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Post traumatic stress disorder diagnosis, management and treatment

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    Post traumatic stress disorder diagnosis, management and treatment. Edited by david nutt, jonathan r t davidson,and joseph zohar (Pp 272, £39.95). Published by Martin Dunitz Publishers, London, 2000. ISBN 1 85317 926 4

    Post-traumatic stress disorder (PTSD) did not enter the psychiatric lexicon until 1980 when the American Psychiatric Association's DSM-III proposed operational diagnostic criteria for a group of stress related disorders. Nevertheless, it is clear from previous descriptive studies that the symptoms which are now associated with PTSD were often and consistently recognised in victims of trauma, particularly involving military conflict. The impetus to the establishment of PTSD as a diagnostic concept came from studies on veterans of the Vietnam war. Since the 1980s there has been a steady growth in the frequency with which PTSD is diagnosed, facilitated by a broadening of the diagnostic criteria, particularly the nature of the precipitating aetiological trauma. Several sceptics have also related the increased tendency to diagnose the condition to a growth in the trade in litigation, actively promoted by the legal profession.

    The popularity of the diagnostic concept has been matched by an explosion of published papers, so this book is a timely review which enables clinicians and lawyers to keep up advances in understanding the aetiology and management of the condition. Like most multiauthor books the quality is uneven and there is some overlap between several chapters. The strength of the book lies mainly in the chapters on treatment. There are useful contributions from Barbara Rothbaum on psychological treatments and from Stein et al on pharmacotherapy. There is also a well balanced article by Martin Deahl on psychological debriefing. This has become a popular form of intervention after trauma but its effectiveness is uncertain and at present its widespread use cannot be justified. More research needs to be undertaken to identify victims who are likely to develop PTSD and to distinguish them from those who are more resilient and who do not require any form of psychological intervention.

    This book is a useful, up to date, and comprehensive summary of the current state of knowledge on PTSD. It deserves to be widely read by neurologists, psychiatrists, psychologists, and personal injury lawyers, all of whom are being consulted by a growing number of victims of trauma.