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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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).


Stanley L. Goodman M.D.

5535 Balboa Blvd. Suite 215

Encino, CA 91316

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