Disturbo da stress post traumatico nei pazienti adulti: revisione integrativa sui fattori biologici

Ricevuto: 13 gennaio 2018
Accettato: 13 gennaio 2018
Pubblicato: 16 gennaio 2018
Abstract Views: 331
PDF: 42
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Introduzione: il disturbo da stress post traumatico (Post Traumatic Stress Disorder, PTSD) è un disordine psichiatrico che, in accordo con il Diagnostic and Statistical Manual of Mental Disorders 5^ edizione, è
definito da quattro gruppi di sintomi: ri-esperienza, evitamento, iperarousal e alterazioni cognitive e dell’umore. I meccanismi sottostanti i PTSDs sono ampiamenti descritti da due differenti discipline, psicologichee biologiche.
Obiettivo: effettuare una revisione sull’origine dei PTSDs dal puntodi vista biologico.



PlumX Metrics


I dati di download non sono ancora disponibili.


Gola H, EnGlEr H, SommErSHof a, adEnauEr H, KolaSSa S, ScHEdlowSKi m, GroEttrup m, ElbErt t, KolaSSa it. Posttraumatic stress disorder is associated with an enhanced spontaneous production of pro-in ammatory cytokines by peripheral blood mononuclear cells. BMC Psychiatry. 2013 Ja n29;13:40.
pErroud n, rutEmbESa E, paoloni-Giacobino a, mutabaruKa J, mutESa l, StEnz l, malafoSSE a, KarEGE f. The Tutsi genocide and transgenerational tran- smission of maternal stress: epigenetics and biology of the HPA axis. World J Biol Psychiatry. 2014 May;15(4):334-45.
YEHuda r, daSKalaKiS np, lEHrnEr a, dESarnaud f, badEr Hn, maKotKinE i, florY Jd, biErEr lm, mEanEY mJ. In uences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring. Am J Psychiatry. 2014 Aug;171(8):872-80.
cErdá m, paczKowSKi m, GalEa S, nEmEtHY K, péan c, dESvariEux m. Psychopathology in the aftermath of the Haiti earthquake: a population-based study of posttraumatic stress disorder and major depression. Depress Anxiety. 2013 May;30(5):413-24.
SHin Km, cHo Sm, lEE SH, cHunG YK. A pilot prospective study of the relationship among cognitive factors, shame, and guilt proneness on post- traumatic stress disorder symptoms in female victims of sexual violence. J Korean Med Sci. 2014 Jun;29(6):831-6.
wadE d, HardY r, HowEll d, mYtHEn m. Identifying clinical and acute psychological risk factors for PTSD after critical care: a systematic review. Minerva Anestesiol. 2013 Aug;79(8):944-63.
rattraY JE. Life after critical illness: an overview. J Clin Nurs. 2014 Mar;23(5-6):623-33.
ditHolE K, tHupaYaGalE-tSHwEnEaGaE G, mGutSHini t. Posttraumatic stress disorder among spouses of patients discharged from the intensive care unit
after six months. Issues Ment Health Nurs. 2013 Jan;34(1):30-5.
amErican pSYcHiatric aSSociation. Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author, 2013.
amErican pSYcHiatric aSSociation. Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author, 1994.
taGliavini G. Modulazione dell’arousal, memoria procedurale ed elaborazione del trauma: il contributo clinico del modello polivagale e della psicoterapia sensomotoria. Cognitivismo Clinico. 2011 (8):60-72.
KESSlEr rc, SonnEGa a, bromEt E, HuGHES m, nElSon cb. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995 Dec;52(12):1048-60.
Bravo-MehMedBaÅ¡ić a, KuÄuKalić a, Kulenović ad, Suljić e. Impact of chronic posttraumatic stress disorder on the quality of life of war survivor. Psychiatr Danub. 2010 Sep;22(3):430-5.
paparriGopouloS t, mEliSSaKi a, tzavEllaS E, KaraiSKoS d, iliaS i, KoKraS n. Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: a two-year follow-up study. Int J Psychiatry Clin Pract. 2014 Jan;18(1):25-31.
davYdow dS, zatzicK df, rivara fp, JurKovicH GJ, wanG J, roY-bYrnE pp, Katon wJ, HouGH cl, KroSS EK, fan mY, JoEScH J, macKEnziE EJ. Predictors of posttraumatic stress disorder and return to usual major activity in traumatically injured intensive care unit survivors. Gen Hosp Psychiatry. 2009 Sep-Oct;31(5):428-35.
walKEr Ea, Katon w, ruSSo J, ciEcHanowSKi p, nEwman E, waGnEr aw. Health care costs associated with posttraumatic stress disorder symptoms in women. Arch Gen Psychiatry. 2003 Apr;60(4):369-74.
clum Ga, calHoun KS, KimErlinG r. Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women. J Nerv Ment Dis. 2000 Oct;188(10):671-8.
ironSon G, wYniniGS c, ScHnEidErman n, baum a, rodriGuEz m, GrEEnwood d, bEniGHt c, antoni m, lapErriErE a, HuanG HS, KlimaS n, flEtcHEr ma. Posttrau- matic stress symptoms, intrusive thoughts, loss, and immune function after Hurricane Andrew. Psychosom Med. 1997 Mar-Apr;59(2):128-41.
Gill Jm, vYtHilinGam m, paGE G. Low cortisol, high DHEA, and high levels of TNF-a and IL-6 in women with PTSD. J Trauma Stress. 2008 Dec;21(6):530-9.
rudY Jw, Huff nc, matuS-amat p. Understanding contextual fear conditioning: insights from a two-process model. Neurosci Biobehav Rev. 2004
brEwin cr, dalGlEiSH t, JoSEpH S. A dual representation theory of posttraumatic stress disorder. Psychol Rev. 1996 Oct;103(4):670-86.
EHlErS a, clarK dm. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000 Apr;38(4):319-45.
coopEr Hm. Scienti c guidelines for conducting integrative reviews. Rev Educ Res. 1982 (52):291-302.
Gill Jm, SaliGan l, woodS S, paGE G. PTSD is associated with an excess of in ammatory immune activities. Perspect Psychiatr Care. 2009 Oct;45(4):262-77.
friES E, HESSE J, HEllHammEr J, HEllHammEr dH. A new
view on hypocortisolism. Psychoneuroendocrinology. 2005 Nov;30(10):1010-6.
StErnbErG Em. Neural regulation of innate immunity: A coordinated nonspeci c host response to pathogens. Nat Rev Immunol. 2006 Apr;6(4):318-28.
wEiSS S. Neurobiological alterations associated with traumatic stress. Perspect Psychiatr Care. 2007 Jul;43(3):114-22.
pErvanidou p, KolaitiS G, cHaritaKi S, lazaropoulou c, papaSSotiriou i, HindmarSH p, baKoula c, tSiantiS J, cHrouSoS Gp. The natural history of neuroendo- crine changes in pediatric posttraumatic stress disorder (PTSD) after motor vehicle accidents: Progressive divergence of noradrenaline and cortisol concentrations over time. Biol Psychiatry. 2007 Nov 15;62(10):1095-102.
raiSon cl, millEr aH. When not enough is too much: The role of insuf cient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry. 2003 Sep;160(9):1554-65.
mcEwEn bS. Protective and damaging effects of stress mediators. N Engl J Med. 1998 Jan 15;338(3):171-9.
dunn Gp, KoEbEl cm, ScHrEibEr rd. Interferons, immunity and cancer immunoediting. Nat Rev Immunol. 2006 Nov;6(11):836-48.
zalcman S, GrEEn-JoHnSon Jm, murraY l, nancE dm, dYcK d, aniSman H, GrEEnbErG aH. Cytokine-speci c central monoamine alterations induced by interleukin-1, -2 and -6. Brain Res. 1994 Apr 18;643(1-2):40-9.
dE KloEt Er, JoElS m, HolSboEr f. Stress and the brain: from adaptation to disease. Nat Rev Neurosci. 2005 Jun;6(6):463-75.
daSKalaKiS np, lEHrnEr a, YEHuda r. Endocrine Aspects of Posttraumatic Stress Disorder and Implications for Diagnosis and Treatment. Endocrinol
Metab Clin North Am. 2013 Sep;42(3):503-13.
van zuidEn m, KavElaarS a, GEuzE E, olff m, HEiJnEn cJ. Predicting PTSD: Pre-existing vulnerabilities in glucocorticoid-signaling and implications for
preventive interventions. Brain Behav Immun. 2013 May;30:12-21.
roozEndaal b, barSEGYan a, lEE S. Adrenal stress hormones, amygdala activation, and memory for emotionally arousing experiences. Prog Brain
Res. 2008;167:79-97.
SEGal SK, cotman cw, caHill lf. Exercise-induced noradrenergic activation enhances memory consolidation in both normal aging and patien-
ts with amnestic mild cognitive impairment. J Alzheimers Dis. 2012;32(4):1011-8.
dE QuErvain dJ, aErni a, roozEndaal b. Preventive effect of betaadrenoceptor blockade on glucocorticoid-induced memory retrieval de cits.
Am J Psychiatry. 2007 Jun;164(6):967-9.
dE QuErvain dJ, HEnKE K, aErni a, trEYEr v, mcGauGH Jl, bErtHold t, nitScH rm, bucK a, roozEndaal b, HocK c. Glucocorticoid-induced impairment of
declarative memory retrieval is associated with reduced blood ow in the medial temporal lobe. Eur J Neurosci. 2003 Mar;17(6):1296-302.
roozEndaal b, GriffitH QK, burandaY J, dE QuErvain dJ, mcGauGH Jl. The hippocampus mediates glucocorticoid-induced impairment of spatial
memory retrieval: dependence on the basolateral amygdala. Proc Natl Acad Sci U S A. 2003 Feb 4;100(3):1328-33.
datSon na, van dEr pErK J, dE KloEt Er, vrEuGdEnHil E. Identi cation of corticosteroid-responsive genes in rat hippocampus using serial analysis of
gene expression. Eur J Neurosci. 2001 Aug;14(4):675-89.
dallman mf. Fast glucocorticoid actions on brain: back to the future. Front Neuroendocrinol. 2005 Oct-Dec;26(3-4):103-8.
taSKEr JG, di S, malcHEr-lopES r. Minireview: rapid glucocorticoid signaling via membrane-associated receptors. Endocrinology. 2006 Dec;147(12):5549-56.
ScHEllinG G, ricHtEr m, roozEndaal b, rotHEnHauSlEr Hb, KrauSEnEcK t, Stoll c, nollErt G, ScHmidt m, KapfHammEr Hp. Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med. 2003 Jul;31(7):1971-80.
KrauSEnEcK t, padbErG f, roozEndaal b, GratHwoHl m, wEiS f, HauEr d, Kaufmann i, ScHmoEcKEl m, ScHEllinG G. A beta-adrenergic antagonist reduces
roozEndaal b, Hui GK, Hui ir, bErlau dJ, mcGauGH Jl, wEinbErGEr nm. Basolateral amygdala noradrenergic activity mediates corticosterone-indu-ced enhancement of auditory fear conditioning. Neurobiol Learn Mem. 2006 Nov;86(3):249-55.
dE QuErvain dJ, aErni a, ScHEllinG G, roozEndaal b. Glucocorticoids and the regulation of memory in health and disease. Front Neuroendocrinol.
dElaHantY dl, raimondE aJ, SpoonStEr E. Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident
victims. Biol Psychiatry. 2000 Nov 1;48(9):940-7.
YEHuda r, biErEr lm. Transgenerational transmission of cortisol and PTSD risk. Prog Brain Res. 2008;167:121-35.
ScHEllinG G, briEGEl J, roozEndaal b, Stoll c, rotHEnHauSlEr Hb, KapfHammEr Hp. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry. 2001 Dec 15;50(12):978-85.
ScHEllinG G, KilGEr E, roozEndaal b, dE QuErvain dJ, briEGEl J, daGGE a., rotHEnHäuSlEr Hb, KrauSEnEcK t, nollErt G, KapfHammEr Hp. Stress doses of hy- drocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry. 2004 Mar 15;55(6):627-33.
ScHEllinG G, roozEndaal b, KrauSEnEcK t, ScHmoElz m, dE Qd, briEGEl J. Ef cacy of hydrocortisone in preventing posttraumatic stress disorder fol- lowing critical illness and major surgery. Ann N Y Acad Sci. 2006 Jul;1071:46-53.
wEiS f, KilGEr E, roozEndaal b, dE QuErvain dJ, lamm p, ScHmidt m, ScHmölz m, briEGEl J, ScHEllinG G. Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: A randomized study. J Thorac Cardiovasc Surg. 2006 Feb;131(2):277-82.
zoHar J, YaHalom H, KozlovSKY n, cwiKEl-HamzanY S, matar ma, Kaplan z, YEHuda r, coHEn H. High dose hydrocortisone immediately after trauma may alter the trajectory of PTSD: interplay between clinical and animal studies. Eur Neuropsychopharmacol. 2011 Nov;21(11):796-809.
rEGEHr wG, carEY mr, bESt ar. Activity-Dependent Regulation of Synapses by Retrograde Messengers. Neuron. 2009 Jul 30;63(2):154-70.
micalE v, di marzo v, Sulcova a, wotJaK ct, draGo f. Endocannabinoid system and mood disorders: priming a target for new therapies. Phar- macol Ther. 2013 Apr;138(1):18-37.
atSaK p, roozEndaal b, campolonGo p. Role of the endocannabinoid system in regulating glucocorticoid effects on memory for emotional expe- riences. Neuroscience. 2012 Mar 1;204:104-16.
Hill mn, mcEwEn bS. Endocannabinoids: The silent partner of glucocorticoids in the synapse. Proc Natl Acad Sci U S A. 2009 Mar 24;106(12):4579-80.
campolonGo p, roozEndaal b, trEzza v, HauEr d, ScHEllinG G, mcGauGH Jl, cuomo v. Endocannabinoids in the rat basolateral amygdala enhance
memory consolidation and enable glucocorticoid modulation of memory. Proc Natl Acad Sci U S A. 2009 Mar 24;106(12):4888-93.
KunoS G, tam J. The case for peripheral CB receptor blockade in the treatment of visceral obesity and its cardiometabolic complications. Br J
Pharmacol. 2011 Aug;163(7):1423-31.
HauEr d, Kaufmann i, StrEwE c, briEGEl i, campolonGo p, ScHEllinG G. The role of glucocorticoids, catecholamines and endocannabinoids in the de-
velopment of traumatic memories and posttraumatic stress symptoms in survivors of critical illness. Neurobiol Learn Mem. 2014 Jul;112:68-74.
uSuKi m, matSuoKa Y, niSHi d, YonEmoto n, matSumura K, otomo Y, Kim Y, Kanba S. Potential impact of propofol immediately after motor vehicle acci-
dent on later symptoms of posttraumatic stress disorder at 6-month follow up: A retrospective cohort study. Crit Care. 2012 Oct 28;16(5):R196.
Hill mn, mclauGHlin rJ, binGHam b, SHrEStHa l, lEE tt, GraY Jm, viau v. Endogenous cannabinoid signaling is essential for stress adaptation. Proc
Natl Acad Sci U S A. 2010 May 18;107(20):9406-11.
cHouKEr a, Kaufmann i, KrEtH S, HauEr d, fEuErEcKEr m, tHiEmE d, voGESEr m, tHiEl m, ScHEllinG G. Motion sickness, stress and the endocannabinoid
system. PLoS One. 2010 May 21;5(5):e10752.
morEira fa, wotJaK ct. Cannabinoids and anxiety. Curr Top Behav Neurosci. 2010;2:429-50.
nEumEiStEr a, normandin md, piEtrzaK rH, piomElli d, zHEnG mQ, GuJarro-anton a, potEnza mn, bailEY cr, lin Sf, naJafzadEH S, ropcHan J, HEnrY S, cor- Si-travali S, carSon rE, HuanG Y. Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: a positron emission tomography study. Mol Psychiatry. 2013 Sep;18(9):1034-40.
HauEr d, ScHEllinG G, Gola H, campolonGo p, moratH J, roozEndaal b, Hamuni G, KarabatSiaKiS a, atSaK p, voGESEr m, KolaSSa it. Plasma concentrations of endocannabinoids and related primary fatty acid amides in patients with post-traumatic stress disorder. PLoS One. 2013 May 7;8(5):e62741.
KrYStal JH, nEumEiStEr a. Noradrenergic and Serotonergic Mechanisms in the Neurobiology of Posttraumatic Stress Disorder and Resilience. Brain Res. 2009 Oct 13;1293:13-23.
olzEwSKi tm, varraSSE Jf. The Neurobiology of PTSD: Implications for Nursing. J Psychosoc Nurs Ment Health Serv. 2005 Jun;43(6):40-7.
mitSuSHima d, Yamada K, taKaSE K, funabaSHi t, Kimura f. Sex differences in the basolateral amygdala: the extracellular levels of serotonin and do-
pamine, and their responses to restraint stress in rats. Eur J Neurosci. 2006 Dec;24(11):3245-54
amato Jl, banKSon mG, Yamamoto bK. Prior Exposure to Chronic Stress and MDMA Potentiates Mesoaccumbens Dopamine Release Mediated by the 5-HT(1B) Receptor. Neuropsychopharmacology. 2007 Apr;32(4):946-54.
bruEninG S, oH E, HEtzEnauEr a, EScobar-alvarEz S, wEStpHalEn ri, HEmminGS Hc Jr, SinGEwald n, SHippEnbErG t, totH m. The anxiety-like phenotype of 5-HT receptor null mice is associated with genetic background-speci c perturbations in the prefrontal cortex GABA-glutamate system. J Neuro- chem. 2006 Nov;99(3):892-9.
antai-otonG d. The Neurobiology of Anxiety Disorders: Implications for Psychiatric Nursing Practice. Issues Ment Health Nurs. 2000 Jan- Feb;21(1):71-89.
clarK mS, nEumaiEr Jf. The 5-HT1B receptor: behavioural implications. Psychopharmacol Bull. 2001 Autumn;35(4):170-85.
corcHS f, nutt dJ, Hood S, bErniK m. Serotonin and sensitivity to trauma-related exposure in selective serotonin reuptake inhibitors-recovered
posttraumatic stress disorder. Biol Psychiatry. 2009 Jul 1;66(1):17-24.
SHin lm, raucH Sl, pitman rK. Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Ann N Y Acad Sci. 2006 Jul;1071:67-79.
mcfarlanE ac, YEHuda r, clarK cr. Biologic models of traumatic memories and post-traumatic stress disorder: The role of neural networks. Psychiatr Clin North Am. 2002 Jun;25(2):253-70, v.
GEracioti td Jr, baKEr dG, KaScKow Jw, Strawn Jr, mulcHaHEY JJ, daSHEvSKY ba, Horn pS, EKHator nn. Effects of trauma-related audiovisual stimulation on cerebrospinal uid norepinephrine and corticotropin-releasing hormone concentrations in post-traumatic stress disorder. Psychoneuroen- docrinology. 2008 May;33(4):416-24.
SoutHwicK Sm, daviS m, HornEr b, caHill l, morGan iii ca, Gold pE, brEmnEr Jd, cHarnEY dc. Relationship of Enhanced Norepinephrine Activity During Memory Consolidation to Enhanced Long-Term Memory in Humans. Am J Psychiatry. 2002 Aug;159(8):1420-2.
pEzzE ma, fEldon J. Mesolimbic dopaminergic pathways in fear conditioning. Prog Neurobiol. 2004 Dec;74(5):301-20.
prESton J. The neurobiology of anxiety, depression, and traumatic stress. 2003 Handout presented at J&K Seminars, Lancaster, PA.
GlovEr da, powErS mb, bErGman l, JaSEr aJ, SmitS JaJ, tElcH mJ, StubEr m. Urinary dopamine and turn bias in traumatized women with and without PTSD symptoms. Behav Brain Res. 2003 Sep 15;144(1-2):137-41.
YEHuda r, SoutHwicK S, GillEr El, ma x, maSon Jw. Urinary catecholamine excretion and severity of PTSD symptoms in Vietnam combat veterans. J Nerv Ment Dis. 1992 May;180(5):321-5.
HamnEr mb, diamond bi. Elevated plasma dopamine in posttraumatic stress disorder: a preliminary report. Biol Psychiatry. 1993 Feb 15;33(4):304-6.
HoExtEr mQ, fadEl G, fElício ac, calzavara mb, batiSta ir, rEiS ma, SHiH mc, pitman rK, andrEoli Sb, mEllo mf, mari JJ, brESSan ra. Higher striatal do-
pamine transporter density in PTSD: an in vivo SPECT study with [(99m)Tc]TRODAT-1. Psychopharmacology (Berl). 2012 Nov;224(2):337-45.
pEttY f, fulton m, KramEr Gl, Kram m, daviS ll, ruSH aJ. Evidence for the segregation of a major gene for human plasma GABA levels. Mol
Psychiatry. 1999 Nov;4(6):587-9.
vaiva G, boSS v, ducrocQ f, fontainE m, dEvoS p, brunEt a, laffarGuE p, GoudEmand m, tHomaS p. Relationship Between Posttrauma GABA Plasma
Levels and PTSD at 1-Year Follow-Up. Am J Psychiatry. 2006 Aug;163(8):1446-8.
SmitH cp. Content analysis and narrative analysis. In: Reis HT, Judd CM, editors. Handbook of research methods in social and personality
psychology. Cambridge: Cambridge University Press p.313-335, 2000.
EGErod i, cHriStEnSEn d. Analysis of patient diaries in Danish ICUs: a narrative approach. Intensive Crit Care Nurs. 2009 Oct;25(5):268-77.
wald J, taYlor S. Interoceptive Exposure Therapy combined with trauma-related Exposure Therapy for post-traumatic stress disorder: a case report. Cogn Behav Ther. 2005;34(1):34-40.
rattraY JE, JoHnSton m, wildSmitH Jaw. Predictors of emotional outcomes of intensive care. Anaesthesia. 2005 Nov;60(11):1085-92.
pEriS a, bonizzoli m, iozzElli d, miGliaccio ml, zaGli G, baccHErEti a, dEbolini m, vannini E, Solaro m, balzi i, bEndoni E, baccHi i, trEviSan m, Giovannini v, bEl- loni l. Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients. Crit Care. 2011;15(1):R41.
JacobS Gd. The physiology of mind-body interactions: the stress response and the relaxation response. J Altern Complement Med. 2001;7 Suppl 1:S83-92.
friESnEr Sa, currY dm, moddEman Gr. Comparison of two pain-management strategies during chest tube removal: relaxation exercise with opioids and opioids alone. Heart Lung. 2006 Jul-Aug;35(4):269-76.
fraziEr SK, moSEr dK, dalEY lK, mcKinlEY S, riEGEl b, Garvin bJ, an K. Critical care nurses’ beliefs about and reported management of anxiety. Am J Crit Care. 2003 Jan;12(1):19-27.
GoinES l, HaGlEr l. Noise pollution: a modem plague. South Med J. 2007 Mar;100(3):287-94.
xiE H, KanG J, millS GH. Clinical Review: The impact of noise on patients sleep and the effectiveness of noise reduction stragies in intensive care
units. Crit Care. 2009;13(2):208.
JoHanSSon l, bErGbom i, waYE Kp, rYHErd, E, lindaHl b. The sound environment in an ICU patient room. A content analysis of sound levels and pa-
tient experiences. Intensive Crit Care Nurs. 2012 Oct;28(5):269-79.
mEllman ta, buStamantE v, finS ai, piGEon wr, nolan b. REM sleep and the early development of posttraumatic stress disorder. Am J Psychiatry. 2002 Oct;159(10):1696-701.

Agenzie di supporto