Post traumatic stress disorder
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Post Traumatic Stress Disorder. Acute Stress Disorder Dr. A. Hadjebi. History. U. S. civil war : Soldier's heart syndrome 1900 s : Traumatic neurosis due to the influence of psychoanalysis World war I : shell shock World war II : combat neurosis or operational fatigue

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Post Traumatic Stress Disorder

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Post traumatic stress disorder

Post Traumatic Stress Disorder

Acute Stress Disorder

Dr. A. Hadjebi


History

History

  • U. S. civil war : Soldier's heart syndrome

  • 1900 s : Traumatic neurosis due to the influence of psychoanalysis

  • World war I : shell shock

  • World war II : combat neurosis or operational fatigue

  • Vietnam war : post traumatic stress disorder


History1

History

  • PTSD: DSM-III (1980)

  • ASD; DSM-IV (1994)

  • PTSD in DSM-III: reexperience(1),psychic numbing(2), other items(1), no duration criteria

  • PTSD in DSM-III-R is similar to DSM-IV-TR

  • In ICD-10 PTSD & ASD are stress related disoders


Epidemiology

Epidemiology

  • Life time prevalence (8%)

  • 30% of Vietnam veterans

  • 25 % subclinical form of disorder

  • In women : life time prevalence 10- 12%

  • In men : life time prevalence 5- 6%

  • PTSD is most prevalent in young adults

  • Men's trauma : combat experience

  • Women's trauma : assault or rape


Epidemiology1

Epidemiology

  • PTSD most likely to occur in single , divorced , widowed , socially withdrawn , low socioeconomic level

  • First degree biological relatives of persons with a history of depression have an increased risk for developing PTSD following a traumatic event


Comorbidity

Comorbidity

  • About 2/3 having at least tow other disorders

  • Common comorbid conditions include : depressive disorders , substance related disorders , other anxiety disorders and bipolar disorders


Etiology

Etiology

  • Stressor

  • Risk factors

  • Psychodynamic factors

  • Cognitive – behavioral factors

  • Biological factors

    Noradrenergic system

    Opioid system

    Corticotropin – releasing factor and the

    HPA axis


Psychological aspects of ptsd

Psychological aspects of PTSD

  • Emotional response to trauma reminder

  • Base line physiological activity

  • Exaggerated startle reflex.


Diagnostic criteria for ptsd

Diagnostic criteria for PTSD

  • Exposure to a traumatic event

  • The traumatic event is persistently

    reexperienced

  • Persistent avoidance of stimuli associated with the trauma

  • Persistent symptoms of increased arousal

  • Duration of the disturbance is more than 1 month


Diagnostic criteria for ptsd1

Diagnostic criteria for PTSD

  • Significant distress or impairment in social, occupational or …

  • Specify if : acute : < 3 months

    chronic : > or = 3 months

  • With delayed onset


Diagnostic criteria for asd

Diagnostic criteria for ASD

The disturbance last for a min. of 2 days and a max. of 4 weeks and occurs within 4 weeks of the traumatic events


Ptsd in children and adolescents

PTSD in children and adolescents

  • Child risk factors include :

    - demographic factors ( age,

    socioeconomic status )

    - life events

    - psychiatric comorbidity

    - parental psychopathology

    - parental marital status


Gulf war syndrome

Gulf war syndrome

  • Health problems

  • Irritability

  • Chronic fatigue

  • Shortness of breath

  • Muscle and joint pain

  • Migraine headaches

  • Digestive disturbances

  • Rash

  • Hair loss

  • Forgetfulness

  • Difficulty concentrating


Differential diagnosis organic head trauma epilepsy alcohol use disorder

Differential diagnosisorganic; head trauma, epilepsy, alcohol use disorder

  • Pain disorder

  • Substance abuse

  • Other anxiety disorders

  • Mood disorders

  • Borderline disorders

  • Dissociative disorders

  • malingering


Course and prognosis

Course and prognosis

30 % recover completely

40 % mild symptoms

20 % moderate symptoms

10 % remain unchanged

  • Good prognosis is predicted by :

    - rapid onset of the symptoms

    - short duration of the symptoms

    - good premorbi functioning

    - strong social supports

    - absence of other psychiatric, medical or substance – related disorders


Course and prognosis1

Course and prognosis

  • The very young and very old have more difficulty with traumatic events than do these in midlife

  • PTSD that is comorbid with other disorders is often more severe and perhaps more chronic and difficult to treat

  • Social support influence the development, severity and duration of PTSD


Treatment

Treatment

  • Psychotherapy

  • Pharmacotherapy


Psychotherapy

Psychotherapy

  • Psychodynamic psychotherapy

  • Cognitive – behavior therapy

  • Group therapy

  • Family therapy


Pharmacotherapy

pharmacotherapy

  • SSRIs : Sertraline and Paroxetine

  • Buspirone

  • TCA: Impramine, Amitriptyline

  • Some studies indicate that pharmacotherapy is more effective in treating the depression, anxiety and hyperarousal than in treating the avoidance and emotional numbing

  • Other drugs ; MAOIs ( Phenelzine ), Trazodone, Anticonvalsants, (carbamazapine, valpoarate ), clonidine, propranolol


Recommendation

Recommendation

  • Strongly recommend selective serotonin reuptake inhibitors (SSRIs) as first line agents for the treatment of PTSD.

  • Recommend tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) as second-line treatments for PTSD.

  • Consider an antidepressant therapeutic trial of at least 12 weeks before changing therapeutic regimen.


Recommendation1

Recommendation

  • Consider prazosin to augment the management of nightmares and other symptoms of PTSD.

  • Recommend medication compliance assessment at each visit.

  • Since PTSD is a chronic disorder, responders to pharmacotherapy may need to continue medication indefinitely; however it is recommended that maintenance treatment should be periodically reassessed


Special considerations on sep 11 2001

Special considerations on sep. 11. 2001

  • 3500 deaths and injuries

  • 45% of adults reported symptoms of stress , such as distressing recollections of the event, insomnia, nightmare,…

  • 90% reported minor degrees of symptoms

  • Susceptibility to symptoms was associated with : female, nonwhite, having previous psychological illness, being close to disaster site


Special considerations on sep 11 20011

Special considerations on sep. 11. 2001

  • Over 80 % of parents reported that their children had one or more symptoms

  • Survey of Manhattan residents conducted 5 to 8 weeks after the world trade center collapsed:

    - 9.8% (90000 ) people had PTSD or clinical depression

    - 3.7% ( 34000 ) people met the criteria for both diagnosis


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