Pathophysiology of PTSD:

Etiologically, there must by definition be a life threatening stressor that induces immense fear (actual or perceived threat). There appear to exist a dose-response relationship between degree of trauma and development of PTSD symptoms. Psychodynamically, PTSD could be interpreted as re-activation of psychological traumas experienced in childhood by a traumatic event later. Patients develop ineffective skills and remain unable to maintain and regulate internal emotional stability and may use somatization to cope with the anxiety brought up by the consequences of traumatic experience. Cognitively, person is thought to be rendered unable by the trauma to rationalize or process the trauma. Biologically, multiple neurotrasmitters have been implicated including stress-response system, HPA-axis disrugulation. (Please refer to Kaplan and Saddock for details).

Treatment:

Treatment of PTSD remain a challenge for both developing and developed worlds. In the developing world individual face life and death situation frequently. In the developed world, violent traumas (e.g. rape, physical violence) in civilian population and combat related trauma in service members render these individuals vulnerable to developing PTSD. In spite of decades of research in PTSD, there is no consensus on the best practice in treating patients with PTSD. Treatment should include addressing co-morbid psychiatric disorders, substance related disorder, psycho-social consequences of trauma (disability, being judged, financial burdens etc.), and physical diseases as well as symptoms of PTSD. One must ensure patients' safety; if patient is suicidal, hospitalization may be warranted.

Psychotropics:

Antidepressants seem helpful in reducing the symptoms of PTSD including SSRIs, tricyclics, and MOAIs as well as buspiron. Anti-epileptic medications seem helpful too. Clonidine and propranolol have been used with some limited success. Psychotherapy seems an effective tool.

Psychotherapy

All types of psychotherapy have been found helpful including long-term and focused psychodynamic psychotherapy. Of particular note are Eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive-behavioral therapy (CBT) both of which are effective and practically more feasible compared to other types of therapies. Group psychotherapy and support groups can also be helpful. However, most of these therapies are unavailable to Afghans especially Afghan women. Therefore, the main focus of treatment in Afghans remain psychotropics.

Further Reading:
1. Cannon W. B. Bodily changes in pain, hunger, fear and rage, an account of recent researches into the function of emotional excitement. New York: Appleton: 1915.
2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Third Edition. Washington, DC, American Psychiatric Association, 1980.
4. Jones E, Fear N, Wessely S. Shell Shock and Mild Traumatic Brain Injury: A Historical Review. Am J Psychiatry 164:1641-1645.
5. BENTLEY S. A Short History of PTSD: From Thermopylae to Hue Soldiers Have Always Had A Disturbing Reaction To War. Voice of Vietnam Veterans of America: 1991, updated April 2005. Accessed June 2010 < http://www.vva.org/archive/TheVeteran/2005_03/feature_HistoryPTSD.htm>
6. Shalev AY. Stress versus Traumatic Stress: from Acute Homeostatic Reactions to Chronic Psychopathology. In Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. Von der Kolk BA, McFarlane AC,Weisaeth L (ed.) New Yor: Guilford; 1996.
7. Sadock BJ, Sadock, VA. Synopsis of Psychiatry. 10th ed. Philadelphia:Lippincott Williams & Wlters Kluwer; 2007.
8. http://www.kan.or.kr/new/kor/sub3/filedata_anr/200902/90.pdf
9.Lopes Cardozo, B., Vergara, A., Agani, F., & Gotway, C.A. (2000). Mental health, social functioning and attitudes of Kosovar Albanians following the war in Kosovo. The Journal of the American Medical Association, 284, 569–577.
10. Bolton, P., & Betancourt, T. S. (2004). Mental health in postwar Afghanistan. The Journal of the American Medical Association, 292, 626–628.