Definition:can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one’s own or someone else’s physical, sexual, or psychological integrity, overwhelming the individual’s ability to cope.
Classification / type of disease:
Epidemiology: rates are 25-80/100,000/yr. ~3 x more common in women.
Presenting symptoms / signs:
Diagnostic investigations: Diagnostic symptoms for PTSD include re-experiencing the original trauma(s) through flashbacks or nightmares, avoidance of stimuli associated with the trauma, and increased arousal – such as difficulty falling or staying asleep, anger, and hypervigilance – lasting >1/12. If briefer than 1/12 – a diagnosis of acute stress disorder may be appropriate.
- Exposure to a traumatic event
- Persistent re-experiencing
- Persistent avoidance and emotional numbing
- Persistent symptoms of increased arousal not present before
- Duration of symptoms for more than 1 month
- Significant impairment
- Physical or psychological trauma
- Trauma leading to an overactive adrenaline response and general neuroendocrinological disarray
- Altered function of: prefrontal cortex, amygdala and hippocampus
- Genetic/hereditary factors
Risk factors for PTSD:
- Military experience: war zone experience, stressful events, Hispanic or Japanese
- Sexual abuse and then subsequent foster care
- Prevention and early intervention strategies = Critical incident stress management
- Psychotherapeutic interventions = trauma focused CBT
- Eye movement desensitization and reprogramming
- Interpersonal psychotherapy
Symptom management: potentially useful medication classes
- Alpha-adrenergic antagonists. Prazosin
- Anti-convulsants, mood stabilizers, anti-aggression agents.
- Antipsychotics. Risperidone
- Atypical antidepressants
- Beta blockers. Propranolol
- Heterocyclic / Tricyclic anti-depressants
- Monoamine-oxidase inhibitors (MAOs)
Prognosis: alcohol and drug abuse commonly co-occur with PTSD and it may make issues of anxiety more difficult to deal with.