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dissociative click here symptoms, panic-like response, extreme withdrawal, psychotic-like symptoms, and suicidality all raise red flags regarding the person’s vulnerability to developing PTSD.11 Why is PTSD suitable for prevention? PTSD is different from other psychiatric disorders, in that it has a very clear point of onset. In most cases, the traumatic event is also the point of onset of symptoms. The second unique feature of PTSD is that it is characterized by a failure of the normal response to disappear. The expected response after exposure to a traumatic event is to experience shock, horror fear, terror, grief, Inhibitors,research,lifescience,medical etc. This is a normal response to an abnormal situation. It becomes a disorder when this normal response continues

(according to DSM-IV, for more than a month). Moreover, as mentioned earlier, the vast majority (80% to 90%) experience spontaneous recovery from these symptoms, and hence, one way to conceptualize PTSD is Inhibitors,research,lifescience,medical as a disorder where there is a failure to recover (Figure 3). If PTSD is a failure to recover, then our obligation, as clinicians, to the patient is primum non nocere Inhibitors,research,lifescience,medical (“First, do no harm” ), ie, not to interfere with the potent spontaneous recovery process which usually takes place. It seems that what we do in this “window of opportunity,” in those “golden hours” – the first few hours after the exposure to the traumatic event – might have the potential to dramatically alter the trajectory of PTSD. Figure 3. Most people exposed to trauma do not develop post-traumatic stress disorder. Memory and PTSD We submit that the main feature of PTSD is the traumatic memory, which is clinically expressed by Inhibitors,research,lifescience,medical criterion B of the DSM-IV, namely that the traumatic

event is persistently re-experienced through recurrent and intrusive distressing recollections and/or recurrent distressing dreams, acting or feeling as if the traumatic Inhibitors,research,lifescience,medical event were recurring (including dissociative flashback episodes) and intense psychological distress and physiological reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of “the event.” Thus, much the core pathology of PTSD is the re-experiencing – the distressing recollections, flashbacks, nightmares, etc. One way to describe this is that patients with PTSD arc haunted by the memory of the event. For them, the past is always present; it is as if the clock has stopped, and they are constantly either reliving the experience, or fighting very hard not to be exposed to triggers which might set off a flashback. The avoidance, numbing, and increased arousal would then be secondary phenomena. One question would be regarding the consolidation of the traumatic event. Consolidation is the transition from unstable to stable memory, and the question is, if we could prevent this consolidation, whether or not it would be beneficial.