Overview The identification of Post traumatic stress disorder (PTSD) in a patient involves understanding the traumatic event and the patient characteristics. PTSD may develop following exposure to 1 or more traumatic events such as deliberate acts of interpersonal violence, severe accidents, disasters, or military action.
Definition Post traumatic Stress Disorder (PTSD): A syndrome that develops after a person witnesses, experiences, or is confronted with a traumatic event. The person reacts with feelings of helplessness, fear, and horror, and has ongoing symptoms of reexperiencing, avoidance of reminders, and symptoms of increased arousal. Acute Stress Disorder: A syndrome that develops shortly after an individual is exposed to a traumatic event. It is characterized by intense fear and feelings of helplessness, as well as a number of dissociative symptoms. Acute stress disorder is defined as occurring within the first 4 weeks after a traumatic event (resolves without progressing to PTSD) Adjustment Disorder: Characterized by mood disturbances (anxiety, depression) in response to a difficult situation, but adjustment disorders do not present with the avoidance symptoms (avoiding talking about the incident) and/or reexperiencing of the traumatic event. |
Epidemiology The lifetime risk of being exposed to a traumatic stressor is high (60.7% for men, 51.2% for women), but only an estimated 8% of exposed men and 20% of exposed women develop PTSD
Side note Patients with PTSD may present in primary care with physical symptoms that are difficult to explain |
Re-experiencing the traumatic event
Avoidance and emotional numbing
Hyper-arousal (hypervigilance)
Triad of symptoms for PTSD: Re-experiencing, avoidance and hypervigilance |
PTSD can be due to indirect or direct forms of trauma
Aetiology
Remember Individual reactions to traumatic events vary greatly and most people do not develop a mental disorder after exposure to trauma. PTSD should be considered in any patient exposed to a major traumatic event |
Diagnosis (1-TRAUMAE)
Side note Sensitive questioning is required to elicit symptoms of PTSD as patients may avoid volunteering their traumatic experience(s) |
Think Post traumatic stress disorder is usually accompanied by a comorbid condition, such as major depression, another anxiety disorder, or substance dependence; this must be kept in mind when reviewing the differential diagnosis |
Think Patients can suffer injuries during traumatic events, and symptoms and sequelae of head injuries, particularly partial complex seizures can mimic symptoms of PTSD |
CHARACTERISTICS OF TRAUMA AND STRESS RELATED DISORDERS | |||
Acute Distress Disorder | Adjustment Disorder | PTSD | |
Type of Stressors | Severe | Mild/Moderate | Severe |
Time between stress and symptoms | Few days to maximum 4 weeks | Up to 3 months | Sometimes years |
Duration of symptoms | Maximum one months | 6 months after end of stressors | >1month |
Trauma-focused psychotherapy and pharmacotherapy with selective serotonin reuptake inhibitors or serotonin–norepinephrine reuptake inhibitors are first-line treatment options for PTSD. Patient choice and availability of psychological therapy will influence the treatment given. Aim of treatment is to:
Non-pharmacological
Remember There is still debate whether early debriefing about traumatic event has better prognosis. |
Pharmacological
Pharmacology SSRI inhibits the reuptake of serotonin into the presynaptic neuron, increasing levels of serotonin the synpatic cleft. SSRI help with most PTSD symptoms, including intrusive thoughts and flashbacks, irritability and anger, problems concentrating, hyperarousal, chronic restlessness and anxiety, and depressed mood. Side effects: weight gain, drowziness, depression, irritability, lethargy, fatigue. |
Remember Benzodiazepines should be avoided in the treatment of PTSD |
Complication
Remember PTSD is associated with comorbidity |
Prognosis
Traumatic and Stress Related Disorders
This will mainly focus on PTSD