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Post Traumatic Stress Disorder PTSD

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Title: Post Traumatic Stress Disorder PTSD


1
Post Traumatic Stress DisorderPTSD
  • By Eglantina Di Mase

2
PTSD
  • Post traumatic Stress Disorder, or PTSD, is
  • a psychiatric disorder that can occur
    following the experience or witnessing of
    life-threatening events such as military combat,
    natural disasters, terrorist incidents, serious
    accidents, or violent personal assaults like
    rape.
  • 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.

3
Symptoms
  • 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

4
Symptoms
  • 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

5
History
  • 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.

6
History
  • 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
  • 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

7
Eitiology
  • 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.
  • 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.

8
Eitiology
  • 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.

9
Treatment
10
Treatment- Learning
  • 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).

11
Treatment-Bio
  • 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.

12
Treatment - Cognitive
  • 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").

13
Treatment Cognitive
  • 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

14
Who is affected by PTSD?
  • Up to 10 of the population
  • Strikes more females than males
  • Can occur with children as well

15
Biography
  • http//www.ncptsd.va.gov/
  • http//www.aafp.org/afp/20031215/2401.html
  • http//www.fbhs.org/PTSD.htm
  • American Psychiatric Association. Diagnostic and
    statistical manual of mental disorders. 3d ed.
    Washington, D.C. American Psychiatric
    Association, 1980232-3
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