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Anxiety Disorders an introduction to clinical management and research - part 7

Năm 1988, Hamner năm 1994; Doerfler và cộng sự, 1994) hoặc Bệnh y tế khác (ví dụ như với một ở lại bệnh viện hoạt động như một bộ nhớ của doanh trại tập trung người bệnh trại), nghỉ hưu hoặc lý do khác cho thả ra từ công việc (nghiện làm việc như kết thúc. cơ chế phòng vệ) | 216 W.S. DE LOOS 1988 Hamner 1994 Doerfler et al. 1994 or other medical illness e.g. with a stay in hospital acting as a memory of the concentration camp sick barrack retirement or other reasons for drop-out from work ending workaholism as a defence mechanism general anaesthesia an accidental unwanted narco-analysis procedure trains association with the concentration camp transports etc. Before the manifestation of their PTSD such patients may have had precursors of an aspecific type like summage or exhaustion syndromes adjustment disorders in DSM-IV terminology functional syndromes which are probably best described as undifferentiated somatoform disorders or unspecified psychiatric syndromes. They also may have been given entirely different psychiatric diagnoses because the trauma criterion had not been recognised or because the flashbacks had been taken for delusions or hallucinations Mueser and Butler 1987 Spivak et al. 1992 a problem that is also known in dissociative identity disorder. A retrospective attempt to follow the longitudinal course of chronic PTSD showed that hyperarousal symptoms developed first followed by avoidance symptoms and finally by symptoms of the intrusive cluster. Symptoms plateaued within a few years after the Vietnam War which was the stressor under study. Recording of alcohol and substance abuse revealed a course grossly parallel to PTSD symptoms Bremner et al. 1996 . Prospectively it has been confirmed that it takes some time for the consequences of traumatic exposure to become apparent. During a two-year followup of veterans after Operation Desert Storm the Gulf War hyperarousal symptoms were more severe than symptoms of re-experiencing or avoidance. Only two years after exposure to combat its level was significantly associated with the score on the Mississippi trauma scale Southwick et al. 1995 . Comorbidity Both in veterans Green et al. 1989 Hovens et al. 1994 and in civilian survivors of disaster Green et al. 1992 PTSD is often .