Post traumatic stress disorder (ptsd)

A Disorder in Psychatiry

1. POST-TRAUMATIC STRESS DISORDER (PTSD). BY, ELDHOSE BOSE

2. INTRODUCTiON According to ICD-10, this disorder arises as a delayed and/protracted response to an exceptionally stressful or catastrophic life event or situation, which is likely to cause pervasive distress in ‘almost any person’ ( eg :- disasters, war, rape or torture, serious accident). The symptoms of PTSD may develop, after a period of latency, within six months after the stress or may be delayed beyond this period.

3. defenition PTSD is characterized by recurrent and intrusive recollections of the stressful event, either in flashbacks . (images, thoughts, or perceptions) and/or in dreams. There is an associated sense of re-experiencing of the stressful event. There is marked avoidance of the events or situations that arouse recollections of the stressful event, along with marked symptoms of anxiety and increased arousal. The term PTSD denotes an intense, prolonged, and sometimes delayed reaction to an intensely stressful event. The essential features of a post- traumatic stress reaction are as follows: 1. Re- experiencing of aspects of the stressful event. 2. Hyperarousal. 3. Avoidance of reminders.

4. AEITOLOGY The necessary cause of PTSD is an exceptionally stressful event. It is not necessary that the person should have been harmed physically or threatened personally; those involved in other ways may develop the disorder;(For Eg : the driver of a train in whose path someone has thrown himself for suicide, and the by standers at a major accident. DSM- 5 describes such events as involving actual or threatened death or serious injury or a threat to the physical integrity of the person or others .In a study of people affected by a volcanic erruption , the highest rate of PTSD was found among those who experienced the greatest exposure to the stressful events .Even so, not all of those most affected by the stressor developed PTSD, a finding that indicates that some form of personal vulnerability plays apart. Such vulnerability might be genetic or acquired.

5. The majority of people will experience at least one traumatic event in their lifetime: Intentional acts of interpersonal violence, in particular combat and sexual- assault, are more like to lead to PTSD than accidents or disasters. Men tend to experience more traumatic events in general than women, but women experience more events that are likely to lead to PTSD (e.g. childhood sexual abuse, rape, and domestic violence). Women are also more likely to develop PTSD in response to a traumatic event than men. This enhanced risk is not explained fully by differences in the type of traumatic event.

6. CLINICAL FEATURES SIGNS & SYMPTOMS :- Hyperarousal Persistent anxiety Irritability Insomnia Poor concentration Re- experiencing Intense intrusive imagery ‘Flashbacks’ Recurrent distressing dreams Avoidance Difficulty in recalling stressful events at will Avoidance of reminders of the events Detachment Inability to feel emotion (‘numbness’) Diminished interest in activities.

7. 1. Re-experiencing the traumatic event :- Intrusive, upsetting memories of the event. Flashbacks. Nightmares. Feelings of intense distress when reminded of the trauma. Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating). 2. Avoidance and numbing :- Avoiding activities, places, thoughts, or feelings that remind the trauma. Inability to remember important aspects of the trauma. Loss of interest in activities and life in general. Feeling detached from others and emotionally numb. Sense of a limited future (you don’t expect to live a normal life span, get married, have a career). 3. Increased anxiety and emotional arousal :- Difficulty falling or staying asleep. Irritability or outbursts of anger . Difficulty concentrating. Hypervigilance (on constant “red alert”). Feeling jumpy and easily startled.

8. FACTORS CAUSING PTSD GENETIC FACTORS :- The genetic liability to PTSD is partly explained by a genetic effect on personality, which modifies the propensity of individuals to engage in risky behaviours . However, even when allowing for genetic effects on personality, there is an additional genetic influence on the liability to experience PTSD after a given trauma. PREDISPOSING FACTORS :- The individual factors that increase vulnerability to the development of PTSD are the following Personal history of mood and anxiety disorder Previous history of trauma Female gender Neuroticism Lower intelligence Lack of social support.

9. Psychological Factors Fear Conditioning Some patients with PTSD experience vivid memories of the traumatic events in response to sensory cues, such as smells and sounds related to the stressful situation. This finding suggests that classical conditioning may be involved, as well as failure to extinguish conditioned responses. 2. Cognitive Theories These suggest that PTSD arises when the normal processing of emotionally charged information is overwhelmed, so that memories persist in an unprocessed form in which they can intrude into conscious awareness. In

10. assessment This should include enquiries about the nature and duration of symptoms, previous personality, and psychiatric history. When the traumatic events have included head injury (e.g. in an assault or transport accident), a neurological examination should be performed. Feelings of anger and thoughts of self-harm are common in PTSD, and an appropriate risk assessment needs to be carried out. The diagnostic criteria used is ICD-10 and DSM-5.

11. In ICD-10 symptoms of re- experiencing, numbing and avoidance are present. In DSM- 5 symptoms like avoidance, arousal, and altered cognitions & moods are experienced by the patient. These Both are similar Tools used for diagnosis.

12. TREATMENT MEDICATIONS ANTIDEPPRESANTS (Sertraline, Fluoxetine, Impremine ) ANTIANXIETY DRUGS (Lorazepam) Cognitive Behaviour Therapy (CBT) Cognitive Behaviour therapy is the most appropriate treatment. This treatment has several components: ● Information about the normal response to severe stress, and the importance of confronting situations and memories related to the traumatic events. ● Self-monitoring of symptoms. ● Exposure in imagination and then in vivo to situations that are being avoided. ● Recall of images of the traumatic events, to integrate these with the rest of the patient’s experience. When first recalled these images are often fragmentary and are not clearly related in time to the other contents of memory. ● Cognitive restructuring through the discussion of evidence for and against the appraisals and assumptions. ● Anger management for people who still feel angry about the traumatic events and their causes.

13. Narrative exposure therapy (NET):- This is a more recently developed treatment that aims to enhance autobiographical memory processing of the trauma by embedding it in a chronological life narrative developed collaboratively by patient and therapist. NET was developed originally for those suffering from PTSD following multiple traumatic events.

14. REFRENCES A SHORT TEXBOOK OF PSYCHIATRY = 20 TH EDITION. NIRAJ AHUJA SHORTER OXFORD TEXTBOOK OF PSYCHIATRY = 7 TH EDITION. PAUL HARRISION PHLIP COWEN TOM BURNS MINA FAZEL KAPLAN & SADDOCKS COMPREHENSIVE TEXTBOOK OF PSYCHIATRY = 7 TH EDITION.