Epidemiological, phenomenological, and treatment aspects of trauma and posttraumatic stress disorder in children and adolescents

[摘要] Many gaps remain in our current state of knowledge aboutthe epidemiology, phenomenology, neurobiology, andpsychopharmacology of posttraumatic stress disorder (PTSD)in children and adolescents. Empirical evidence,particularly in non-Western settings, is sparse and thereis little convergent understanding of the interrelationshipof epidemiological factors, PTSD symptomexpression, full and partial syndromes, disorders comorbidwith PTSD, and pharmacotherapeutic interventions.Clinicians are faced with the difficult task of treatingthis often complicated and debilitating disorder in youthin the absence of data from well-controlled clinicaltrials. The studies detailed here are a point of departurefor understanding the confluence that exists betweenepidemiological, phenomenological, and pharmacotherapeuticaspects of adolescent PTSD. Two studies were conducted toinvestigate the prevalence and effects of violence exposureand PTSD, clinical and functional correlates of full andpartial syndromes, and associated gender differences inschool and clinic samples, respectively. Two preliminaryopen-label trials assessed the efficacy and safety of aselective serotonin reuptake inhibitor (SSRI) inadolescents with at least moderate severity PTSD. The results indicate that (i) partial PTSD is a commonnosological entity in adolescents, (ii) gender-relateddifferences in PTSD, even if not manifest in differences inprevalence (i.e., in the rates of trauma exposure and fulland partial PTSD), may well manifest in symptom expression(i.e., higher symptom burden in girls), associatedmorbidity, and functional impairment, and (iii) SSRIs maybe effective in treating core PTSD symptoms in this agegroup.While not yet demonstrated, the partial subtype may havesimilar biological underpinnings to full PTSD inadolescents and may benefit from similarpharmacotherapeutic interventions. This is an areadeserving of further investigation. Controlled SSRI dataare needed to establish if these should be agents of choicefor paediatric PTSD.

[发布机构] Stellenbosch University