Post traumatic stress disorder

Specialties > Mental health

Background knowledge 🧠

Definition

Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a traumatic event.
Characterized by intrusive thoughts, nightmares, flashbacks, and severe anxiety.
Can lead to significant impairment in social, occupational, and other important areas of functioning.

Epidemiology

Lifetime prevalence in the UK is approximately 3-4%.
Higher prevalence in military personnel, emergency responders, and survivors of severe trauma (e.g., assault, accidents).
Women are more likely to develop PTSD than men.
Higher incidence in individuals with a history of mental health disorders.
PTSD often coexists with other psychiatric disorders, such as depression and substance abuse.

Aetiology and pathophysiology

Caused by exposure to traumatic events such as warfare, sexual assault, natural disasters, or serious accidents.
Pathophysiology involves dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to abnormal stress responses.
Amygdala hyperactivity contributes to exaggerated fear responses and intrusive memories.
Hippocampal atrophy observed, affecting memory processing and contextualization of the trauma.
Genetic predisposition and environmental factors also play a role.

Types

Acute PTSD: Symptoms last for less than 3 months.
Chronic PTSD: Symptoms last for 3 months or longer.
Delayed-onset PTSD: Symptoms appear at least 6 months after the traumatic event.
Complex PTSD: Involves prolonged or repeated trauma, often with additional symptoms like emotional dysregulation and interpersonal difficulties.

Clinical Features 🌡️

Symptoms

Re-experiencing: Flashbacks, intrusive memories, nightmares.
Avoidance: Avoiding reminders of the trauma, emotional numbness.
Hyperarousal: Irritability, difficulty sleeping, hypervigilance.
Negative cognitions: Feelings of detachment, guilt, and persistent negative emotions.
Emotional distress: Intense emotional reactions when reminded of the trauma.

Signs

Hypervigilance: Constantly on guard, easily startled.
Sleep disturbances: Insomnia, nightmares.
Psychosomatic symptoms: Headaches, gastrointestinal distress, chronic pain.
Emotional blunting: Difficulty experiencing positive emotions.
Social withdrawal: Isolation from friends and family.

Investigations 🧪

Tests

Clinical assessment: Comprehensive psychiatric evaluation to assess symptoms and their impact on daily life.
Use of screening tools: PTSD Checklist for DSM-5 (PCL-5), Clinician-Administered PTSD Scale (CAPS-5).
Differential diagnosis: Rule out other conditions such as depression, anxiety disorders, and substance use disorders.
Physical examination: To identify any comorbid conditions or complications.

Management 🥼

Management

Psychotherapy: Trauma-focused cognitive behavioral therapy (CBT) is first-line treatment.
Pharmacotherapy: SSRIs (e.g., sertraline, paroxetine) and SNRIs (e.g., venlafaxine) are commonly prescribed.
EMDR: Eye Movement Desensitization and Reprocessing therapy for reducing distress.
Lifestyle interventions: Encouraging regular physical activity, sleep hygiene, and social support.
Multidisciplinary approach: Involving psychologists, psychiatrists, and primary care physicians.

Complications

Chronic PTSD can lead to substance abuse, depression, and anxiety disorders.
Increased risk of cardiovascular disease due to chronic stress.
Social isolation and relationship difficulties.
Occupational impairment and reduced quality of life.
Suicidality: Increased risk of suicidal thoughts and behaviors.

Prognosis

With appropriate treatment, many patients experience significant symptom reduction.
Some patients may have chronic symptoms, requiring long-term management.
Early intervention is associated with better outcomes.
Prognosis can be affected by comorbid conditions and the severity of the initial trauma.

Key points

PTSD is a common and serious mental health condition requiring early recognition and treatment.
Combination of psychotherapy and pharmacotherapy is often most effective.
Holistic care approach improves outcomes.
Continuous monitoring and support are crucial for managing chronic PTSD.

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