STANLEY L. GOODMAN, M.D. – Qualified Medical Examiner #962948
Diplomate, American Board of Psychiatry & Neurology
in Forensic, Child, Adolescent, Adult, Addiction, and Geriatric Psychiatry
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THE NEUROPSYCHIATRIC BASIS OF POST-TRAUMATIC STRESS DISORDER
A traumatic situation, where a threat to one's body integrity or life occurs, may produce severe anxiety symptoms which are diagnosed as Post-Traumatic Stress Disorder (PTSD). Most patients also develop a concurrent agitated depression.
The Neuroanatomical Basis of Post-Traumatic Stress Disorder
The reason treatment of PTSD is prolonged can be understood on the basis of neuroanatomy. A group of neurons in the brain stem (below the cortical areas of the brain) are called the LOCUS CERULEUS. Connections between the LOCUS CERULEUS -- which activate the brain/memory center in the temporal lobe of the brain (the HIPPOCAMPUS) -- are a neuroanatomic basis for the recurrence of PTSD since this area of the brain contains norepinephrine-containing neurons with neuroanatomic connections to the HIPPOCAMPUS. When a person reexperiences a trauma, the hypocampal connections activate the norepinephrine-containing neurons. This norepinephrine surge causes subjective symptoms of severe anxiety -- a "flight or fight" response -- which is maladaptive when one experiences a non-life-threatening trauma. For example, a person traumatized by a past auto accident later experiences severe anxiety even while riding safely in a car.
Treatment of Post-Traumatic Stress Disorder
Psychotropic medication to treat depression and anxiety -- i.e., anti-depressants and anti-anxiety agents -- cannot diminish PTSD trauma-induced memory and are only partially effective in decreasing PTSD anxiety/depressive symptoms. Since trauma-induced memories last a lifetime, there is need for extensive, prolonged psychological treatment, i.e., cognitive behavioral therapy/desensitization. However, psychotherapy also is only partially effective in reducing locus ceruleus-induced norepinephrine cerebral activation which occurs during the frequent re-experiencing of the traumatic event.
Knowledge of the neuropsychiatric basis of PTSD is essential in order to understand the chronicity, as well as the need for long-term lifetime treatment.1
1.Textbook of Neuropsychiatry, edited by Stuart Yudofsky and Robert E. Hales, M.D. (American Psychiatric Association Press, June 1997).