The Optimization Of Research And Clinical Applications For Combat-Related Posttraumatic Stress Disorder (Ptsd): Progress Through Modern Translational Methodologies

The state of ongoing military conflict in the Middle East and the recent rise in acts of domestic terrorism have created an increasing need for identifying potential vulnerability risk factors and for developing more effective treatment strategies for posttraumatic stress disorder (PTSD). Post-traumatic stress disorder (PTSD) appears to occur in a subset of vulnerable individuals after exposure to severe traumatic events. In order to tailor therapeutic interventions to the needs of the individual patient, it is important to develop a better understanding of the intrinsic and extrinsic factors that determine one's risk versus resilience for the development of PTSD following trauma exposure. The following chapter is a review of the most promising translational research findings that will help shape the direction and form for the optimal clinical applications for combat-related PTSD in the current military climate.This chapter begins with a discussion of emerging findings from animal models as these basic science studies form the foundation upon which pre-clinical and clinical investigations are formed. Following this introductory section, we will highlight recent psychophysiological results that illustrate a direct link between basic science and clinical studies. Psychophysiological measures such as fear-potentiated startle and galvanic skin response have revealed several important findings with respect to the expression and inhibition of conditioned fear in humans. After discussing the translational bridge between animal models and clinical studies, we will discuss how these efforts have been expanded using virtual reality; a field that affords the integration of cutting edge technologies with established treatment and investigational protocols. Given the widespread administration of pharmacotherapies to individuals with combat-related PTSD, we next review the most promising pharmacological interventions to be used in conjunction with many of the established clinical approaches such as CBT and exposure therapy. Newly emerging pharmacotherapies will receive specific emphasis. Finally, evidence suggests that the differential risk for developing PTSD following trauma is due in part to genetically-mediated vulnerability and resilience. For this reason, we will close with a review of candidate genetic markers for risk versus resilience following exposure to trauma.In conclusion, this chapter represents a comprehensive examination, intended for scientists and clinicians, of the state of translational studies of PTSD with special emphasis on the reciprocal process by which researchers and clinicians have "cross-fostered" their efforts toward the common goal of optimizing the identification and treatment of at risk combat-exposed veterans from the current military theaters of conflict.