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Post traumatic stress
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- 2. INTRODUCTION Disorder drivenby pathogenic memories of past danger. Symptoms must last for more than one month.
- 3. PTSD canoccur in persons who witnessed an extraordinarily terrifying and potentially deadly event. After traumatic event the person re experiences all or some of it through dreams or waking recollections and responds defensively to these flashbacks.
- 4. EPONYMS OF PTSD CIVIL WAR: IRRITABLE HEART WORLD WAR I : SHELL SHOCK/ EFFORT SYNDROME WORLD WAR II : COMBAT STRESS SYNDROME VIETNAM WAR: CONCEPT OF PTSD PTSD ENTERED IN DSM III IN 1980
- 5. DEFINITION PTSD isdescribed as the development of characteristic symptoms following exposure to an extreme traumatic stress or involving a personal threat to physical integrity or to the physical integrity of others.
- 6. EPIDEMIOLOGY Life timeprevalence is about 8% in general population 10-12% among women 5-6% among men Higher in women, single, divorced , widowed , socially withdrawn or low socio economic class Sexual assault Sudden unexpected death of a loved one and road traffic accidents
- 7. ETIOLOGY PSYCHOSOCIAL THEORY: Green,Wilson and Lindy have proposed an etiological model of PTSD that has become widely accepted. This explains why certain persons exposed to massive trauma develops PTSD and others do not. The variables include,
- 8. THE TRAUMATIC EXPERIENCE The specific characteristics related to trauma Severity and duration of the stressor Degree of anticipatory preparation prior to the onset Numbers of affected by life threat Location where in trauma was experienced
- 9. THE INDIVIDUAL FACTORSRELATED TO INDIVIDUALS RESPONSE TO TRAUMA Degree of ego strength Effectiveness of coping resources Presence of preexisting psychopathology Behavior tendencies Current stage of psychosocial development Demographic factors
- 10. THE RECOVERY ENVIRONMENT The quality of the environment where the individual attempt to work. Availability of social support Supportiveness of family and friends Attitude of society regarding the experience
- 11. OTHER CAUSES Co-morbidpsychiatric disorders Certain personality traits Traumatic painful experiences Witnessing abuse inflicted on others Witnessing kidnapping, robbery Automobile accidents Inadequate system Serious injury or death of loved one
- 12. TYPES OF PTSD ACUTE PTSD: subsides after a duration of few weeks to 3 months. CHRONIC PTSD: if the symptoms persist beyond 3 months DELAYED PTSD: it may progress to months, years and decades after the event; endures personality changes.
- 13. CLINICAL FEATURES Re-experiencing of the traumatic event A sustained and high levels of anxiety Intrusive recollections or nightmares of the event Some are unable to remember some aspects of the trauma Features of depression Restlessness Insomnia Aggressiveness
- 14. Memory lossabout an aspect of traumatic event Hyper arousal: state of nervousness Avoidance: individual strives to avoid contact with everything and everyone Hyper vigilance: close attention to and anticipation of approaching danger
- 15. DIAGNOSTIC CRITERIA ICD10 Significant evidence of trauma Onset with in 6 months of traumatic event Repetitive, intrusive recollection of the event in memories Daytime imagery or dreams Conspicuous emotional detachment Numbness of feelings Avoidance of stimuli that might arouse recollection of the trauma
- 16. MANAGEMENT Co-morbid depression– treat PTSD first Substance dependence should be addressed first before treating PTSD Support, encouragement to discuss the event and education about a variety of coping mechanisms Sedatives and hypnotics can be helpful
- 17. PHARMACOTHERAPY ANTIDEPRESSANTS SSRI TCA MAOIS
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- 19. EXPOSURE TREATMENT IMAGINALEXPOSURE IN-VIVO EXPOSURE: going to the site of traumatic event./ driving again after a road traffic accidents Exposure is repeated until the patient no longer responds with high levels of distress. Helps in decreasing dysfunctional beliefs about danger.
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