Post-traumatic stress disorder (PTSD) is characterized by intrusive thoughts, nightmares, and flashbacks of traumatic events along with avoidance of trauma reminders and hypervigilance. It is commonly caused by sexual violence, interpersonal trauma like loss of a loved one, and violence. Symptoms include re-experiencing the trauma, avoidance of trauma reminders, negative thoughts and mood, and increased arousal. Treatment involves psychotherapy like exposure therapy and medication like SSRIs.

1. Science doesn't make it impossible to believe in God, it just makes it possible not to
believe in God”
― Steven Weinberg
INTRODUCTION
● characterized by
○ intrusive thoughts
○ nightmares
○ flashbacks of past traumatic events
○ avoidance of reminders of trauma
○ Hypervigilance
○ sleep disturbance
● lead to considerable social, occupational, and interpersonal dysfunction.
EPIDEMIOLOGY
● Sexual violence
○ M/C cause
○ Rape
○ Childhood sexual abuse
● Interpersonal-network traumatic experiences
○ unexpected death of a loved one
● Violence
○ Physical assault
○ Refugee
○ Kidnapped
○ Torture
● motor vehicle collision
● natural disaster
● P​retrauma risk factors
○ Gender
■ F>M
○ age at trauma
■ Adults have better coping mechanisms
○ Region
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

2. Science doesn't make it impossible to believe in God, it just makes it possible not to
believe in God”
― Steven Weinberg
■ More prevalent in North America
○ lower education
○ lower socioeconomic status
○ being separated, divorced, or widowed
○ previous trauma
○ general childhood adversity
○ personal and family psychiatric history
PATHOPHYSIOLOGY
● Unclear
● fMRI scans have shown in PTSD
○ Decreased volume of the hippocampus, left amygdala, and anterior cingulate
cortex
○ Increased central norepinephrine levels
○ decreased glucocorticoid levels
● genetics may contribute to an individual's susceptibility to PTSD
CLINICAL MANIFESTATIONS
● Most individuals who experience trauma react to some degree
● PTSD experience
○ marked cognitive, affective, and behavioral responses to stimuli
○ Flashbacks
○ severe anxiety
○ fleeing or combative behavior
○ attempting to avoid experiences that may begin to elicit symptoms
○ more dissociation, somatic symptoms, self-destructive behavior, and suicidal
behavior.
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

3. Science doesn't make it impossible to believe in God, it just makes it possible not to
believe in God”
― Steven Weinberg
COURSE
● Most individuals who develop PTSD experience its onset within a few months of the
traumatic event.
● Approximately 25 percent experience a delayed onset > 6 months
● 30-40% patients recover after one-year
● One-third still symptomatic after 10 years
SCREENING
● High risk population after some traumatic event
○ Soldiers
○ injured civilians
○ Assault victims
○ Rape victims
● Assessment tools
○ PTSD checklist (PCL-5)
■ 20-items
■ self-report measure
DIAGNOSIS​ = DSM-5 criteria
● Exposure to actual or threatened death, serious injury, or sexual violence
○ Directly experiencing the traumatic event
○ Witnessing, in person, the event(s) as it occurred to others
○ Learning that the traumatic event(s) occurred to a close family member or close
friend
● Presence of >=1 of the following intrusion symptoms
○ Recurrent, involuntary, and intrusive distressing memories of the traumatic
event(s)
○ Recurrent distressing dreams
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

4. Science doesn't make it impossible to believe in God, it just makes it possible not to
believe in God”
― Steven Weinberg
○ Dissociative reactions
■ Eg flashbacks in which the individual feels or acts as if the traumatic
event(s) were recurring
○ psychological distress at exposure to internal or external cues that resemble an
aspect of the traumatic event
○ Marked physiological reactions to internal or external cues that symbolize or
resemble an aspect of the traumatic event(s)
● Persistent avoidance of stimuli associated with the traumatic event
● Negative alterations in cognitions and mood
○ Inability to remember an important aspect of the traumatic event (typically due to
dissociative amnesia)
○ Persistent and exaggerated negative beliefs or expectations about oneself
○ Negative emotional state (eg, fear, horror, anger, guilt, or shame)
○ Diminished interest or participation in significant activities
○ Feelings of detachment or estrangement from others
● Marked alterations in arousal and reactivity associated with the traumatic event
○ Irritable behavior and angry outbursts (with little or no provocation)
○ Reckless or self-destructive behavior
○ Hypervigilance
○ Problems with concentration.
● Duration of the disturbance > 1 month
● Causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
Mx
● Psychotherapy
○ exposure and response prevention
○ Cognitive-behavioral therapy
● SSRI
● Rx of Substance use disorders
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

5. Science doesn't make it impossible to believe in God, it just makes it possible not to
believe in God”
― Steven Weinberg
● Sleep disturbance, nightmares
○ Prazosin
○ SSRI
● For patients who do not respond to the SSRI after 8 to 10 weeks
○ trial of a different SRI
○ SNRI
○ Atypical antipsychotics
● Other add on drugs
○ Benzodiazepines
■ have not been studied in PTSD
■ Propranolol
■ Tiagabine
■ Topiramate
■ Ketamine
■ cannabis
DURATION OF TREATMENT
● 6-12 months
● Monitor for relapse
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava