Chapter 28. POST-TRAUMATIC STRESS DISORDER

The concept of "post-traumatic stress disorder" (PTSD) is a new nosological entry introduced in ICD-10.

The prerequisite of the onset of PTSD is considered to be the factor of an individual's involvement in extraordinary situations that have a sizeable influence on the psyche. According to some researchers (Girolamo, 1992; et al.), in most injured people PTSD is caused by similar traumatic mental events, but this does not mean that the same disorder cannot begin in some people in situations that are not considered to be extraordinary, but for various reasons they are realised to be a serious psychological trauma by such people.

Before separating PTSD as an independent heading, such disorders were closest to the clinical concept of "traumatic neurosis" (H. Oppenheim, 1888), which had developed in connection with the described psychological consequences of a railway accident. The term "military neurosis" was introduced later (S. Barrois, 1907).

Describing one of the forms of "acquired mental disability" in young people, who did not have experience or knowledge, and the current social conditions promote them to responsible posts which required to be completely devoted ignoring their resources, P.B. Gannushkin identified three groups of symptoms. Great excitability and shortness of temper, which go beyond the limits of asthenic irritable weakness, were referred to the first group. To the second, a more common group of symptoms, he referred seizures of depression of various intensity and duration, which he connected with peculiarities of the constitutional basis and patient's reaction to one or another morbid experience in their past. Finally, the third group of symptoms as the most frequent manifestation consists of various psychogenic hysterical disorders. The disease develops during 2-4 years and leads to "stable, incurable weakening of intellectual activity" (P.B. Gannushkin, 1927). Because of severe overwork (physical, intellectual, moral), according to P.B. Gannushkin, in patients, lesions develop of small vessels of their cerebral cortex and, thus, their functional (neurotic) disorder becomes organic one.