Treatment of Posttraumatic Stress Disorder An Assessment of the Evidence (2008) / Chapter Skim
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1 Introduction
1 Introduction
Pages 17-38
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veterans grows, their continued care is a national health care concern. -- Mapping the Landscape of Deployment Related Adjustment and Mental Disorders, 2006 M ental disorders, including posttraumatic stress disorder (PTSD)
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. In conducting its search of the literature, the committee excluded studies on patient groups that did not fully meet the Diagnostic and Statistical Manual of Mental Disorders definition. Box 1-2 below lists other topics that are not included in this report.
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V. The committee shall note when the evidence base does not allow for respond ing to these questions due to insufficient research attention or poorly con ducted studies. THE STUDY PROCESS The committee held five meetings over a period of approximately nine months.
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• PTSD in children or adolescents • Feasibility, cost, or cost-effectiveness of various treatment modalities The committee also received public submissions of material for its consideration at the meetings and by e-mail throughout the course of the study. A Web site (http://www.iom.edu/PTSDtreatment) and e-mail listserv were created to provide information to the public about the committee's work and to facilitate communication with the committee.
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. The Diagnostic and Statistical Manual of Mental Disorders (DSM)
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. The most common comorbid disorders among male veterans with PTSD were alcohol use disorder and major depression.
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) and several comorbid mental disorders (such as major depression and other anxiety disorders)
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The committee's review of the evidence was not restricted to veterans, but included all relevant studies of PTSD treatment in a variety of populations, including veterans. Since such a broad examination of the literature is necessary, it presents an important challenge in the question of applicability of nonveteran research findings to veteran populations.
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Special Issues Related to PTSD in the Military Military sexual assault (sexual assault experienced while in military service) is an additional traumatic stressor that affects military personnel, and subsequently, is identified as an exposure leading to PTSD in some, generally female, veterans.
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Description of the Pharmacotherapies In its review of the literature the committee found seven main categories (and a miscellaneous category) of pharmacotherapy used to treat PTSD for which there are randomized controlled clinical trials (RCTs)
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Other known potential side effects include drowsiness, light-headedness, tiredness, dizziness, irritability, talkativeness, dry mouth, increased salivation, changes in sex drive or ability, changes in appetite, weight changes, and difficulty urinating. Monoamine Oxidase Inhibitors Monoamine oxidase inhibitors (MAOIs)
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Also FDA approved to treat social anxiety disorder. Also FDA approved to treat social anxiety disorder, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder.
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Potential side effects include anxiety, blurred vision, changes in taste, constipation, sexual dysfunction, dizziness, drowsiness, dry mouth, flushing, headache, increased sweating, loss of appetite, nausea, nervousness, stomach upset, trouble sleeping, vomiting, weakness, and weight loss. Nefazodone Nefazodone is another drug used in PTSD treatment that is FDA approved to treat depression.
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; (2) cognitive restructuring used in cognitive therapy and cognitive processing therapy; (3)
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SUMMARY OF THE MAJOR CLINICAL PRACTICE GUIDELINES To be sure that the committee was aware of all pharmacotherapies and psychotherapies in general clinical use, a search was conducted for clinical practice guidelines developed by major professional organizations. The committee reviewed clinical practice guidelines developed by the Management of Post-traumatic Stress Working Group of VA and the Department of Defense (DoD)
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An A rating means that the evidence comes from "at least one RCT as part of a body of literature of overall good quality and consistency addressing the specific recommendation (evidence level I10) without extrapolation." A B rating means that evidence comes from "well-conducted clinical studies but no randomised clinical trials on the topic of recommendation" (evidence levels II or III11)
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At the time of this writing, the Australian government's Centre for Posttraumatic Mental Health had just published its Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. The guidelines drew on the British NICE guidelines and U.S.
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2000. Efficacy and safety of sertraline treatment of posttraumatic stress dis order: A randomized controlled trial.
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2006. Posttraumatic stress disorder in female veterans with military and civilian sexual trauma.
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2006. Reboxetine versus fluvoxamine in the treatment of motor vehicle accident-related posttraumatic stress disorder: A double-blind, fixed-dosage, controlled trial.
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2001. P aroxetine in the treatment of chronic posttraumatic stress disorder: Results of a placebo controlled, flexible-dosage trial.
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