Staging model of PTSD: a strategy for the implementation of precision medicine in military settings.

IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Bmj Military Health Pub Date : 2024-09-20 DOI:10.1136/military-2023-002352
Alexander McFarlane
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Abstract

Biomarkers have been of considerable interest in military medicine as a strategy to identify objective measures of resilience in the context of the cumulative trauma exposure of combat as well defining the emerging neurobiological dysregulation associated with post-traumatic stress disorder (PTSD). This body of work has been driven by the imperative of developing strategies to optimally manage the long-term health outcomes of personnel and finding novel treatment approaches. However, the challenge of defining the relevant phenotypes of PTSD and in the context of the multiplicity of biological systems of interest has hampered the identification of biomarkers that have clinical utility. One key strategy to improve the utility of precision medicine in military settings is to use a staging approach to define the relevant phenotypes. A staging model of PTSD captures the progression of the disorder and the transitions from being at risk to subsyndromal disorder and the path to chronic disorder.A staging approach addresses the longitudinal course of PTSD and the fluidity of the disorder across time. Staging describes how symptoms evolve into more stable diagnostic syndromes and the stepwise changes in clinical status which is key to the identification of phenotypes that can be tied to relevant biomarkers. When a population is exposed to a trauma, the individuals will be at different stages in the emergence of risk and the development of PTSD. The staging approach provides a method of capturing the matrix of phenotypes that need to be demarcated to study the role of multiple biomarkers. This paper forms part of the Special issue of BMJ Military Health dedicated to personalised digital technology for mental health in the armed forces.

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创伤后应激障碍分期模型:在军事环境中实施精准医疗的策略。
生物标志物一直是军事医学中颇受关注的一种策略,它可以在战斗中累积的创伤暴露背景下确定复原力的客观指标,并定义与创伤后应激障碍(PTSD)相关的新出现的神经生物学失调。这一系列工作的动力来自于制定策略以优化人员的长期健康状况并找到新的治疗方法。然而,如何定义创伤后应激障碍的相关表型以及相关生物系统的多样性是一项挑战,这阻碍了具有临床效用的生物标志物的鉴定。提高精准医学在军事环境中的实用性的一个关键策略是使用分期方法来定义相关表型。创伤后应激障碍的分期模型可以捕捉到该疾病的发展过程、从高危到亚临床障碍的过渡以及通往慢性障碍的道路。分期描述了症状如何演变为更稳定的诊断综合征,以及临床状态的逐步变化,这对于确定可与相关生物标志物联系起来的表型至关重要。当一个群体受到创伤时,其个体将处于风险出现和创伤后应激障碍发展的不同阶段。分期方法提供了一种捕捉表型矩阵的方法,研究多种生物标志物的作用需要对这些表型进行划分。本文是《BMJ 军事健康》特刊的一部分,该特刊专门讨论了针对武装部队心理健康的个性化数字技术。
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来源期刊
Bmj Military Health
Bmj Military Health MEDICINE, GENERAL & INTERNAL-
CiteScore
3.10
自引率
20.00%
发文量
116
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