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目的观察创伤后应激障碍（PTsD）模型大鼠海马、杏仁核神经元自噬和凋亡的改变，探讨PTSD海马、杏仁核体积异常的机制。方法成年健康雄性SD大鼠40只，随机分为对照组和模型组。采用改良的单一连续应激方法制备PTSD大鼠模型；采用Westernblotting方法检测海马、杏仁核组织LC-3和Beclin1的表达水平；TUNEI，染色和流式细胞术检测海马、杏仁核神经元凋亡情况。结果模型组海马、杏仁核组织LC3Ⅱ／LC3-I比值和Beclin-l表达水平高于对照组（P〈0．05）；模型组海马、杏仁核神经元TUNEI。阳性细胞百分率和凋亡率高于对照组（P〈0．01）。结论PTSD模型大鼠海马、杏仁核神经元存在明显的细胞自噬和凋亡，这可能是海马、杏仁核体积异常的机制之一。

创伤后应激障碍（Post一traumatic Stress Disorder,PTSD）是对异乎寻常的威胁性或灾难性应激事件或情境延迟的和/或延长的反应（世界卫生组织,1992）.1980年 DSM-Ⅲ首次确立创伤后应激障碍诊断标准后,对PTSD患者认知特点的研究主要集中于记忆方面.Kanagaratnam等[1]提出,个体将对环境的感知整合为一个整体的能力,是其成功地认知创伤事件的关键。

目的观察电针联合舍曲林对创伤后应激障碍（PTSD）的疗效及安全性.方法将50例PTSD患者随机分为研究组（舍曲林联合电针治疗）和对照组（舍曲林治疗）各25例,均治疗4周.于治疗前和治疗4周末采用创伤后应激障碍检查表（PCL）及汉密尔顿焦虑量表（HAMA）评定疗效.结果共47位患者完成研究,两组治疗4周末PCL总评分、重现、回避、高警觉、HAMA评分均较治疗前低,差异有统计学意义（P〈0.05）;研究组治疗4周末PCL总评分、重现、高警觉、HAMA评分低于对照组,差异有统计学意义（P〈0.05）.结论在舍曲林基础上联用电针治疗,能够增加舍曲林对PTSD的重现、高警觉核心症状和焦虑症状的疗效.

DSM-5中,创伤及应激相关障碍的代表性疾病是创伤后应激障碍、适应障碍、反应性依恋障碍及脱抑制性社会参与障碍。这组障碍与暴露于创伤性或应激性事件有关。个体可表现焦虑、恐惧症状、快感缺失、烦躁、外化的愤怒和攻击性及分离症状等。创伤后应激障碍发生于经历或目睹创伤性事件之后,存在侵入性症状、回避相关刺激、认知与心境存在负性改变、警觉性增加,且症状持续超过1个月;适应障碍发生于应激源出现后3个月内,表现为超出应有程度的情绪反应或行为变化,应激源或其结果终止后症状持续时间不超过6个月;反应性依恋障碍与脱抑制性社会参与障碍的诊断均需有严重的童年期社会忽略或剥夺史,但前者表现为抑郁及退缩行为,后者表现为脱抑制与缺乏社交边界。创伤及应激相关障碍的治疗方法包括药物治疗和心理咨询等。

Background: The ability to resist adverse outcomes, or demonstrate resilience after exposure to trauma is a thriving field of study. Yet ongoing debate persists regarding definitions of resilience, generalizability of the extant literature, neurobiological correlates, and a consensus research agenda. Objectives: To address these pressing questions, Drs. Christy Denckla and Karestan Koenen (co-chairs) convened a multidisciplinary panel including Drs. Dante Cicchetti, Laura Kubzansky, Soraya Seedat, Martin Teicher, and David Williams at the 2019 annual meeting of the International Society for Traumatic Stress Studies (ISTSS). Questions included (1) how have definitions of resilience evolved, (2) what are the best approaches to capture the complexity of resilience processes, and (3) what are the most important areas for future research? Methods: The proceedings of this panel are summarized in this report, and prominent themes are synthesized and integrated. Results: While different definitions emerged, all shared a focus on conceptualizing resilience at multiple levels, from the biological to the social structural level, a focus on the dynamic nature of resilience, and a move away from conceptualizing resilience as only an individual trait. Critical areas for future research included 1) focused efforts to improve assessment that has international and cross-cultural validity, 2) developing within-study designs that employ more intensive phenotyping strategies, 3) examining outcomes across multiple levels and domains, and 4) integrating conceptualizations of resilience from the individual-level to the larger social context at the population health level. Conclusion: Increasingly sophisticated and nuanced conceptual frameworks, coupled with research leveraging advances in genetics, molecular biology, increased computational capacity, and larger, more diverse datasets suggest that the next decade of research could bring significant breakthroughs. * The field of psychological resilience is characterized by ongoing debate over definitions, generalizability, and a research agenda.*Evolving definitions share a focus on conceptualizing resilience at multiple levels, a focus on dynamic processes, and moving away from individual trait conceptualizations.* Future research recommendations include improving assessment cross-culturally, employing within-study designs, and examining outcomes at multiple levels and domains.

A study in Lithuania showed that the International Trauma Interview is a valid tool for assessing and diagnosing ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). The 11 th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). The International Trauma Interview (ITI) is a novel clinician-administered diagnostic interview for the assessment of ICD-11 PTSD and CPTSD. The aim of this study was to evaluate the psychometric properties of the ITI in a Lithuanian sample in relation to interrater agreement, latent structure, internal reliability, as well as convergent and discriminant validity. In total, 103 adults with a history of various traumatic experiences participated in the study. The sample was predominantly female (83.5%), with a mean age of 32.64 years (SD = 9.36). For the assessment of ICD-11 PTSD and CPTSD, the ITI and the self-report International Trauma Questionnaire (ITQ) were used. Mental health indicators, such as depression, anxiety, and dissociation, were measured using self-report questionnaires. The latent structure of the ITI was evaluated using confirmatory factor analysis (CFA). In order to test the convergent and discriminant validity of the ITI we conducted a structural equation model (SEM). Overall, based on the ITI, 18.4% of participants fulfilled diagnostic criteria for PTSD and 21.4% for CPTSD. A second-order two-factor CFA model of the ITI PTSD and disturbances in self-organization (DSO) symptoms demonstrated a good fit. The associations with various mental health indicators supported the convergent and discriminant validity of the ITI. The clinician-administered ITI and self-report ITQ had poor to moderate diagnostic agreement across different symptom clusters. The ITI is a reliable and valid tool for assessing and diagnosing ICD-11 PTSD and CPTSD.

Background: Perceived social support (PSS) is one of the most important risk factors for the onset and maintenance of posttraumatic stress disorder (PTSD) symptoms, however the relationship between PSS and Complex PTSD (CPTSD) is unknown. The evidence-base for CPTSD treatment is currently lacking, though increasingly important given the recent publication of the ICD-11, which now allows for a formal diagnosis of CPTSD. Objective: This research aims to develop understanding of the relationship between PSS and CPTSD with a view to informing the development of new and existing treatments. Method: A cross-sectional study was undertaken with 246 individuals recruited to the National Centre for Mental Health (NCMH) cohort. Measures of PSS and PTSD/CPTSD were undertaken with this clinical sample and linear and logistic regression were conducted to assess for associations between PSS and the PTSD symptom clusters of DSM-5 and ICD-11, and to explore the predictive utility of any PSS association on the likelihood of a CPTSD presentation. Results: It was found that individuals with a presentation of CPTSD tend to exhibit lower levels of PSS, compared with individuals not presenting with CPTSD, and lower PSS had a statistically significant unique association with the likelihood of presenting with CPTSD. Conclusions: Intervention aiming to improve PSS could be particularly helpful for some individuals with CPTSD, especially those with disturbances in relationships, and there is opportunity to develop skills training within a phase-based approach to treatment that targets factors related to PSS. * Individuals with a presentation of Complex Posttraumatic Stress Disorder (CPTSD) tend to exhibit particularly low levels of perceived social support (PSS), compared with individuals not presenting with CPTSD.* Lower PSS was found to have a statistically significant unique association with the likelihood of presenting with CPTSD.* Intervention aiming to improve PSS could be particularly helpful for some individuals with CPTSD, especially those with disturbances in relationships.

Background: Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates. Objective: To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity. Method: A systematic review of dropout rates from randomized controlled trials (RCTs) of psychological therapies was conducted. The pooled rate of dropout from psychological therapies was estimated and reasons for heterogeneity explored using meta-regression. Results:: The pooled rate of dropout from RCTs of psychological therapies for PTSD was 16% (95% CI 14-18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological therapies with a trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatized by sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated. Conclusions: Dropout rates from recommended psychological therapies for PTSD are high and this appears to be particularly true of interventions with a trauma focus. There is a need to further explore the reasons for dropout and to look at ways of increasing treatment retention.

Background: The ICD-11 classifies posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as two distinct diagnoses. Few studies have tested the validity of ICD-11 CPTSD in non-Western settings, particularly in Asia. Objective: This study assessed the factorial, concurrent, and discriminant validity of CPTSD symptoms with four samples of young adults from mainland China, Hong Kong, Japan, and Taiwan. Method: Young adults aged 18-24 years were recruited by convenience sampling and provided their data anonymously online. Study measures included the International Trauma Questionnaire (ITQ) to measure PTSD and CPTSD, and measures of childhood adversity, depression, anxiety, age, and sex. Confirmatory factor analysis (CFA) was performed for each sample to evaluate the validity of two CPTSD measurement models. Structural equation modelling (SEM) was used to determine the multivariate associations between study variables for the full sample. Results: A total of 1,346 young adults completed the survey. CFA showed both models of CPTSD examined fit the data well across all four samples. SEM findings showed that number of childhood adversities significantly associated with both PTSD and CPTSD factors; depression significantly associated with CPTSD factors but not PTSD, whereas anxiety significantly associated with both. Conclusions: Study findings provide evidence for PTSD and CPTSD as separate and valid diagnoses in Asia. More cross-cultural comparisons are needed to understand whether risks for either condition differ by geographical or sociocultural norms.

Complex posttraumatic stress disorder (CPTSD) describes the results of complex, prolonged, and/or inescapable trauma, and is typified by avoidance, re-experiencing, sense of threat, affect dysregulation, negative self-concept, and interpersonal disturbances. Additionally, CPTSD is highly comorbid with other common psychopathologies. A study was conducted in a trauma-exposed UK Armed Forces Veteran population resident in Northern Ireland (N = 638, NI) to determine the prevalence of CPTSD and comorbid associations. Data from the Northern Ireland Veterans Health and Wellbeing Study (NIVHWS), including self-report data describing traumatic stress, depression, anxiety, and suicidality, were used in a latent class analysis to identify distinct profiles of symptomology in the sample, and in a multinomial logistic regression to identify comorbidities associated with class membership. Three distinct classes emerged: a low endorsement 'baseline' class (36%), a 'Moderate Symptomatic' class (27%), and a high endorsement 'Probable CPTSD' class (37%). Both the Moderate Symptomatic and CPTSD classes were predicted by cumulative trauma exposure. Depression was highly comorbid (OR =  23 .06 in CPTSD), as was anxiety (OR =  22 .05 in CPTSD) and suicidal ideation (OR =  4 .32 in CPTSD), with suicidal attempt associated with the CPTSD class (OR =  2 .51). Cases of probable CPTSD were more prevalent than cases of probable posttraumatic stress disorder (PTSD) without Difficulties in Self-Organisation (DSO) symptoms in a UK Armed Forces veteran sample, were associated with repeated/cumulative trauma, and were highly comorbid across a range of psychopathologies. Findings validate previous literature on CPTSD and indicate considerable distress and thus need for support in UK Armed Forces veterans resident in NI. CPTSD was more prevalent than PTSD in a UK Armed Forces veteran sample. CPTSD was associated with repeated/cumulative trauma, and was highly comorbid across a range of psychopathologies. These findings validate the previous literature on CPTSD