efficacy of SSRIs in treating sPTSD as well as different pharmacological interventions that are necessary for the treatment of cPTSD/DES. In addition, since both sPTSD and cPTSD/DES frequently coexist with other mental disorders, treatment of comorbid PTSD will be addressed. Finally, given that existing rating scales are not designed to measure symptoms of cPTSD/DES, we will describe the Symptoms of Trauma Scale (SOTS), designed to measure symptoms of both sPTSD and cPTSD.     

Pharmacotherapy for post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a serious mental illness of considerable importance from a public health perspective. Management of PTSD may involve the use of various treatment modalities, involving both nondrug treatments and pharmacotherapy. Nondrug treatment is regarded as the first-line option for PTSD and should be routinely incorporated into management plans for patients with PTSD. However, some patients do not achieve a sufficient response to nondrug therapy or are left with disabling residual symptoms in one or more areas. Antidepressants are currently the preferred medication for PTSD, with the most substantial evidence available to support the use of the selective serotonin reuptake inhibitors. Many patients with PTSD have symptoms that are resistant to initial drug treatment, meaning that it is often necessary to explore additional pharmacotherapy options to achieve optimal symptom control: antipsychotics, anti-adrenergic drugs, anxiolytics and anticonvulsants have all been advocated as treatments for PTSD. In addition to the management of core PTSD symptoms, it is also necessary for clinicians to address important associated comorbidities, most notably, substance-use disorders and mood disturbances. Interpretation of research studies of the efficacy and safety of PTSD pharmacotherapy is often difficult owing to methodological limitations and factors such as inclusion bias. Further research in fundamental neurosciences and pharmacogenomics may help to elucidate optimal pharmacotherapy options for PTSD in the future.     

Long-term pharmacotherapy for post-traumatic stress disorder

This article reviews the literature on the long-term pharmacological treatment of post-traumatic stress disorder (PTSD). A PUBMED search was conducted; only studies on the effects of long-term (>14-weeks) pharmacological treatment for PTSD in adults or children were considered. Our search identified three randomised, double-blind, placebo-controlled studies (one each for sertraline, fluoxetine and risperidone), four open-label studies (one each for sertraline, paroxetine, nefazodone and valproate), one retrospective case series (clozapine) and one pooled analysis (sertraline). All studies involved adult populations, with the exception of the study of clozapine. The studies demonstrate that long-term treatment of PTSD with SSRIs effectively maintains the previous treatment response and improvement in quality of life, converts more patients to responder status and accounts for one-third of overall treatment gains. Greater PTSD severity predicts a longer time to response to these drugs. Discontinuation of SSRI treatment after 12 weeks results in a greater risk of relapse and symptom exacerbation compared with extended treatment. In addition to improved PTSD symptoms, extended treatment with paroxetine improves verbal declarative memory and increases hippocampal volume. Long-term treatment of PTSD with atypical antipsychotics (risperidone and clozapine), non-SSRI antidepressants (nefazodone) and antiepileptic drugs (AEDs; valproate) also appears to result in significant improvements in PTSD symptoms. In conclusion, long-term treatment of PTSD with SSRIs improves the psychiatric and clinical outcome of patients with the disorder and prevents relapse and symptom exacerbation. The effect of other agents (atypical antipsychotics, AEDs and other psychotropic medications) requires further controlled study.     

Review of sertraline in post-traumatic stress disorder

Sertraline (Zoloft?, Pfizer) is a selective serotonin re-uptake inhibitor (SSRI) with proven efficacy in the treatment of post-traumatic stress disorder (PTSD). PTSD is a serious, complex and often chronic mental illness that may follow exposure to a traumatic event. The high prevalence of traumatic events and PTSD in the general population and the resulting distress and dysfunction present a need for the systematic study of the efficacy and effectiveness of treatments for PTSD. Sertraline offers advantages over the older antidepressants, including demonstrated efficacy in PTSD, improved tolerability and low risk of lethality in overdose. Sertraline’s efficacy, favourable tolerability profile and relatively weak effect on the cytochrome P450 system are factors that contribute to make it a first-line agent of choice in the treatment of PTSD.     

Review of sertraline in post-traumatic stress disorder

Sertraline (Zoloft trade mark, Pfizer) is a selective serotonin re-uptake inhibitor (SSRI) with proven efficacy in the treatment of post-traumatic stress disorder (PTSD). PTSD is a serious, complex and often chronic mental illness that may follow exposure to a traumatic event. The high prevalence of traumatic events and PTSD in the general population and the resulting distress and dysfunction present a need for the systematic study of the efficacy and effectiveness of treatments for PTSD. Sertraline offers advantages over the older antidepressants, including demonstrated efficacy in PTSD, improved tolerability and low risk of lethality in overdose. Sertraline's efficacy, favourable tolerability profile and relatively weak effect on the cytochrome P450 system are factors that contribute to make it a first-line agent of choice in the treatment of PTSD.     

New drug development for post-traumatic stress disorder

US FDA approval of two serotonin-selective reuptake inhibitor (SSRI) agents for post-traumatic stress disorder (PTSD) has created new opportunities for drug development. This follows many years of exploring the potential utility of several classes of psychotropic agents for this very common, yet under-recognized and under-treated disorder. This review examines some of the basic neurobiological abnormalities observed in PTSD and summarizes open and controlled drug trials for major classes of medications, including SSRIs, other antidepressants, atypical neuroleptics, noradrenergic modulators and anticonvulsants, while critically evaluating the extent of effectiveness of these agents and reviewing unmet gaps in therapeutic need.