Die posttraumatische Belastungsstörung: Teil 1 - Eine Übersicht

Zusammenfassung

Die posttraumatische Belastungsstörung (PTBS) wurde schon vor Jahrzehnten insbesondere im Zusammenhang mit Kriegsereignissen beschrieben. Sie wird bis heute bei Menschen, die mit Krieg, Naturkatastrophen, Terrorismus, Unglücken oder schwerwiegenden persönlichen Schicksalsschlägen konfrontiert werden, beobachtet. Zahlreiche Einflussfaktoren begünstigen das Auftreten einer PTBS. Beispielsweise werden Männer häufiger mit traumatischen Situationen konfrontiert, Frauen hingegen entwickeln häufiger eine PTBS als Männer. Auch liegen mittlerweile interessante Ergebnisse für Zusammenhänge zwischen genetischen Faktoren und Umweltbedingungen vor. Die Persönlichkeitsvariablen Ängstlichkeit, Stressreaktivität, emotionale Labilität und Neigung zu Depressionen sind signifikant mit dem kurzen Allel der Promotorregion des Serotonin-Transporters assoziiert. Bei Menschen, die dieses Allel tragen, ist der Serotoninmetabolismus signifikant verringert, was zur Entstehung einer PTBS beiträgt. Ähnliche Untersuchungen werden in den kommenden Jahren zur Aufklärung dieser bislang nur wenig verstandenen Erkrankung beitragen.

Abstract

Posttraumatic stress disorder (PTSD) has been described since more than one century, especially following war and combat experiences. Until today it can be seen frequently in subjects which have encountered war, natural catastrophes, terrorism or other severe psychotraumas. In the past decades, operationalized diagnostic criteria have been established, which are currently described in the ICD-10 and DSM-IV manuals. Interesting findings on the interplay between genetic risk factors and life events have been published in the recent years. A polymorphism of the serotonin transporter promoter has been studied most comprehensively in this respect. The short allele of the promoter is significantly associated with the personality variables Anxiety, Stress reactivity, Emotional lability and Depression. In subjects carrying the short allele, serotonin metabolism is significantly decreased which contributes to the development of PTSD. In the coming years, similar studies will shed further light on the pathophysiology of this only poorly understood disorder.

Schlüsselwörter

Posttraumatische Belastungsstörung - PTBS - Geschichte - Diagnostik - Risikofaktoren - Epidemiologie - Pathophysiologie - Serotonin-Transporter-Polymorphismus - 5HTT Promoter

Key words

Posttraumatic stress disorder - PTSD - history - diagnosis - risk factors - epidemiology - pathophysiology - serotonin transporter polymorphism - 5HTT promoter

Literatur

• 1 American Psychiatric Association Diagnostic and Statistic Manual of Mental Disorders .First, Second, Third, Fourth Edition, American Psychiatric Association. 
• 2 Ayers S, Pickering A D. Do woman get posttraumatic stress disorder as a result of childbirth? A prospective study of incidence.  Birth. 2001;  28 111-118
• 3 Bennett A J, Lesch K P, Heils A, Long J C, Lorenz J G, Shoaf S E, Champoux M, Suomi S J, Linnoila M V, Higley J D. Early experience and serotonin transporter gene variation interact to influence primate CNS function.  Molecular Psychiatry. 2002;  7 118-122
• 4 Blanchard E B, Hickling E J, Barton K A, Taylor A E, Loos W R, Jones-Alexander J. One-year prospective follow-up of motor vehicle accident victims.  Behav Res Ther. 1996;  34 775-786
• 5 Breslau N, Davis P, Andreski E, Peterson E L. Traumatic events and posttraumatic stress disorder in an urban population of young adults.  Arch Gen Psychiatry. 1991;  48 216-222
• 6 Breslau N, Davis P, Peterson E L, Schultz L. Psychiatric sequelae of posttraumatic stress disorder in women.  Arch Gen Psychiatry. Jan 1997;  54 81-87
• 7 Breslau N, Kessler R C, Kessler Ph D, Howard D, Chichot H D, Lonni R, Schultz Ph D, Glenn C, Davis M D, Patricia Andrewski M A. Trauma and posttraumatic stress disorder in the community. The 1996 Detroit Area Survey of Trauma.  Arch Gen Psychiatry. 1998;  55 626-632
• 8 Buckley T C, Blanchard E B, Neill W T. Information processing and PTSD, a review of the empirical literature.  Clin Psychol Rev. Nov 2000;  20 1041-1065
• 9 Caldera T, Palma L, Penayo U, Kullgren G. Psychological impact of the hurricane mitch in Nicaragua in a one-year perspective.  Soc Psychiatry Psychiatr Epidemiol. 2001;  36 108-114
• 10 Czarnocka J, Slade P. Prevalence and predictors of post-traumatic stress symptoms following childbirth.  Br J Clin Psychol. 2000;  39 35-51
• 11 Dew A M, Roth L H, Thompson M E, Kormos R L, Griffeth B D. Medical compliance and its predictors in the first year after heart transplantation.  J Heart Lung Transplant. 1996;  15 631-645
• 12 Dew A M, Kormos R L, Di Martini A F, Switzer G E, Schulberg H C, Roth L H, Griffith B P. Prevalence and risk of depression and anxiety-related disorders during the first three years after heart transplantation.  Psychosomatics. Jul-Aug 2001;  42 300-313
• 13 Engelhard I M, Hout M A van den, Arntz A. Posttraumatic stress disorder after pregnancy loss.  Gen Hosp Psychiatry. Mar-Apr 2000;  23 62-66
• 14 Farley M, Barkan H. Prostitution, violance and posttraumatic stress disorder.  Woman Health. 1998;  27 37-49
• 15 Feinstein A, Dolan R. Predictors of post-traumatic stress disorder following physical trauma: an examination of the stressor criterion.  Psychol Med. Feb 1991;  21 85-91
• 16 Feusner J, Ritchie T, Lawford B, Young R M, Kann B. Noble EP.GABA(A) receptor beta 3 subunit gene and psychiatric morbidity in a post-traumatic stress disorder population.  Psychiatry Res. Nov 1 2001;  104 109-117
• 17 Foa E B. Failure of emotional processing: post trauma psychopathology. Copenhagen, Den Haag: Presented at the World Congress of Behavioural & Cognitive Therapies 1995 July 15
• 18 Foa E B. Trauma and woman: course, predictors and treatment.  J Clin Psychiatry. 1997;  Suppl 9 25-28
• 19 Fullerton C S, Ursano R J, Epstein R S, Crowley B, Vance K, Kao T C, Dougall A, Baum A. Gender differences in posttraumatic stress disorder after motor vehicle accidents.  Am J Psychiatry. 2001;  158 1486-1491
• 20 Goenijan A K, Najarian L M, Pynoos R S, Steinberg A M, Manoukian G, Tavosian, A , Fairbanks L A. Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia.  Am J Psychiatry. 1994;  151 6
• 21 Helzer J E, Robins L N, McEvoy L. Posttraumatic stress disorder in the general population.  N Engl J Med. 1987;  317 1630-1634
• 22 Internationale Klassifikation der Krankheiten - ICD 10. 
• 23 Kessler R C, Sunnega A, Bromet E, Hughes M, Nelson C. Posttraumatic stress disorder in the National Comorbidity Survey.  Arch Gen Psychiatry. 1995;  52 1048-1060
• 24 Kulka R A, Schlenger W E, Fairbank J A, Hough R L, Jordan B K, Marmar C R, Weiss D S. Trauma and Vietnam war generation: report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner & Mazel 1990
• 25 Lesch K P, Bengel D, Heils A, Sabol S Z, Greenberg B D, Petri S, Benjamin J, Müller C R, Hamer D H, Murphy D L. Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region.  Science. 1996;  29 1527-1531
• 26 McCarren M, Goldberg J, Ramakrishnan V, Fabsitz R. Insomnia in Vietnam era veteran twins: influence of genes and combat experience.  Sleep. Aug 1994;  17 465-561
• 27 Möller H-J, Laux G, Kapfhammer H-P. Psychiatrie und Psychotherapie. Springer 2000
• 28 Oppenheim H. Die traumatischen Neurosen nach den in der Nervenklinik der Charité in den letzten Jahren gesammelten Beobachtungen. Berlin: Hirschwald 1889
• 29 Proctor S P, Harley R, Wolfe J, Heeren T, White R F. Health-related quality of life in Persian Gulf War Veterans.  Mil-Med. 2001;  166 510-609
• 30 Resnick H S, Kilpatrick D G, Dansky B S, Saunders B E. Best CL Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women.  J Consult Clin Psychol. Dec 1993;  61 984-991
• 31 Riggs D S, Rothbaum B O, Foa E B. A prospective examination of symptoms of posttraumatic stress disorder in victims of nonsexual assault.  J Interpersonal Violence. 1995;  10 201-214
• 32 Smeraldi E, Zanardi R, Benedetti F, Di-Bella D, Perez J, Catalano M. Polymorphism within the promoter of the serotonin transporter gene and antidepressant efficacy of fluvoxamine.  Mol Psychiatry. 1998;  3 508-511
• 33 Stein M B, Walker J R, Haven A L. Full and partial posttraumatic stress disorder: findings from a community survey.  Am J Psychiatry. 1997;  154 1114-1119
• 34 Stukas A A jr, Dew A M, Switzer G E, Di Martini A, Kormos R L, Griffith B P. PTSD in heart transplant recipients and their primary family caregivers.  Psychosomatics. 1999;  40 212-221
• 35 Vanderlinden J, Dyck R van, Vandereycken W, Vertommen H. Dissociation and traumatic experiences in the general population of The Netherlands.  Hosp Community Psychiatry. 1993;  4 786-788
• 36 Verger P, Hunault C, Rotily M, Baruffol E. Risk factors for post traumatic stress symptoms five years after the 1992 flood in the Vaucluse.  Rev Epidemiol Sante Publique. 2000;  48 Suppl 2 44-53
• 37 Vogel L C, Marshall L L. PTSD symptoms and partner abuse, low income woman at risk.  J Trauma Stress. 2001;  14 369-384
• 38 Wagner D, Heinrichs M, Ehlert U. Prevalence of Symptoms of Posttraumatic Stress Disorder in German Professional Firefighters.  Am J Psychiatry. Dec 1998;  155 1727-1732
• 39 Wang X, Gao L, Zhang H, Zhao C, Shen Y, Shinfuku N. Post-earthquake quality of life and psychological well-being: longitudinal evaluation in rural community sample in northern china.  Psychiatry Clin Neurosci. 2000;  54 427-433
• 40 Wijma K, Soderquist J, Wijma B. Posttraumatic stress disorder after childbirth: a cross sectional study.  J Anxiety Disord. 1997;  11 587-597