NEUROBIOLOGICAL ASPECTS OF PATHOGENETIC MECHANISMS IN THE DEVELOPMENT OF POST-TRAUMATIC STRESS DISORDER (LITERATURE REVIEW)

Post-traumatic stress disorder (PTSD) occurs as a result of exposure to a life-threatening traumatic event or situation involving violence. The main manifestations of PTSD are obsessive re-experiencing of the traumatic event, increased nervous arousal, avoidance of stimuli related to the traumatic event, emotional and cognitive disorders that persist for a long time. This mental disorder is exhausting and causes changes that make it difficult and sometimes impossible for patients with PTSD to function professionally and socially. This results in a significant clinical burden and high socioeconomic costs. Materials and methods. The authors have reviewed more than 100 scientific papers from the world literature on the problems of diagnosis, symptoms, pathophysiological and neurobiological mechanisms that play an important role in the development of PTSD and can be used as key elements in the choice of treatment measures. Results. Post-traumatic stress disorder is a multifactorial disease, therefore, numerous pathophysiological mechanisms and factors are involved in its occurrence and progression. The immediate response to stress is the activation of the neuroendocrine and autonomic systems with the release of adrenaline and norepinephrine. The involvement of the hypothalamic-pituitary-adrenal system and subsequent secretion of cortisol may be a trigger for the PTSD development. A link has been found between increased activity of the noradrenergic system, increased glucocorticoid exposure, and impaired interaction between neurons in the amygdala and prefrontal cortex. In addition, glucocorticoids are associated with the development of immune response disorders and neuroinflammation. Inflammatory cytokines can regulate and modify the functioning of neurotransmitters such as serotonin and dopamine, which contributes to the onset and progression of PTSD symptoms. Conclusions. The data from the reviewed literature and the results of a large number of studies allow us to confirm the important role of the following mechanisms in the pathogenesis of PTSD. These include disorders of vegetative regulation, dysfunction of the hypothalamic-pituitary-adrenal system, disorders of immunological regulatory and inflammatory mechanisms, and dysregulation of the monoaminergic transmission system. Further study of the mechanisms of development and pathogenetic pathways will allow for better implementation of the strategy of medical care for patients with PTSD.