Post Traumatic Stress Disorder (PTSD)

Published At: 18 January 2020 , 06:24 PM

Post-traumatic stress disorder (PTSD) characterized by recurring obsessive memories of a shocking, traumatic event that begins up to 6 months after the event and lasts for> 1 month. The pathophysiology of the disorder is not fully understood. Symptoms also include avoiding traumatic event irritants, nightmares, and flashbacks — the diagnosis based on an anamnesis. Treatment consists of exposure therapy and drug therapy.

After a life-threatening situation, many people suffer for a long time; in some cases, their condition is so persistent and debilitating that it forms a painful disorder. As a rule, events that can cause PTSD to cause a feeling of fear, helplessness, or horror. These events can be experienced directly (for example, patients were seriously injured or were in mortal danger) or indirectly (for example, patients witnessed others seriously injured, were killed or were mortally dumbfounded, or learned about events that happened to close relatives or friends). Military action, sexual abuse, natural or human-made disasters are common causes of post-traumatic stress disorder.

Their prevalence is approaching 9%, in 12 months, the prevalence among the population is about 4%.

Clinical manifestations

Symptoms of PTSD can be divided into the following categories: symptoms of presence, symptoms of avoidance, adverse changes in cognitive processes, and moods, as well as changes in arousal and reactivity. Most often, patients have unwanted memories and a reproduction of the triggering event. Dreams about this event are common.

Less common are dissociative wakefulness states in which events experienced as if they were happening. This sometimes leads patients to respond, as in the initial situation (for example, loud noises, such as fireworks, can trigger a memory of the battle, which in turn can lead to asylum-seeking or falling to the ground for protection).

Patients find it difficult to avoid the incentives associated with trauma, and they often feel emotionally numb in everyday activities.

Sometimes the symptoms are a continuation of acute stress disorder, or they can occur separately for up to 6 months after an injury. Sometimes the full manifestation of individual symptoms is delayed and begins only a few months or even years after a traumatic event.

Depression, other anxiety disorders, and substance abuse are common in patients with chronic PTSD.

Moreover, in addition to traumatic anxiety, patients may feel guilty about their actions during the event or often associating this with the fact that they survived, and those close to them died.

Diagnostics

  • Clinical criteria

The clinical diagnosis based on the requirements of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

To meet the diagnostic criteria, patients had to directly or indirectly encounter a traumatic event. Also, they should have symptoms from each of the following categories over one month:

Symptoms of distortion (≥ 1 of the following symptoms):

  • Repeating, involuntary, obsessive disturbing memories
  • Recurring disturbing dreams (e.g., nightmares) on the subject of an event
  • The patient acts or feels as if the event is happening again; it can be different sensations, from flashbacks to a complete loss of awareness of the surrounding reality
  • Intense psychological or physiological discomfort when reminded of a traumatic event (for example, in the form of sounds similar to those that the patient heard during the event, or in the form of the anniversary of the event)

Avoidance Symptoms (≥ 1 of the following symptoms):

  • Avoiding activities, places, conversations, or people who evoke an event

Adverse effects on cognitive ability and mood (≥ 2 of the following symptoms):

  • Loss of memory about essential components of an event (dissociative amnesia);
  • Persistent and exaggerated negative beliefs or expectations from oneself, others or the world in general
  • Distorted thoughts continuously about the cause or consequences of the injury, leading to blaming yourself or others
  • Significant decrease in interest or participation in relevant events
  • A sense of disunity or estrangement from other people;
  • Persistent inability to experience positive emotions (e.g., happiness, satisfaction, the feeling of love)

Altered level of consciousness and reactivity (≥ 2 of the following symptoms):

  • difficulty sleeping;
  • irritability or outbursts of anger;
  • Unreasonable behavior or auto-aggression
  • Concentration problems
  • increased start reflex;
  • hyperactivity

Also, the manifestations should cause significant discomfort or significantly impede social or professional activity, and should not be associated with the physiological effects of psychoactive substances or other diseases.

Treatment

  • Psychotherapy
  • Drug therapy (e.g., using SSRIs)

A wide range of psychotherapeutic methods has been successfully used to treat PTSD. SSRIs or other drugs are also often used.

If untreated, chronic PTSD may be somewhat compensated, but in many people, severe disorders persist for a long time.

The main form of psychotherapy is exposure therapy, which is characterized by the patient's encounter with situations that he avoids because they can trigger memories of the injury. A return to fantasies of a traumatic experience usually reduces stress after some initial increase in discomfort.

Desensitization and eye movement processing (DPDG) is a form of exposure therapy. This therapy is that patients asked to monitor the therapist's finger movement while the patients themselves imagine they are experiencing a traumatic event.

It also helps to stop specific ritual behavior, such as excessive washing, to gain a sense of cleanliness after sexual abuse.

SSRIs can reduce anxiety and depression. Prazosin helps in reducing the intensity of nightmares. Sometimes mood stabilizers and atypical antipsychotics are used, but the number of arguments in favor of their use is minimal.

Supportive psychotherapy in all cases plays an important role. Psychotherapists must be empathetic and responsive, recognize patients' mental pain and the reality of traumatic events. At the early stage of treatment, many patients need to learn to relax and control their anxiety (for example, be attentive to themselves, do breathing exercises, yoga) before they can tolerate external influences, which, as a rule, will be paid attention to during PTSD treatment.

Psychotherapy aimed at helping patients understand and change their self-critical or hostile attitudes can help eradicate the guilt complex of the survivor.