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Book Forum: Stress   |    
Posttraumatic Stress Disorder: Acute and Long-Term Responses to Trauma and Disaster
STEPHEN A. YOUNG, M.D.
Am J Psychiatry 2001;158:1178-1178. doi:10.1176/appi.ajp.158.7.1178
View Author and Article Information
Columbia, S.C.

Edited by Carol S. Fullerton, Ph.D., and Robert J. Ursano, M.D. Washington, D.C., American Psychiatric Press, 1997, 309 pp., $42.50.

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This book is a contribution to the Progress in Psychiatry series of the American Psychiatric Press. The goal of these books is to compile the latest in clinical and research information regarding specific topics in the field.

Drs. Fullerton and Ursano have established international reputations in the area of trauma research. Indeed, Dr. Ursano has developed a unique site for research and teaching in posttraumatic stress disorder (PTSD) at the Uniformed Services University of the Health Sciences. Although the author selection includes contributors with ties to the Uniformed Services University and the U.S. military experience, it is nicely complemented by chapters from a worldwide collection of interesting voices. In addition, the chapters describe a number of clinical populations that are nonmilitary in nature.

As titled, the book consists of two divisions, acute and long-term responses to trauma and disaster. The Acute section contains six chapters that describe various research efforts examining "on the ground" techniques of assessing patients in the immediate aftermath of trauma. This section contains some fascinating geopolitical contexts. For example, the team leader of the World Health Organization group that entered Kuwait in late 1991 writes a compelling description of the immediate postwar situation in that country. Fullerton’s paper discussing acute psychological effects on the spouses and significant others of rescue workers is an excellent illustration of just how difficult studying this population can be. Karam’s chapter on comorbid depression and PTSD raises an issue emphasized throughout the book, namely, that individuals exposed to trauma are vulnerable to a number of other problems, including depressive, anxiety, and substance abuse disorders.

The Long-Term section contains six chapters examining some of the chronic issues that clinicians treating PTSD patients will likely encounter. The chapter on comorbid alcohol dependence presents some interesting incidence data but gets bogged down with general information about substance abuse. Given the crucial importance of substance abuse to those treating traumatized patients in the field, more treatment information would have been helpful. The chapters on traumatic death and homelessness in Vietnam veteran populations present interesting perspectives, as well as some unexpected findings. Finally, the last two chapters in this section address models of etiology and treatment. Shalev’s comprehensive review of pharmacological and psychotherapeutic published reports is excellent. Unfortunately, the section is somewhat dated in that it does not discuss sertraline, recently given a Food and Drug Administration label indication for treatment of PTSD.

The editors have successfully collated recent findings in PTSD research into one place, allowing the busy clinician to review a variety of papers that address clinical, experiential, and research initiatives. Because the book is really a series of papers, it does not have the continuity of a textbook or a more comprehensive review. It will serve the reader well to review these papers, which bring life to the difficult work of studying and treating trauma survivors, while at the same time respecting the importance of rational thought and scientific method in furthering knowledge in the field.

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