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Minerva Psichiatrica 2009 September;50(3):265-75

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Anxiety disorders prevention: overview and focus on post-traumatic stress disorder

Bienvenu O. J., Gould N. F., Mason S. T., Fauerbach

Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA


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Anxiety disorders are the most highly prevalent psychiatric conditions worldwide. Apparent risk factors include female sex, young age, family history of anxiety or depressive disorder, personality vulnerabilities (e.g., high neuroticism, behavioral inhibition, or low extraversion), and overprotective/critical parenting. Prior non-disorder-specific prevention studies have used cognitive-behavioral interventions in youths at varying levels of risk, and the results are promising for at least short-term preventive effects. The effect of public and physician education – about the nature and treatment responsiveness of anxiety disorders – on outcomes deserves further attention from the clinical and scientific community. Some cognitive-behavioral and medication interventions show promise in preventing post-traumatic stress disorder (PTSD) in particular contexts. Specifically, trauma-focused cognitive-behavioral therapy appears helpful in preventing PTSD in persons suffering with acute stress disorder, and in speeding the natural recovery process in persons with acute PTSD symptoms. There are many gaps in knowledge regarding prevention of PTSD using medications; however, it appears that benzodiazepine administration may be harmful, morphine may be helpful in the physically injured, early post-trauma propranolol may be helpful in patients with post-trauma hyperarousal, and corticosteroids may be helpful in the context of critical illness/intensive care (e.g., septic shock and cardiac surgery). To our knowledge, no studies have incorporated PTSD risk factor information (beyond acute symptoms) to inform in whom interventions should be applied; i.e., these studies do not appear to have used additional information to select especially high-risk groups for intervention. In this paper the authors discuss several limitations that could be addressed in future studies.

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