Transcript Post Traumatic Stress Disorder PTSD

Post Traumatic Stress
Disorder
PTSD
By: Eglantina Di Mase
PTSD
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Post traumatic Stress Disorder, or PTSD, is
a psychiatric disorder that can occur following
the experience or witnessing of lifethreatening events such as military combat,
natural disasters, terrorist incidents, serious
accidents, or violent personal assaults like
rape.
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PTSD is marked by clear biological changes
as well as psychological symptoms. PTSD is
complicated by the fact that it frequently
occurs in conjunction with related disorders
such as depression, substance abuse,
problems of memory and cognition, and other
problems of physical and mental health. The
disorder is also associated with impairment of
the person's ability to function in social or
family life, including occupational instability,
marital problems and divorces, family discord,
and difficulties in parenting.
Symptoms
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People who suffer from PTSD often relive
the experience through nightmares and
flashbacks, have difficulty sleeping, and
feel detached or estranged, and these
symptoms can be severe enough and last
long enough to significantly impair the
person's daily life
Intrusive Symptoms
 "Re-experience" of the trauma
 This usually occurs in nightmares
 Sometimes comes as a sudden, painful
onslaught of emotions that seem to have no
cause
Symptoms
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Symptoms of Avoidance
Person avoids close emotional ties with family, colleagues and
friends
At first, person had diminished emotions and can complete only
routine, mechanical activities
Avoid situations that are reminders of the traumatic event because
the symptoms may worsen
Symptoms of Hyperarousal
May have trouble concentrating or remembering current information
May develop insomnia
Children may develop stomachaches and headaches, in addition to
symptoms of increased arousal
Associated Features
Rid themselves of their "re-experience" by abusing alcohol or other
drugs as a "self-medication"
May show poor control over his or her impulses
May be at risk for suicide
History
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PTSD is not a new disorder. There are written accounts of similar
symptoms that go back to ancient times, and there is clear
documentation in the historical medical literature starting with the
Civil War, when a PTSD-like disorder was known as "Da Costa's
Syndrome."
 Careful research and documentation of PTSD began in earnest
after the Vietnam War. The National Vietnam Veterans
Readjustment Study estimated in 1988 that the prevalence of
PTSD in that group was 15.2% at that time and that 30% had
experienced the disorder at some point since returning from
Vietnam.
 PTSD has subsequently been observed in all veteran
populations that have been studied, including World War II,
Korean conflict, and Persian Gulf populations, and in United
Nations peacekeeping forces deployed to other war zones
around the world. There are remarkably similar findings of PTSD
in military veterans in other countries. For example, Australian
Vietnam veterans experience many of the same symptoms that
American Vietnam veterans experience.
History
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PTSD formally entered into psychiatric
nomenclature in the DSM-III (1980). The
DSM.-III-R (1987) expanded the definition of
the concept of stressors of PTSD, rearranged
the symptoms in all the clusters, increased the
range of items in both the re-experience and
avoidant cluster symptoms, and revised
criteria to include items representing PTSD in
children
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PTSD has most often been studied in soldiers,
but clearly many types of natural and civilian
catastrophes, criminal assaults, rape, terrorist
attacks, and accidents may precipitate it
Eitiology
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Although the etiology of PTSD is unknown, most investigators
believe that a personal predisposition is necessary for symptoms to
develop after a traumatic event. Clinically significant symptoms
following a traumatic event occur in a minority of persons. Those
likely to develop PTSD tend to have a pre-existing depression or
anxiety disorder, or a family history of anxiety and neuroticism.
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From a biologic perspective, the body's failure to return to its
pretraumatic state differentiates PTSD from a simple fear response.
In a normal fear response, the immediate sympathetic discharge
activates the "fight-or-flight" reaction. Increases in both
catecholamines and cortisol occur relative to the severity of the
stressor. Cortisol release stimulated by corticotropin-releasing factor
via the hypothalamic-pituitary-adrenal (HPA) axis acts in a negative
feedback loop to suppress sympathetic activation and cause further
release of cortisol.
Eitiology
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In patients with PTSD, ambient cortisol levels are lower than normal;
this state has been attributed to chronic "adrenal exhaustion" from
inhibition of the HPA axis by persistent severe anxiety. However,
recent data note that cortisol levels in the immediate aftermath of a
motor vehicle wreck were significantly lower in persons who went on
to develop PTSD. In a related study, cortisol levels immediately after
rape were lower in women with a previous history of rape. Some
investigators have hypothesized that the HPA axis and the
sympathetic nervous system are disassociated in persons who
develop PTSD, which may allow for an uncontrolled
catecholamine release that affects formation of memories
during the trauma and perhaps exacerbates symptoms when
that person is exposed to cues after the trauma.
Treatment
Treatment- Learning
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·learning skills for coping with anxiety (such
as breathing retraining or biofeedback) and
negative thoughts ("cognitive
restructuring"),
·managing anger,
·preparing for stress reactions ("stress
inoculation"),
·handling future trauma symptoms,
·addressing urges to use alcohol or drugs
when trauma symptoms occur ("relapse
prevention"), and
·communicating and relating effectively with
people (social skills or marital therapy).
Treatment-Bio
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Pharmacotherapy (medication) can reduce the anxiety,
depression, and insomnia often experienced with PTSD,
and in some cases, it may help relieve the distress and
emotional numbness caused by trauma memories.
Several kinds of antidepressant drugs have contributed
to patient improvement in most (but not all) clinical trials,
and some other classes of drugs have shown promise.
At this time, no particular drug has emerged as a
definitive treatment for PTSD. However, medication is
clearly useful for symptom relief, which makes it possible
for survivors to participate in psychotherapy.
Treatment - Cognitive
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Cognitive-behavioral therapy involves working with
cognitions to change emotions, thoughts, and behaviors.
Exposure therapy is one form that is unique to trauma
treatment. It uses careful, repeated, detailed imagining
of the trauma (exposure) in a safe, controlled context to
help the survivor face and gain control of the fear and
distress that was overwhelming during the trauma. In
some cases, trauma memories or reminders can be
confronted all at once ("flooding"). For other individuals
or traumas, it is preferable to work up to the most severe
trauma gradually by using relaxation techniques and by
starting with less upsetting life stresses or by taking the
trauma one piece at a time ("desensitization").
Treatment –Cognitive
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Eye Movement Desensitization
and Reprocessing (EMDR) is a
relatively new treatment for
traumatic memories that
involves elements of exposure
therapy and cognitive-behavioral
therapy combined with
techniques (eye movements,
hand taps, sounds) that create
an alternation of attention back
and forth across the person's
midline. While the theory and
research are still evolving for
this form of treatment, there is
some evidence that the
therapeutic element unique to
EMDR, attentional alternation,
may facilitate the accessing and
processing of traumatic material
Who is affected by PTSD?
 Up
to 10% of the population
 Strikes more females than males
 Can occur with children as well
Biography
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http://www.ncptsd.va.gov/
 http://www.aafp.org/afp/20031215/2401.html
 http://www.fbhs.org/PTSD.htm
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American Psychiatric Association. Diagnostic
and statistical manual of mental disorders. 3d
ed. Washington, D.C.: American Psychiatric
Association, 1980:232-3