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David M. Benedek, M.D., is Professor, Deputy Chair, and Associate Director and Senior Scientist of the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Gary H. Wynn, M.D., is Assistant Chief of the Inpatient Psychiatry Service, Walter Reed Army Medical Center, Washington, D.C., and Assistant Professor of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Senior International Editorial Advisory Board: Robert J. Ursano, M.D., (chair), Richard A. Bryant, Ph.D., Arieh Y. Shalev, M.D., and Simon A. Wessely, M.D.
Contributors | p. xv |
Disclosure of Interests | p. xxi |
Preface | p. xxiii |
Introduction and Overview | |
Introduction | p. 3 |
A Brief History of PTSD | p. 4 |
The Purpose of This Manual | p. 5 |
How to Use This Manual | p. 6 |
Epidemiology | p. 11 |
Relationship of Epidemiology to Clinical Practice | p. 11 |
What Is PTSD? | p. 18 |
Epidemiology of Criterion A | p. 19 |
Epidemiology of PTSD Following Traumatic Events | p. 22 |
Course of Illness and Symptom Persistence | p. 26 |
Factors That Modify Risk | p. 27 |
Impact of PTSD on the Community and Health Care System | p. 32 |
Applying Epidemiological Knowledge to the Clinical Management of PTSD | p. 33 |
Conclusion | p. 36 |
Key Clinical Points | p. 37 |
Biology | p. 45 |
The Interactive Role of Heritability and Environment in the Etiology of PTSD | p. 46 |
Influence of Gender in PTSD | p. 48 |
Neuroendocrine and Neurochemical Aspects of PTSD | p. 49 |
Neuroimaging Studies in PTSD | p. 54 |
Conclusion | p. 60 |
Key Clinical Points | p. 60 |
Assessment and Diagnosis | p. 69 |
General Considerations | p. 70 |
PTSD Diagnostic Criteria | p. 71 |
Threats to Reliability and Validity | p. 75 |
Assessment of PTSD | p. 83 |
Differential Diagnosis of PTSD | p. 91 |
Key Clinical Points | p. 96 |
Psychiatric Comorbidities | p. 101 |
Theories of Psychiatric Comorbidity With PTSD | p. 102 |
Psychiatric Comorbidities in Different PTSD Populations: Review of the Research Literature | p. 109 |
Clinical Implications of Psychiatric Comorbidity With PTSD | p. 118 |
Key Clinical Points | p. 119 |
Therapeutics and Management | |
Pharmacotherapy | p. 131 |
Antidepressants | p. 133 |
Antiadrenergic Agents | p. 143 |
Anticonvulsant/Mood Stabilizer Agents | p. 144 |
D-Cycloserine | p. 144 |
Benzodiazepines | p. 145 |
Atypical Antipsychotic Medications | p. 146 |
Hypothalamic-Pituitary-Adrenocortical System | p. 146 |
Applicability to Military and Veteran Populations | p. 147 |
Gaps in Current Knowledge | p. 148 |
Combined Therapy | p. 149 |
Key Clinical Points | p. 150 |
Psychosocial Treatments | p. 157 |
Theoretical Foundations of Cognitive-Behavioral Treatments for PTSD | p. 158 |
CBT Treatments and Techniques for PTSD | p. 164 |
Treatment Outcome Research in PTSD | p. 168 |
Future Directions for Treatment Outcome Research | p. 190 |
Conclusion | p. 94 |
Key Clinical Points | p. 195 |
Violence and Aggression | p. 205 |
General Risk Factors for Violence or Aggression | p. 209 |
Assessment and Management of PTSD and Violence | p. 212 |
Conclusion | p. 217 |
Key Clinical Points | p. 219 |
Emerging and Alternative Therapies | p. 227 |
Virtual Reality Exposure Therapy | p. 228 |
Other Emerging and Alternative Nonpharmacological Therapies | p. 241 |
Emerging and Alternative Pharmacological Therapies | p. 244 |
Conclusion | p. 247 |
Key Clinical Points | p. 247 |
Assessment of Functioning and Disability | p. 255 |
Rationale for Assessment of Functioning and Disability | p. 256 |
Conceptual Framework and Definitions | p. 262 |
Selection of Domains for Assessment | p. 263 |
Measures of Global, Social, and Occupational Functioning | p. 264 |
Assessment of Contextual Factors | p. 276 |
Conclusion | p. 278 |
Key Clinical Points | p. 280 |
Special Topics | |
Children and Adolescents | p. 291 |
Developmental Considerations of PTSD | p. 292 |
Comorbidity | p. 294 |
Childhood Traumatic Grief: A Unique Clinical Condition | p. 294 |
Childhood Trauma Exposures | p. 295 |
Prevalence of Childhood PTSD | p. 297 |
Therapeutic Interventions | p. 298 |
Conclusion | p. 315 |
Key Clinical Points | p. 316 |
Sexual Assault | p. 325 |
Sexual Assault and PTSD | p. 327 |
Social Reactions to Sexual Assault | p. 328 |
Assessment of Sexual Assault Survivors | p. 328 |
Treatment Approaches for Sexual Assault Survivors With PTSD | p. 335 |
Common Treatment Themes | p. 337 |
Conclusion | p. 343 |
Key Clinical Points | p. 344 |
Military and Veteran Populations | p. 349 |
Rates and Risk Factors for PTSD in Combat Veterans | p. 349 |
Research on Treatment of Combat-Related PTSD | p. 350 |
Assessment and Treatment of Service Members and Veterans With PTSD | p. 352 |
Future Directions | p. 363 |
Key Clinical Points | p. 364 |
Geriatrics | p. 371 |
Etiologies of Geriatric PTSD | p. 372 |
Presentation of PTSD | p. 373 |
Pharmacological Treatments | p. 375 |
Cognitive-Based Therapies | p. 377 |
Exposure-Based Therapies | p. 377 |
Eye Movement Desensitization and Reprocessing | p. 378 |
Key Clinical Points | p. 378 |
Traumatic Brain Injury | p. 383 |
Overview of Traumatic Brain Injury | p. 384 |
Shared Neurobiology | p. 387 |
TBI and PTSD Comorbidity | p. 388 |
Neuropsychological Features | p. 393 |
Substance Abuse, PTSD, and Traumatic Brain Injury | p. 396 |
Military Aspects | p. 397 |
Treatment Considerations | p. 400 |
Conclusion | p. 402 |
Key Clinical Points | p. 403 |
Sociocultural Considerations | p. 415 |
Trauma in Cultural Context | p. 416 |
Assessment | p. 418 |
Treatment | p. 430 |
Conclusion | p. 436 |
Key Clinical Points | p. 438 |
Index | p. 445 |
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