[9] Post-Traumatic Stress Disorder Flashcards
What is PTSD?
PTSD is an intense, delayed reaction following exposure to exceptionally traumatic events. Examples of events include severe assault, major natural disaster, serious RTA, or involvement in wars
What can the risk factors for PTSD be divided into?
- Risk factors for exposure
- Pre-trauma risk factors
- Peri-trauma
- Post-trauma
What are the risk factors for exposure in PTSD?
- Member of an at risk profession, e.g. armed forces, police, fire service, journalists, doctor
- Refugees or asylum seekers
What are the pre-trauma risk factors for PTSD?
- Previous trauma
- History of mental illness
- Female gender
- Low socio-economic background
What are the peri-trauma risk factors for PTSD?
- High severity of trauma
- Trauma with perceived threat to life
What are the post-trauma risk factors for PTSD?
- Concurrent life stressors
- Absence of social support
When must the symptoms of PTSD occur?
Within 6 months of the event
What categories can the symptoms of PTSD be divided into?
- Reliving the situation
- Avoidance
- Hyperarousal
- Emotional numbing
What are the ‘reliving the situation’ symptoms of PTSD
- Flashbacks
- Vivid memories
- Nightmares
- Distress when exposed to similar circumstances as the stressor
These symptoms are persistent, involuntary, and intrusive
What are the avoidance symptoms of PTSD?
- Avoiding reminders of the trauma, e.g. associated people or locations
- Excessive rumination about the trauma
- Inability to recall aspects of the trauma
What are the hyperarousal symptoms of PTSD?
- Irritability or outbursts
- Difficulty with concentration
- Difficulty with sleep
- Hypervigilance
- Exaggerated startle response
What are the emotional numbing symptoms of PTSD?
- Negative thoughts about oneself
- Difficulty experiencing emotions
- Feeling of detatchment from others
- Giving up previously enjoyed activities
What are the ICD-10 criteria for diagnosis of PTSD?
There must have been an exposure to a stressful event, or situation of an extremely threatening or catastrophic nature. The patient must have persistent remembering (reliving) of the situation, actual or preferred avoidance of similar situations resembling or associated with the stressor, and either an inability to recall some of the important aspects of period of exposure to stressor, or persistent symptoms of increased psychological sensitivity and arousal. All these things must occur within 6 months of the stressful event, or the end of a period of stress.
How is PTSD investigated?
- History
- MSE
- Questionnaires - Trauma Screening Questionnaire, Post-traumatic diagnostic scale
What are the differential diagnoses of PTSD?
- Adjustment disorder
- Acute stress reaction
- Bereavement
- Dissociative disorder
- Mood or anxiety disorder
- Personality disorder
- Head injury (may result from the traumatic event)
- Alcohol/substance misuse
How is PTSD managed when symptoms are present within 3 month of the trauma?
- Watchful waiting can be used for mild symptoms lasting for <4 weeks
- Trauma focused CBT
- Short-term drug treatment can be considered for acute phase management of sleep disturbance, e.g. zopiclone
- Risk assessment - risk for neglect or suicide
How much trauma focused CBT should be given in PTSD when symptoms have been present for <3 months?
Should be given at least once a week for 8-12 sessions
How is PTSD managed when symptoms have been present for >3 months after trauma?
- All sufferers should be offered a course of trauma-focused psychological intervention
- Drug treatment
What trauma-based psychological interventions can be offered in PTSD when symptoms persist for over 3 months after trauma?
- CBT
- Eye movement desensitisation and reprocessing (EMDR)
What is EMDR?
A technique that involves eye movements to help the brain process traumatic events. It is aimed at reducing distress in the shortest period of time.
When should drug treatment be offered in PTSD?
- When little benefit from psychological therapy
- When the patient doesn’t want to engage in psychological therapy
- If there is co-morbid depression or severe hyperarousal which would benefit from pharmacological interventions
What drugs are used in the treatment of PTSD?
- Paroxetine
- Mirtazapine
- Amitriptyline
- Phenylzine
Mirtazapine is probably the best option
What is the mechanism of action of mirtazapine?
It acts as a 5HT-2 and 5HT-3 antagonist.
What are the side effects of mirtazapine?
- Sedation
- Weight gain
How does mirtazapine cause sedation?
It is a strong H1 antagonist (antihistamine) activity
What is good about the side effects of mirtazapine?
They can be used to therapeutic advantage
