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Trauma and victims: epidemiology of post-traumatic stress disorder
- Giovanni de Girolamo, Elisabetta Marchiori
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- Journal:
- Epidemiologia e Psichiatria Sociale / Volume 4 / Issue 2 / August 1995
- Published online by Cambridge University Press:
- 11 October 2011, pp. 110-144
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Objectives - To present a comprehensive review of the studies assessing the frequency of PTSD in the general population, in clinical populations and among subjects at risk. Design - An extensive search was made using the Excerpta Medica Psychiatry CD-ROM 1980-1993 (October). Using post-traumatic stress disorder as a key word, a total of 1,057 papers published in this timespan were retrieved. A further search was made using the same key word with MEDLINE CD-ROM 1988-1993. A manual search was also performed for all issues of the Journal of Traumatic Stress. Results - A total of 135 studies meeting inclusion criteria were selected for this review. Almost two thirds (n = 86, 64%) of these studies were carried out in the United States; only 8 (6%) studies have been carried out in developed countries. The sample size ranges from a low of 11 subjects up to a high of 22,463 subjects. The mean sample size is 500 and the median is 108. In terms of assessment methods, in one third (n = 45, 33%) of the studies the investigators used a PTSD symptom checklist (either self- administered or administered by a clinician), based on DSM criteria, to generate a PTSD diagnosis. In more than in one third of the studies (n = 44, 33%) of the studies, a structured interview was administered (e.g., the DIS, the SCID, the SADS), while in the remaining surveys the diagnostic evaluation was based either on an un- structured clinical assessment or on the administration of other specific assessment instruments (e.g., M-PTSD, IES, SCL-90-R or others). In 77 studies (57%) the investigators based their assessment on DSM-III diagnostic criteria for PTSD, whereas in 55 studies (41 %) DSM-III-R criteria were employed. Prevalence rates are discussed separately for the different population groups. Conclusions - There has been a remarkable increase in the number and quality of epidemiological studies on PTSD over the past decade. A substantial amount of information is now available about the frequency of PTSD among different population groups and among at risk subjects, and about risk factors, common symptom patterns, and natural history of this disorder. However, a number of important limitations of these studies are to be noted and should be addressed by future research efforts.
Anatomical MRI findings in mood and anxiety disorders
- Paolo Brambilla, Francesco Barale, Edgardo Caverzasi, Jair Constante Soares
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- Journal:
- Epidemiologia e Psichiatria Sociale / Volume 11 / Issue 2 / June 2002
- Published online by Cambridge University Press:
- 11 October 2011, pp. 88-99
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Objective – In vivo structural magnetic resonance imaging (MRI) studies have evaluated the brain anatomy of various psychiatric disorders, allowing the investigation of putative abnormal brain circuits possibly involved in the patophysiology of psychiatric disorders. Here we reviewed the structural MRI literature in mood and anxiety disorders. Methods – All anatomical MRI studies evaluating mood and anxiety disorder patients were identified through a comprehensive Medline search conducted for the period from 1966 to January 2002, and a manual search of bibliographic cross-referencing complemented the Medline search. Results – Differential patterns of anatomical brain abnormalities appear to be involved in subtypes of mood disorders, with hippocampus and basal ganglia being abnormal in unipolar disorder, and amygdala and cerebellum in bipolar disorders, suggesting that these two mood disorders are biologically distinct. As for anxiety disorders, orbital frontal regions and basal ganglia have been reported to be anatomically abnormal in obsessive-compulsive disorder, temporal lobe was found to be abnormally reduced in panic disorder, and abnormal hippocampus shrinkage was shown in posttraumatic stress disorder. Conclusions – The structural MRI findings reviewed here suggest abnormalities in specific brain regions participating in proposed neuroanatomic models possibly involved in the pathophysiology of mood disorders and anxiety disorders. Nonetheless, available MRI studies have suffered from limitations related to relatively small patient samples and involvement of medicated patients, and were largely cross-sectional investigations. Therefore, longitudinal MRI studies involving more sizeable samples of drug-free patients, patients at first episode of illness or at high risk for mood or anxiety disorders, associated to genetic studies, are likely to be extremely valuable to separate state from trait brain abnormalities and to characterize further the pathophysiology of these disorders.