Post Traumatic Stress Disorder (PTSD)
Dr.Balan Stephen
Definition
It is a mental health condition that is triggered by a terrifying event - either experiencing it or witnessing it.
Aetiology
The reason for difference of such experience is not clearly understood.
Many War victims particularly World War 1 have PTSD - referred to as shell / combat neurosis / operational fatigue / soldier heart etc.
Rape
Assault
Torture
Armed robbery
Flood storms
Fire
Volcano.
Epidemiology
Prevalance : Life time prevalence is 5-15% of general population.
Age/sex : Women are more affected than men,
Type of trauma.
Men- commonly combat operation
Women - commonly assault or rape.
Risk Factors
Living alone, poor social support
Severity of traumatic event, its duration, and proximity of the person to traumatic event.
Pathophysiology
Biological model
Altered nor adrenergic systems has been implicated in PTSD.
Hypersensitivity of hypothalamo pituitary adrenal axis to stress as evidenced by abnormally low secretion of cortisol in response to stress with subsequently decreased levels of cortisol.
Psychological model
Fear in PTSD is a consequence of classical conditioning.
Results from faulty or incomplete cognitive and emotional processing of trauma related experience.
Clinical Features
Painful flashbacks of the terrifying incident
Feeling and reacting as if the traumatic events were recurring
Nightmares
Severe anxiety
Uncontrollable thoughts about the event
Efforts to avoid thoughts / feelings or conversation associated with the trauma.
Efforts to avoid activities or places that are associated with trauma.
Decreased interest in activities
Feelings of detachment from others.
Constant hyper arousal state as evidenced by
Sleep disturbance
Difficulty in concentration
Anger outbursts
Hypervigilance
Most people can experience extreme trauma and yet they are not affected by it.
Some people have temporary difficulty adjusting and coping, but with time and good self-care get better.
If the symptoms get worse, last for months or even years and interfere with day-to-day functioning → PTSD
It can develop after months or years after the traumatic event
Panic attack, illusion, hallucination and even dissociate state has been described by the patient.
Other symptoms like aggression, violence, poor impulse control and substance abuse abuse can also be seen in these patients.
Course and Prognosis
PTSD develops in 1 week or as long as 20 years later
About 30% recover spontaneously, 40% continue to have mild symptoms 20% continue to have moderate symptoms, 10% remain unchanged or become worse.
50% of patients recover after 1 year and 18 % recover after 5 years.
Good prognostic factors include rapid onset of symptoms, short duration, strong social support, and absence of psychiatric illness and substance abuse.
Treatment.
Goals
ALLEVIATION of symptoms and behavioural disturbance.
Alleviation of manifestations of co-occurring conditions
Better understanding of the trauma, its meaning, implications and consequences with sensible incorporation of traumatic experience and traumatic memories into ones identity.
Increased resistance to stress.
Improvement in functioning
Minimization of disability
Prevention of complication.
Drugs
SSRI --- escitalopram 10- 20 mg
Tricyclic-----amitriptyline50- 100 mg
Benzodiazepines ----- clonazepam. 0.5 to 2 mg
Psychological management includes behaviour therapy, cognitive therapy, psychological debriefing and group therapy.
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