Psychiatry
PTSD
외상후스트레스장애
Persistent intrusion/avoidance/arousal symptoms ≥1 mo after trauma
- How common
- Lifetime 7–8% (combat/disaster 30%)
- Typical age
- Any age post-trauma
What is it?
Amygdala hyperactivity, hippocampal atrophy, PFC underregulation, HPA dysregulation, NE excess.
Commonly affected: Amygdala, hippocampus, mPFC, locus coeruleus
How it develops
- Traumatic eventActual/threatened death, injury, sexual violence
- Fear memory consolidationAmygdala-hippocampus over-consolidation
- Amygdala↑/PFC↓Failed top-down fear inhibition
- NE/HPA dysregulationParadoxically low cortisol, NE surges
Symptoms
- IntrusionFlashbacks, nightmares, intrusive memories
- HyperarousalHypervigilance, startle, insomnia
- AvoidanceAvoid trauma-related cues/thoughts
- Negative cognition/moodGuilt, anger, emotional numbing
- DissociationDepersonalization (dissociative subtype)
How it is examined
- DSM-5 PTSDTrauma exposure + 4 clusters + ≥1 month
- PCL-5PCL-5, cutoff ≥33
- Comorbidity assessmentHigh comorbidity with MDD, AUD, suicide risk
Imaging
MRI: reduced hippocampal volume.
- Hippocampal atrophy
fMRI: amygdala hyperactivity, mPFC underactivity.
- Amygdala hyperactivity
Non-surgical care
- Trauma-focused CBTProlonged Exposure (PE), Cognitive Processing Therapy (CPT)
- EMDREye Movement Desensitization and Reprocessing
- SSRI/SNRISertraline/paroxetine (FDA-approved), venlafaxine
- Prazosin (nightmares)α1-blocker for trauma nightmares
- Treat comorbiditiesConcurrent AUD, depression treatment
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Treatment-resistant PTSD
Procedures that may be discussed
- MDMA-assisted therapy (clinical trial)
- Stellate ganglion block
- Ketamine
- rTMS
Outlook
60% become chronic. 80% improve with early trauma-focused treatment.