![]() ![]() Records were eligible if they were: (1) About trauma and PTSD (2) About delayed onset (3) About neurobiology and (4) About causal mechanisms or risk factors. The screening process consisted of three phases: (1) Stepwise inclusion of records based on titles and abstracts with the aid of automatic Rayyan keywords for inclusion (2) Manual inclusion and exclusion of records based on the inclusion and exclusion criteria and (3) Manual exclusion of articles based on the full text. To screen and select articles, we used Rayyan, a web-based program for systematic reviews. These articles were then screened for inclusion in this review. Supplementary Table 2 shows the number of items retrieved in each search system, the number of duplicates and thus the new articles collected. The search results were imported into Endnote and deduplicated using the method outlined elsewhere. These clusters were combined using Boolean operators, and the combined clusters for question 1 (set 12) and question 2 (set 13) were combined. For Question 2 (delayed PTSD with a long-term asymptomatic interval), we used the following clusters: late-onset PTSD (set 6), remission and asymptomatic periods (set 7) and study types (sets 8 through 11). For Question 1 (the role of neurobiological mechanisms in developing delayed PTSD), we had these clusters: etiology and neurobiological factors (sets 1 through 5), late-onset PTSD (set 6), and study types (sets 8 through 11). The search terms were grouped into clusters. The full search strategy for PsycINFO can be found in Supplementary Table 1. We built a search strategy in PsycINFO (Ovid), which we then adapted to the other databases. We based the search strategy on the two research questions and several lead articles (which we presented to Ovid Citation Analyzer to harvest search terms). ![]() The search was performed in early December 2020 in the following databases (all in the Ovid platform): PsycINFO Ovid Medline ALL, Ovid Evidence Based Medicine Reviews (EBM Reviews - Cochrane Database of Systematic Reviews and EBM Reviews - Database of Abstracts of Reviews of Effects) and Embase. The PRISMA scoping reviews checklist was used to ensure correct reporting. We searched for publications examining the role of neurobiological mechanisms in developing delayed PTSD. Since our aim was to provide an overview of key concepts and types of evidence, we performed a scoping review. The research questions were to determine what role neurobiological mechanisms have in the delayed expression of PTSD, and how neurobiological mechanisms contribute to explaining the occurrence of delayed PTSD following a long asymptomatic interval. ![]() We therefore conducted a scoping review to obtain an overview of key concepts explaining and types of evidence supporting neurobiological underpinnings of delayed PTSD. Neurobiological mechanisms and systems are likely to play a central role in determining the duration of the prodromal phase, the presence of prodromal symptoms and mental and physical disorder comorbidities.īecause delayed expression is the exception rather than the rule, neurobiological mechanisms underlying delayed PTSD have received limited research attention. Specifically, neurobiological models of PTSD may explain variability in the progressive increase in PTSD symptoms over time following exposure to trauma that characterizes PTSD with delayed expression. A proper understanding of the neurobiological basis for delayed expression of PTSD is clinically useful since it has implications for diagnostic assessment in both treatment and forensic settings and in the context of litigation. Subsequently, the capacity of PTSD to occur with delayed expression has been documented in several systematic reviews and meta-analyses. Since the inclusion of the PTSD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, a delayed category has been discerned. While the majority of people who develop PTSD do so within the first wk or mo following the traumatic encounter, a significant minority of people with PTSD present delayed expression of the disorder. ![]() Posttraumatic stress disorder (PTSD) with delayed expression (also known as delayed PTSD or delayed-onset PTSD) is a diagnostic category that applies to people who first meet the criteria for a PTSD diagnosis at least 6 mo following exposure to a traumatic event. ![]()
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