Transcript Post-traumatic stress disorder

Symptoms, prevalence rate,
assignments.
 Youtube
– The deer hunter. (more suggestions
of films to see at the end of the
presentation).
A: The person has been
exposed to a traumatic
event involving death or
serious injury, and their
reponse involved intenese
fear, helplessness or horror.
B: The traumatic event is reexperienced in ways that might
inclue intrusive distressing
thoughts, and dreams of the
event, feeling that the
traumatic event is recurring
and showing intense
psychological distress when
exposed to anything that
resembles or sumbolises the
tramatic event.
C: Persistent avoidance of
stimuli associated with the
trauma, e.g. Avoiding
anything that might arouse
recolletions of the trauma,
and feeling detached from
others.
D: Persistent symptoms, of
increased arousal, including
sleeping difficulties, outburst
of anger and concentration
difficulties.
E: These symptoms last for a
period of more than 1 month
F: The disturbance causes clincially
significant distress of impairment in
social, occupational, or other
important areas of functioning.
 Affective:
adhedonia; emotional numbing
 Behavioural: hypervigilance; passitivity,
nightmares; flashbacks; exaggerated startle
respose
 Cognitive: intrusive memories, inability to
concentrate, hyperarousal
 Somatic lower back pain, headaches,
stomach ache and digestion problems,
insomnia, regression in some children.
Complication in diagnosis:
PTSD frequently occurs together with related
disorders such as depression, substance
abuse, problems of memory and cognition
and other problems of physical and mental
health.
(two last parts of ”the gorund truth”)
Not a new phenomenon. WWI ”Shell shock”,
and was seen as nothing more than
cowardice or personal weaknessess.
After WWI – the conclusion was that it was of
physical origin (injury to the nerves) – but
as not all who suffered these symtoms
actually had been near the fights – this
suggested psychological nature instead.
The anticipation of the horrors – a
significant determinant of mental health
problems. (Hoge (2004), found that among
US combat infantry units, over 9%
developed mental health problems juch as
major depression or PTSD prior to
deployment in Iraq)
WW II – psychiatrists were deployed to fighting
units.
A realization that the bloodier the combants and
closer to fights the soldiers were – the greater
the likelyhood of PTSD.
Post – Vietnam syndrom  PTSD
First in DSM IV (revised 2000) that the other than
war related traumas were included. First, the
trauma had to be ”outside the range of usual
human experience” and rape – unfortunately
being common – was not seen to be. New version
describe the traumatic event as ”one in which
the person experienced a threat of death or
serious injury and responded with intense fear”
Prevalence rate = the measure of the total
number of cases of the disorder in a given
population.
Lifetime prevalence = the percentage of the
population that will experience the disorder
at some time in their life.
.
US prevalence rate = 1-3 per cent and
estimated lifetime prevalence 5 per
cent in men and 10 per cent in women.
Davidson et al (2007) estimate that PTSD
affects 15-24 per cent of individuals
who are exposed to traumatic events
(see etiology for a discussion why some
are affected and some not). In
communities that have experienced
traumatic events, average prevalence
increases to 9 per cent (eg. September
11).
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PTSD may not be a mental disorder because it is a reaction to an
even that would be disstressing for almost anyone.
PTSD should be separated from anxiety disorders and placed in an
etiologically based category along with other disorders that
follow traumatic events (McNally). That is also how it is classified
in ICD.
The core symtoms are both anxiety (anxiety, intrusive images…)
related but also dissociative (amnesia, multible personality,
flashbacks)
Future versions of DSM should address these.
True prevalence is difficult to judge – especially when some
traumatic events affect a large number of people
simulataneously (hurricane, flooding) – 60 % of all men and 51 %
of women reported at least one traumatic event at some time
during their lives (Kessler, 1999).
Unclearities of why more women experience PTSD than men.
Rape might be one reason, more psychological than physical
trauma.
Type of trauma is a key factor:
3 % of those who experience a personal attack,
20 % of wounded veterans and 50% of rape
victims develop PTSD. Above all – loss of a
loved one (in a trauma) – 1/3 of the total of
all cases.
 Watch
a movie of your choice:
 Taxi Driver (1976)
 Coming Home (1978)
 Apocalypse Now (1979)
 The Deer Hunter (1979)
 Return of the Soldier (1982)
 Birdy (1984)
 Born on the Fourth of July (1989)
 Heaven and Earth (1993)
 These movies unleash the inner mindset of
combat veterans trying their best to cope with
the trauma of war.
For the ambitious – at home:
”Using the criteria listen in box 1 (in article) – what aspects of the
main character’s behaviour in each of these films would lead you
to diagnose PTSD?”
In class:
 Research evidence – using the internet, read more abou thte
hoge it al. (2004) and Iversen et al. (2009). These can be found
at: http//content.nejm.org/cgi/content/full/351/1/13 (Hoge et
al.) and at www.biomedcenter.com/1471-244X/9/68 (Iversen at
al.).
 What were the main methods used in each study?
 What were the main conclusions drawn about the relationship
between combat stress and the development of psychiatric
illness
Homework:
Read about Jocelyn’s case. Underline 10 sentences (paragraphs)
that you reacted against, or felt was especially important
when reading the case. Thursday will be spent covering the
case and etiology. If you are not prepared, you will not
participate in the seminar.