Post-traumatic stress disorder: Hypotheses from clinical neuropsychology and psychopharmacology research

Characteristic features of post-traumatic stress disorder (PTSD) include intrusive memories, avoidance, memory and concentration difficulties, and hyperalertness. Neuropsychological investigations of individuals with PTSD have suggested global and specific impairments of performance on standardized tests of memory. The use of the Emotional Stroop test has shown that trauma-related words are a sensitive measure of clinical state in PTSD patients. The Stroop paradigm has also shown that patients with PTSD appear to be characterized by implicit, explicit and autobiographical memory impairment. Available treatments for chronic post-traumatic stress disorder include cognitive-behaviour therapy, psychodynamic therapy and pharmacotherapy. Whereas drug treatment alone can rarely alleviate the suffering in PTSD, it appears to be most useful as an adjunct to psychotherapy. Tricyclic antidepressants are generally thought to be effective in alleviating symptoms, including nightmares, depression, sleep disorders and startle reactions, but are less able to relieve numbing. On the other hand, selective re-uptake blockers may be effective in decreasing numbing. However, rigorous clinical trials with double-blind placebo-controlled designs need to be performed to confirm these results. With new scientific discoveries in the understanding of PTSD, a new generation of pharmacological treatment is likely to emerge. (Int J Psych Clin Pract 2000; 4:3-18).