4. • Posttraumatic Stress Disorder and Acute Stress Disorder are
marked by increased stress and anxiety following exposure to
traumatic or stressful event
• Stressful events may include being a witness to or being
involved in a violent accident or crime, military combat, or
assault, being kidnapped, being involved in a natural disaster,
being diagnosed with a life-threatening illness, or experiencing
systematic physical or sexual abuse
5. • The person reacts to the experience with fear and helplessness,
persistently relives the event, and tries to avoid being
reminded of it
• The event may be relived in dreams and waking thoughts
(flashbacks)
• The stressors causing the both ASD and PTSD are sufficiently
overwhelming to affect almost everyone
6. • Epidemiology
>lifetime incidence of PTSD estimated to be 9-15%
>lifetime prevalence of PTSD is 8% of the general
population
> subclinical form: 5-15%
> moe common among women
7. • Epidemiology
> can appear at any age but most prevalent in
young adults
> men's trauma is usually combat experience
> women's trauma is most commonly rape or
assault
> single, divorced, widowed, socially withdrawn,
low socioeconomic level
> anyone can be affected
8. • Epidemiology
> most important risk factors are severity,
duration, and proximity of a person's exposure to the
actual trauma
> a familial pattern seems to exist for the disorder
and first-degree biological relatives of persons with a
history of depression have an increased risk for
developing PTSD following a traumatic event
9. • Comorbidity
>depressive disorders, substance-related
disorders, anxiety disorders, bipolar disorders
> comorbid disorders make persons more
vulnerable to develop PTSD
10. • Etiology
> stressor is the main causative factor, but this alone does
not suffice to cause the disorder
> the response to the traumatic event must include
intense fear and horror
> also consider risk factors
11.
12. • Etiology
> psychodynamic factors - the trauma has
reactivated a previously quiescent , yet unresolved
psychological conflict---> regression and use of defense
mechanisms of repression, denial, reaction formation,
undoing
> cognitive-behavioral factors - affected persons
cannot process or rationalize the trauma that
precipitated the disorder
13. • Etiology
> biological factors - noradrenergic system, opiod system,
corticotropin-releasing factor and the HPA axis
15. • clinical features
> 3 symptom domains: intrusion symptoms following the
trauma
> avoiding stimuli associated with the trauma
> symptoms of increased automatic arousal (enhanced startle)
17. • Course and Prognosis
> develops some time after the trauma
> symptoms fluctuate over time, most intense during
periods of stress
> untreated: 30% recover completely
40% mild symptoms
20% moderate symptoms
10% unchanged or become worse
18. • Good prognosis
> rapid onset of symptoms
> short duration of symptoms (<6 months)
> good premorbid functioning
> strong social supports
> absence of other psychiatric, medical or
substance-related disorders or other risk factors
19. • In general, the very young and the very old have more
difficulty with traumatic life events than do those in midlife
20. • Treatment
1. pharmacotherapy - SSRI (sertraline, paroxetine are first
line treatments)
2. psychotherapy after a traumatic event should follow a
model of crisis intervention with support, education, and
the development of coping mechanisms and acceptance of
the event
Eye movement desensitization and reprocessing (EMDR)
group and family therapy
22. • Adjustment disorders are characterized by an emotional
response to a stressful event
• Typically, the stressor involves financial issues, a medical
illness, or a relationship problem
• The symptom complex may involve anxious or
depressive affect or may present with a disturbance of
conduct
• By definition, the symptoms must begin within 3 months
of the stressor
23. • Epidemiology
> prevalence estimated at 2-8% general population
> women are twice as often to be diagnosed
> in children and adolescents, boys and girls are equally
diagnosed
> most frequently diagnosed in adolescents
> common precipitating stresses: school problems, parental
rejection and divorce, and substance abuse
24. • Epidemiology
> among adults , common precipitating stresses are marital
problems, divorce, moving to a new environment, and financial
problems
> one of the most common psychiatric diagnoses for
disorders of patients hospitalized for medical and surgical
problems
26. • Clinical features
> symptoms do not necessarily begin immediately
> physical symptoms can occur in any age group
> can also manifest as assaultive behavior, reckless
driving, excessive drinking, defaulting on legal
responsibilities, withdrawal, vegetative signs, insomnia,
suicidal behavior
27. • Types
adjustment disorder with depressed mood,
with anxiety,
with mixed anxiety and depressed mood,
with disturbance of conduct,
with mixed disturbance of emotions and conduct,
unspecified (a residual category)
28. • Course and Prognosis
> with appropriate treatment, prognosis is generally
favorable
> most patients return to their previous level of
functioning within 3 months
> research over the past year has disclosed a risk of
suicide not previously fully appreciated (case)
29. • Treatment
> psychotherapy
> crisis intervention
> pharmacotherapy - to treat specific symptoms
antidepressant, benzodiazepine
