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Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence
The committee’s database searches used the National Library of Medicine’s Medical Subject Headings (MeSH) keyword nomenclature developed for MEDLINE. Searches included terms for drug interventions, psychotherapy interventions, and study design, and were limited to studies published in English, after 1980,2 and conducted in adult populations (≥18 years old). The committee also reviewed selected reference lists of relevant review articles, meta-analyses, and books. The committee did not undertake a systematic search for unpublished data. A more detailed explanation of this search can be found in Appendix B. Databases consulted include:
EMBASE (Excerpta Medica),
Cochrane Database of Systematic Reviews,
Cochrane Controlled Trials Register,
National Technical Information Service (NTIS),
Social service abstracts, and
Database of Abstracts of Reviews of Effectiveness (DARE).
The searches identified a total of 2,771 sources. All citations were imported into an electronic database (EndNote). Table 2-1 outlines the sources of the citations.
The committee developed criteria for inclusion and exclusion based on the patient populations and outcome measures (see Box 2-1 for specific criteria). Once the nonrelevant studies were eliminated—including those that were not on treatment (many were on assessment and diagnosis of PTSD, biologic markers for PTSD, or were not in a PTSD population)—each abstract was reviewed for relevance, and the full text was retrieved for all potentially relevant abstracts for further review, with the guidance of all committee members. Decisions to include and exclude studies were made by the committee.
This review focused on adult patients (ages 18 years and older) with PTSD diagnosed by the study investigators according to Diagnostic andStatistical Manual of Mental Disorders (DSM) criteria. That is why the committee’s search included only studies published beginning in 1980, when the first DSM definition was published. Studies with patients of mixed diagnoses (e.g., some with diagnosed PTSD, others subsyndromal) only were included if results were reported separately for the relevant subgroups.
In 1980 the Diagnostic and Statistical Manual of Mental Disorders (DSM) first recognized PTSD as a disorder and provided a definition and symptoms list.