Post Traumatic Stress Disorder PTSD

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Post Traumatic Stress DisorderPTSD

• By Eglantina Di Mase

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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.

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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

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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

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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.

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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

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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.

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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.

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Treatment
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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).

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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.

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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").

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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

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Who is affected by PTSD?

• Up to 10 of the population
• Strikes more females than males
• Can occur with children as well

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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