The process that resulted in the diagnostic criteria for posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5; American Psychiatric ...Association; ) was empirically based and rigorous. There was a high threshold for any changes in any DSM‐IV diagnostic criterion. The process is described in this article. The rationale is presented that led to the creation of the new chapter, “Trauma‐ and Stressor‐Related Disorders,” within the DSM‐5 metastructure. Specific issues discussed about the DSM‐5 PTSD criteria themselves include a broad versus narrow PTSD construct, the decisions regarding Criterion A, the evidence supporting other PTSD symptom clusters and specifiers, the addition of the dissociative and preschool subtypes, research on the new criteria from both Internet surveys and the DSM‐5 field trials, the addition of PTSD subtypes, the noninclusion of complex PTSD, and comparisons between DSM‐5 versus the World Health Association's forthcoming International Classification of Diseases (ICD‐11) criteria for PTSD. The PTSD construct continues to evolve. In DSM‐5, it has moved beyond a narrow fear‐based anxiety disorder to include dysphoric/anhedonic and externalizing PTSD phenotypes. The dissociative subtype may open the way to a fresh approach to complex PTSD. The preschool subtype incorporates important developmental factors affecting the expression of PTSD in young children. Finally, the very different approaches taken by DSM‐5 and ICD‐11 should have a profound effect on future research and practice.
Traditional and Simplified Chinese s by AsianSTSS
標題：敲定DSM‐5中的PTSD：從這裏到那裏，下一步又如何
撮要：敲定精神疾病診斷和統計手冊(DSM‐5；美國精神學會；2013)中創傷後壓力症(PTSD)的診斷準則是嚴謹而建基於臨床經驗的。改變任何DSM‐Ⅳ診斷準則要求都有高門檻。本文詳述當中過程和理據，因而有新一章，即〝創傷和壓力相關障礙〞在DSM‐5的元結構中設立。而DSM‐5 PTSD準則中曾討論的特定議題包括：闊或窄的PTSD結構，對準則A的決定，其他PTSD症狀羣和區分符的支持實証，加入解離和學前子類別，在互聯網調查和DSM‐5現場測試新準則的研究，加入PTSD子類別，取消複雜PTSD，和比較DSM‐5與世界衛生組織即將實行的國際疾病分類(ICD‐11)兩者的PTSD準則。PTSD結構不斷演變。DSM‐5中，它從一個狹窄地以驚恐為本的焦慮症走到包括煩躁/快感和外在化PTSD等表型。解離子類別可能開展對複雜PTSD的新研究路向。學前子類別包括影響幼兒表現PTSD的重要發展因素。DSM‐5和ICD‐11在不同的方向發展，對未來研究和臨床工作方面必定有深遠影響。
标题：敲定DSM‐5中的PTSD：从这里到那里，下一步又如何
撮要：敲定精神疾病诊断和统计手册(DSM‐5；美国精神学会；2013)中创伤后压力症(PTSD)的诊断准则是严谨而建基于临床经验的。改变任何DSM‐Ⅳ诊断准则要求都有高门坎。本文详述当中过程和理据，因而有新一章，即〝创伤和压力相关障碍〞在DSM‐5的元结构中设立。而DSM‐5 PTSD准则中曾讨论的特定议题包括：宽或窄的PTSD结构，对准则A的决定，其他PTSD症状羣和区分符的支持实证，加入解离和学前子类别，在互联网调查和DSM‐5现场测试新准则的研究，加入PTSD子类别，取消复杂PTSD，和比较DSM‐5与世界卫生组织即将实行的国际疾病分类(ICD‐11)两者的PTSD准则。PTSD结构不断演变。DSM‐5中，它从一个狭窄地以惊恐为本的焦虑症走到包括烦躁/快感和外在化PTSD等表型。解离子类别可能开展对复杂PTSD的新研究路向。学前子类别包括影响幼儿表现PTSD的重要发展因素。DSM‐5和ICD‐11在不同的方向发展，对未来研究和临床工作方面必定有深远影响。
Despite extensive study of the neurobiological correlates of post-traumatic stress disorder (PTSD), little is known about its molecular determinants. Here, differential gene expression and network ...analyses of four prefrontal cortex subregions from postmortem tissue of people with PTSD demonstrate extensive remodeling of the transcriptomic landscape. A highly connected downregulated set of interneuron transcripts is present in the most significant gene network associated with PTSD. Integration of this dataset with genotype data from the largest PTSD genome-wide association study identified the interneuron synaptic gene ELFN1 as conferring significant genetic liability for PTSD. We also identified marked transcriptomic sexual dimorphism that could contribute to higher rates of PTSD in women. Comparison with a matched major depressive disorder cohort revealed significant divergence between the molecular profiles of individuals with PTSD and major depressive disorder despite their high comorbidity. Our analysis provides convergent systems-level evidence of genomic networks within the prefrontal cortex that contribute to the pathophysiology of PTSD in humans.
We conducted a systematic review of the literature to explore the longitudinal course of PTSD in DSM-5-defined trauma exposed populations to identify the course of illness and recovery for ...individuals and populations experiencing PTSD.
We reviewed the published literature from January 1, 1998 to December 31, 2010 for longitudinal studies of directly exposed trauma populations in order to: (1) review rates of PTSD in the first year after a traumatic event; (2) examine potential types of proposed DSM-5 direct trauma exposure (intentional and non-intentional); and (3) identify the clinical course of PTSD (early onset, later onset, chronicity, remission, and resilience). Of the 2537 identified articles, 58 articles representing 35 unique subject populations met the proposed DSM-5 criteria for experiencing a traumatic event, and assessed PTSD at two or more time points within 12 months of the traumatic event.
The mean prevalence of PTSD across all studies decreases from 28.8% (range =3.1-87.5%) at 1 month to 17.0% (range =0.6-43.8%) at 12 months. However, when traumatic events are classified into intentional and non-intentional, the median prevalences trend down for the non-intentional trauma exposed populations, while the median prevalences in the intentional trauma category steadily increase from 11.8% to 23.3%. Across five studies with sufficient data, 37.1% of those exposed to intentional trauma develop PTSD. Among those with PTSD, about one third (34.8%) remit after 3 months. Nearly 40% of those with PTSD (39.1%) have a chronic course, and only a very small fraction (3.5%) of new PTSD cases appears after three months.
Understanding the trajectories of PTSD over time, and how it may vary by type of traumatic event (intentional vs. non-intentional) will assist public health planning and treatment.
Despite well-known peripheral immune activation in posttraumatic stress disorder (PTSD), there are no studies of brain immunologic regulation in individuals with PTSD.
CPBR28 Positron Emission ...Tomography brain imaging of the 18-kDa translocator protein (TSPO), a microglial biomarker, was conducted in 23 individuals with PTSD and 26 healthy individuals-with or without trauma exposure. Prefrontal-limbic TSPO availability in the PTSD group was negatively associated with PTSD symptom severity and was significantly lower than in controls. Higher C-reactive protein levels were also associated with lower prefrontal-limbic TSPO availability and PTSD severity. An independent postmortem study found no differential gene expression in 22 PTSD vs. 22 controls, but showed lower relative expression of TSPO and microglia-associated genes TNFRSF14 and TSPOAP1 in a female PTSD subgroup. These findings suggest that peripheral immune activation in PTSD is associated with deficient brain microglial activation, challenging prevailing hypotheses positing neuroimmune activation as central to stress-related pathophysiology.
Posttraumatic stress disorder (PTSD) is an important mental health issue in terms of the number of people affected and the morbidity and functional impairment associated with the disorder. The ...purpose of this study was to examine the efficacy of all treatments for PTSD.
PubMed, MEDLINE, PILOTS, and PsycINFO databases were searched for randomized controlled clinical trials of any treatment for PTSD in adults published between January 1, 1980, and April 1, 2012, and written in the English language. The following search terms were used: post-traumatic stress disorders, posttraumatic stress disorder, PTSD, combat disorders, and stress disorders, post-traumatic.
Articles selected were those in which all subjects were adults with a diagnosis of PTSD based on DSM criteria and a valid PTSD symptom measure was reported. Other study characteristics were systematically collected. The sample consisted of 137 treatment comparisons drawn from 112 studies.
Effective psychotherapies included cognitive therapy, exposure therapy, and eye movement desensitization and reprocessing (g = 1.63, 1.08, and 1.01, respectively). Effective pharmacotherapies included paroxetine, sertraline, fluoxetine, risperidone, topiramate, and venlafaxine (g = 0.74, 0.41, 0.43, 0.41, 1.20, and 0.48, respectively). For both psychotherapy and medication, studies with more women had larger effects and studies with more veterans had smaller effects. Psychotherapy studies with wait-list controls had larger effects than studies with active control comparisons.
Our findings suggest that patients and providers have a variety of options for choosing an effective treatment for PTSD. Substantial differences in study design and study participant characteristics make identification of a single best treatment difficult. Not all medications or psychotherapies are effective.
New Scope of the Document Although reports on cardiovascular screening efficacy have predominantly involved populations of adolescents and young adults participating in competitive athletics, the ...context of the present discussion is intentionally (and necessarily) much more expansive. ...it is underscored that the present report is not limited in scope to universal mass screening for athlete populations but importantly includes considerations for screening large, young, and truly general populations (school-aged, 12-25 years old, of both sexes) with respect to relevant logistical, ethical, legal, and societal issues (e.g., in the United States or other countries or communities of various sizes, in schools, or in regional or military populations).
Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM‐5; 2013) and fourth edition ...(DSM‐IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self‐administered survey. Traumatic event exposure using DSM‐5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past‐12‐month, and past 6‐month PTSD prevalence using the Same Event definition for DSM‐5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM‐5 prevalence estimates were slightly lower than their DSM‐IV counterparts, although only 2 of these differences were statistically significant. DSM‐5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM‐IV criteria, but not DSM‐5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.
Traditional and Simplified Chinese s by AsianSTSS
標題：使用DSM‐Ⅳ和DSM‐5準則去估算全國的創傷經歷和PTSD患病率
撮要 : 透過網上小組集合美國全國成人樣本(N=2,953), 套用美國精神學協會的精神疾病診斷和統計手冊(DSM)的DSM‐5和DSM IV版本來診斷PTSD的患病率並比較。評估是在網上利用一個高度結構自我評估調查：創傷經歷，PTSD症狀，和功能障礙。創傷經歷若使用DSM‐5準則會有高比率(89.7%)，但標準是多重創傷經歷。利用同一事件(即所有症狀準則符合同一事件類別)和綜合事件(即症狀準則符合事件類別的混合)定義來決定PTSD病例。使用DSM‐5和同一事件定義的終身、過去12個月及過去6個月PTSD患病率分別為8.3%，4.7%和3.8%。所有6個DSM‐5患病率估量都比DSM‐IV者為低，雖然其中只有2個的差別是統計上有效的。DSM‐5 PTSD患病率是女性高於男性，而且隨着更大創傷經歷而增加。有些人符合DSM‐IV但不合DSM‐5診斷的主因是：撇除在準則A內非意外非暴力死亡和新加的最少一個主動迴避症狀的要求。
标题：使用DSM‐Ⅳ和DSM‐5准则去估算全国的创伤经历和PTSD患病率
撮要 : 透过网上小组集合美国全国成人样本(N=2,953), 套用美国精神学协会的精神疾病诊断和统计手册(DSM)的DSM‐5和DSM IV版本来诊断PTSD的患病率并比较。评估是在网上利用一个高度结构自我评估调查：创伤经历，PTSD症状，和功能障碍。创伤经历若使用DSM‐5准则会有高比率(89.7%)，但标准是多重创伤经历。利用同一事件(即所有症状准则符合同一事件类别)和综合事件(即症状准则符合事件类别的混合)定义来决定PTSD病例。使用DSM‐5和同一事件定义的终身、过去12个月及过去6个月PTSD患病率分别为8.3%，4.7%和3.8%。所有6个DSM‐5患病率估量都比DSM‐IV者为低，虽然其中只有2个的差别是统计上有效的。DSM‐5 PTSD患病率是女性高于男性，而且随着更大创伤经历而增加。有些人符合DSM‐IV但不合DSM‐5诊断的主因是：撇除在准则A内非意外非暴力死亡和新加的最少一个主动回避症状的要求。
Introduction
The ongoing coronavirus disease 2019 (COVID‐19) pandemic is a globally significant crisis with a rapid spread worldwide, high rates of illness and mortality, a high degree of ...uncertainty, and a disruption of daily life across the sociodemographic spectrum. The clinically relevant psychological consequences of this catastrophe will be long‐lasting and far‐reaching. There is an emerging body of empirical literature related to the mental health aspects of this pandemic and this body will likely expand exponentially. The COVID‐19 pandemic is an example of a historic catastrophe from which we can learn much and from which the field will need to archive, interpret, and synthesize a multitude of clinical and research observations.
Methods
In this commentary, we discuss situations and contexts in which a diagnosis of posttraumatic stress disorder (PTSD) may or may not apply within the context of diagnostic and statistical manual of mental disorders, fifth edition (DSM‐5) criteria.
Results
Our consensus is that a COVID‐related event cannot be considered traumatic unless key aspects of DSM‐5's PTSD Criterion A have been established for a specific type of COVID‐19 event (e.g., acute, life‐threatening, and catastrophic).
Conclusion
The application of a more liberal interpretation of Criterion A will dilute the PTSD diagnosis, increase heterogeneity, confound case–control research, and create an overall sample pool with varying degrees of risk and vulnerability factors.
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