Post-Traumatic Stress Disorder Dr. Mohammad Hussein Jan 2017

1. Posttraumatic stress disorder
‫للصدمة‬ ‫التالي‬ ‫الكرب‬ ‫اضطراب‬
‫النفس‬
‫ية‬
‫حسين‬ ‫محمد‬

2. Post-Traumatic Stress Disorder
 Directly experienced
 witnessed
Trauma and related disorder
develops after exposure to an extreme
traumatic “life threatening” event
Trauma events are:
1
2
3

3. Natural Response

4. Post-Traumatic Stress Disorder
• It is natural to feel afraid during and after a
traumatic situation
• Fear triggers many changes in the body to help
defend against danger or to avoid it.
• This “fight-or-flight” response is a typical reaction
meant to protect a person from harm.
• Nearly everyone will experience a range of
reactions after trauma, yet most people recover
from initial symptoms naturally.
• Not recovered ---------- ≥ PTSD
Natural Response
Natural Response

5. Epidemiology

6. Epidemiology
 Risk of developing PTSD after a traumatic event
8–13% for men,
20–30% for women.
 Lifetime prevalence estimated as 7.8%
 Cultural differences exist.
 Some types of stressor are associated with
higher rates of PTSD (e.g. rape, torture, being a
prisoner of war).
Epidemiology

7. Where we are
…….. Psychiatric Disorders
Where We Are?

8.  Disorders Usually First Diagnosed in Infancy, Childhood, or
Adolescence
 Delirium, Dementia, and Amnestic and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition
 Substance-Related Disorders
 Schizophrenia and Other Psychotic Disorders
 Mood Disorders
 Anxiety Disorders
 Somatoform Disorders
 Factitious Disorders
 Dissociative Disorders
 Sexual and Gender Identity Disorders
 Eating Disorders
 Sleep Disorders
 Impulse-Control Disorders Not Elsewhere Classified
 Adjustment Disorders
 Personality Disorders
DSM IV DSM 5

9. Myths related to
Posttraumatic Stress Disorder

10. Myths related to
Posttraumatic Stress Disorder
PTSD
MYTH #2
PTSD
MYTH #3
PTSD
MYTH #1
PTSD
MYTH #4

11. Posttraumatic Stress Disorder is a
common problem that can occur
following trauma.
PTSD
MYTH #1
Myths related to
Posttraumatic Stress Disorder

12. Posttraumatic Stress Disorder Myths
PTSD affects someone immediately
after a traumatic ordeal.
If time has passed, someone is no
longer at risk for PTSD.
PTSD
MYTH #2
Myths related to
Posttraumatic Stress Disorder

13. Posttraumatic Stress Disorder Myths
Only
military veterans
experience PTSD
PTSD
MYTH #3
Myths related to
Posttraumatic Stress Disorder

14. Posttraumatic Stress Disorder Myths
Experiencing PTSD is a symptom of
mental weakness PTSD
MYTH #4
Myths related to
Posttraumatic Stress Disorder

15. Symptoms Of PTSD

16. Symptoms Of PTSD
Re-experiencing
symptoms
Avoidance
symptoms
Arousal and
reactivity
symptoms
Cognition and
mood symptoms

17. Re-experiencing
symptoms
Avoidance
symptoms
Arousal and
reactivity
symptoms
Cognition and
mood symptoms
Symptoms Of PTSD

18. Re-experiencing
symptoms
• Flashbacks—reliving the trauma over and over,
including physical symptoms like a racing heart or sweating
• Bad dreams
• Frightening thoughts
Symptoms Of PTSD

19. Avoidance
symptoms
 Staying away from places, events, or objects that are
reminders of the traumatic experience
 Avoiding thoughts or feelings related to the traumatic
event
 May cause a person to change his personal routine, eg:
avoid driving after a bad car accident
Symptoms Of PTSD

20. Arousal and
reactivity
symptoms
• Being easily startled
• Feeling tense or “on edge”
• Having difficulty sleeping
• Having angry outbursts
Symptoms Of PTSD

21. Cognition and
mood symptoms
• Trouble remembering key features of the traumatic event
• Negative thoughts about oneself or the world
• Distorted feelings like guilt or blame
• Loss of interest in enjoyable activities
Symptoms Of PTSD

22. DSM 5
CRITERIA IN DSM 5
Criterion A
(one required):
The person was exposed to:
death, threatened death, actual
or threatened serious injury, or
actual or threatened sexual
violence, in the following
way(s):
 Direct exposure
 Witnessing the trauma
 Learning that a relative or
close friend was exposed to
a trauma
 Indirect exposure to aversive
details of the trauma,
usually in the course of
professional duties (e.g., first
responders, medics)
Criterion B
(one required):
The traumatic event is
persistently re-experienced,
in the following way(s):
 Intrusive thoughts
 Nightmares
 Flashbacks
 Emotional distress after
exposure to traumatic
reminders
 Physical reactivity after
exposure to traumatic
reminders
Criterion C
(one required):
Avoidance of trauma-related
stimuli after the trauma, in the
following way(s):
 Trauma-related thoughts or
feelings
 Trauma-related reminders
Criterion D
(two required):
Negative thoughts or feelings
that began or worsened after the
trauma, in the following way(s):
 Inability to recall key features
of the trauma
 Overly negative thoughts and
assumptions about oneself or
the world
 Exaggerated blame of self or
others for causing the trauma
 Negative affect
 Decreased interest in activities
 Feeling isolated
 Difficulty experiencing positive
affect
Criterion E
(two required):
Trauma-related
arousal and reactivity that
began or worsened after the
trauma, in the following way(s):
 Irritability or aggression
 Risky or destructive behavior
 Hypervigilance
 Heightened startle reaction
 Difficulty concentrating
 Difficulty sleeping
Criterion F
(required):
Symptoms last for
more than 1 month.
Criterion G
(required):
Symptoms create distress or
functional impairment
(e.g., social, occupational).
Criterion H
(required):
Symptoms are not due to
medication, substance use, or
other illness.
Less =
acute stress
disorder

23. PTSD In
Children
&
Adolescents

24. PTSD In Children & Adolescents
Children and teens can have extreme reactions to trauma,
but their symptoms may not be the same as adults.
PTSD In Children & Adolescents
Older children and teens

25. Risk Factors

26. Not everyone who lives
through a dangerous
event develops PTSD.
Risk Factors

27. Bad
Good
Risk Factors

28. Bad
Risk Factors
 low education
 female gender
 Living through dangerous events and traumas
 low self-esteem
 Getting hurt
 Seeing another person hurt, or seeing a dead body
 Childhood trauma
 Feeling horror, helplessness, or extreme fear
 Having little or no social support after the event
 Dealing with extra stress after the event, such as loss of
a loved one, pain and injury, or loss of a job or home
 Having a history of mental illness or substance abuse

29. Good
Risk Factors
 Having a positive coping strategy, or a way of getting
through the bad event and learning from it
 Being able to act and respond effectively despite feeling
fear
 high IQ
 male gender
 psychopathic traits
 Seeking out support from other people, such as friends
and family
 Finding a support group after a traumatic event
 Learning to feel good about one’s own actions in the
face of danger

30. Outcome

31.  50 % will recover within 1st year,
 30% will run a chronic course.
 Outcome depends on initial symptom severity.
Outcome

32. Treatment

33. Symptoms
of PTSD
Re-
experiencing
symptoms
hyperarousal
Avoidance
Cognition and
mood
symptoms
imaginal
reliving
Relaxation
techniques
exposure
cognitive
restructuring

34. Treatment
trauma-focused treatments
TRAUMA FOCUSED COGNITIVE BEHAIORAL THERAPY

35. Treatment
trauma-focused treatments
1-EMDR
eye movement
desensitization
& repossessing

36. Treatment
trauma-focused treatments
2-Cognitive behavioral therapy:
 education about the nature of PTSD
 imaginal reliving
 Relaxation techniques
 exposure to anxiety-producing stimuli
 cognitive restructuring

37. Treatment
Pharmacological Treatment
When?
• severe ongoing threat,
• if the patient is too distressed or unstable to engage in psychological
therapy,
• fails to respond to an initial psychological approach

38. Treatment
Pharmacological Treatment
SSRIs:
 paroxetine 20–40mg/day  sertraline 50–200mg/day

39. Treatment
Pharmacological Treatment
Other antidepressants: :
• Other SSRIs
(fluoxetine, citalopram, escitalopram, &
fluvoxamine
 TCAs (e.g. amitriptyline, imipramine);

40. Treatment
Pharmacological Treatment
Sleep disturbance (including nightmares):
improved by mirtazapine (45mg/day
or specific hypnotics (e.g. zopiclone, zolpidem).
Anxiety symptoms/hyperarousal:
BDZs (e.g. clonazepam 4–5mg/day),
buspirone,
antidepressants,
propranolol.
Intrusive thoughts/hostility/impulsiveness:
some evidence for use of
carbamazepine,
valproate,
topiramate,
or lithium.
 Psychotic symptoms/severe
aggression or agitation:
antipsychotic
(some evidence for olanzapine, risperidone,
quetiapine, clozapine, aripiprazole).

42. Mental and behavioural disorders (F00-F99)
• F00-F09 Organic, including symptomatic, mental disorders
• F10-F19 Mental and behavioural disorders due to psychoactive substance use
• F20-F29 Schizophrenia, schizotypal and delusional disorders
• F30-F39 Mood [affective] disorders
• F40-F48 Neurotic, stress-related and somatoform disorders
• F50-F59 Behavioural syndromes associated with physiological disturbances and
physical
• factors
• F60-F69 Disorders of adult personality and behaviour
• F70-F79 Mental retardation
• F80-F89 Disorders of psychological development
• F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood
• and adolescence
• F99 Unspecified mental disorder
 Acute stress reaction
 Posttraumatic stress disorder
 Adjustment disorders
 Other reactions to severe stress
 Reaction to severe stress, unspecified