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Review
. 2023 Mar 9;24(6):5238.
doi: 10.3390/ijms24065238.

To Predict, Prevent, and Manage Post-Traumatic Stress Disorder (PTSD): A Review of Pathophysiology, Treatment, and Biomarkers

Ghazi I Al Jowf  1   2   3 , Ziyad T Ahmed  4 , Rick A Reijnders  1   3 , Laurence de Nijs  1   3 , Lars M T Eijssen  1   3   5
Affiliations
Review

To Predict, Prevent, and Manage Post-Traumatic Stress Disorder (PTSD): A Review of Pathophysiology, Treatment, and Biomarkers

Ghazi I Al Jowf et al. Int J Mol Sci. .

Abstract

Post-traumatic stress disorder (PTSD) can become a chronic and severely disabling condition resulting in a reduced quality of life and increased economic burden. The disorder is directly related to exposure to a traumatic event, e.g., a real or threatened injury, death, or sexual assault. Extensive research has been done on the neurobiological alterations underlying the disorder and its related phenotypes, revealing brain circuit disruption, neurotransmitter dysregulation, and hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Psychotherapy remains the first-line treatment option for PTSD given its good efficacy, although pharmacotherapy can also be used as a stand-alone or in combination with psychotherapy. In order to reduce the prevalence and burden of the disorder, multilevel models of prevention have been developed to detect the disorder as early as possible and to reduce morbidity in those with established diseases. Despite the clinical grounds of diagnosis, attention is increasing to the discovery of reliable biomarkers that can predict susceptibility, aid diagnosis, or monitor treatment. Several potential biomarkers have been linked with pathophysiological changes related to PTSD, encouraging further research to identify actionable targets. This review highlights the current literature regarding the pathophysiology, disease development models, treatment modalities, and preventive models from a public health perspective, and discusses the current state of biomarker research.

Keywords: PTSD; behaviour changes; biomarkers; pathophysiology; prevention; public health; stress; traumatic stress; treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A graphical summary of the main findings of the paper. The entirety of the pre-, peri- and post-traumatic factors can be biological, psychological, or social, according to the biopsychosocial model.
Figure 2
Figure 2
Basal activity of the HPA axis with or without PTSD. CRH secretion from the hypothalamus increases in PTSD (represented by a thicker black line). The release of ACTH from the anterior pituitary, and hence cortisol from the adrenal cortex, is decreased in PTSD (represented by a thinner black line). Cortisol’s negative feedback inhibition of the HPA axis is increased in PTSD (represented by thicker red lines).
Figure 3
Figure 3
Social-ecological model for traumatic stress and related preventive interventions.
See this image and copyright information in PMC

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