Post Traumatic Stress Disorder_2_

							Post Traumatic Stress Disorder (309.81)
                                                                                      Villela 8.19.2005


PTSD is a complex chronic disorder characterized by somatic, cognitive, affective and
behavioral effects secondary to psychological trauma.
Characterized by intrusive thoughts, nightmares/flashbacks, sleep disturbances, and significant
social dysfunction.
Women are more likely to develop PTSD and have a more chronic course than men.

Etiology:
 Noradrenergic system and the hypothalamic pituitary adrenal (HPA) axis.
        o HPA attenuates the sympathetic nervous system’s response to stress (to ensure that
           it is short-lived).
        o This feedback mechanism may not be functioning properly in PTSD.
 Prolonged continuation of biological responses following stress leads to an inappropriate
    pairing of the traumatic memory with distress and may then initiate a cascade of secondary
    biological alterations.
 The noradrenergic system is overactive in PTSD. A number of observations (increased
    urinary catecholamine, exaggerated physiologic responses to yohimbine, decreased platelet
    alpha 2 receptor binding) support this view.

Criteria for diagnosis:
 Person experienced, witnessed, or was confronted with an event that involved actual or
    threatened death or serious injury, or a threat to the physical integrity of self or others. In
    addition, the person’s response involved intense fear, helplessness or horror;
 Person persistently re-experiences the event through intrusive recollection or nightmares,
    reliving of the experience (flashbacks), or intense distress when exposed to reminders of the
    event;
 Person may have feelings of detachment (emotional numbing0, anhedonia, amnesia,
    restricted affect, or active avoidance of thoughts or activities that may be reminders of the
    trauma (3 required);
 General state of increased arousal persists after the traumatic event, which is characterized
    by poor concentration, hypervigilance, exaggerated startle response, insomnia, or irritability
    (2 required);
 Symptoms have been present for at least one month; AND
 Symptoms cause significant distress or impaired occupational or social functioning.

Complications: Substance abuse and/or Depression

Course
 Symptoms usually begin within 3 months; though long delays have been documented.
 Onset of symptoms often associated with a significant new stress.
 50% will show recovery within 3 months. Remainder tends to have a chronic course, with
   33% having the diagnosis after 36 months.
 Social support, family history, personality factors, and preexisting mental conditions all
   influence outcome.
Stein DJ, Zungu-Dirwayi N, van der Linden GJH, Seedat S. Pharmacotherapy for post
traumatic stress disorder (PTSD). The CochraneDatabase of Systematic Reviews 2000, Issue
4. Art. No.: CD002795. DOI: 10.1002/14651858.CD002795.
Medication treatments can be effective in PTSD, acting to reduce its core symptoms, and
should be considered as part of the treatment of this disorder. The existing evidence
base does not provide sufficient data to suggest particular predictors of response to
treatment or to demonstrate that any particular class of medication is more effective or
better tolerated than any other. However, the largest trials showing efficacy to date
have been with the SSRIs, and in contrast, there have been negative studies of some
agents. Given the high prevalence and enormous personal and societal costs of PTSD,
there is a need for additional controlled trials in this area. Additional questions for
future research include the effects of medication on quality of life in PTSD, appropriate
dose and duration of medication, the use of medication in different trauma groups, in
pediatric and geriatric subjects, and the value of early (prophylactic), combined (with
psychotherapy), and long-term (maintenance) medication treatment.




Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees
resettled in western countries: a systematic review. Lancet 2005; 365: 1309–14.
Refugees resettled in western countries could be about ten times more likely to have
post-traumatic stress disorder than age-matched general populations in those countries.
Worldwide, tens of thousands of refugees and former refugees resettled in western
countries probably have post-traumatic stress disorder.
Bas¸og˘lu M, Livanou M, Crnobaric´ C, et.al. Psychiatric and Cognitive Effects of War in
Former Yugoslavia: Association of Lack of Redress for Trauma and Posttraumatic
Stress Reactions. JAMA. 2005;294:580-590.
PTSD and depression in war survivors appear to be independent of sense of injustice
arising from perceived lack of redress for trauma. Fear of threat to safety and loss of
control over life appeared to be the most important mediating factors in PTSD and
depression. These findings may have important implications for reconciliation efforts in
postwar countries and effective interventions for traumatized war survivors.
Resources:

National Mental Health Association
http://www.nmha.org                   800.969.NMHA

National Institute of Mental Health
http://www.nimh.nih.gov/anxiety/      888.8.ANXIETY

American Psychiatric Association
http://www.psych.org                  202.682.6000

American Psychological Association
http://www.apa.org
http://helping.apa.org/               800.964.2000