PTSD Flashcards
the complex somatic, cognitive, affective, and behavioral effects of psychological
trauma
PTSD
Types of Trauma
(1) Sexual Trauma
(2) Trauma to someone in close interpersonal network
(3) Interpersonal violence
(4) Participation in organized violence
(5) Other
(a) Rape
(b) Childhood sexual abuse
(c) Intimate partner violence
Sexual Trauma
(a) Death of a loved one
(b) Critically ill child
Trauma to someone in close interpersonal network
(a) Assault
(b) Childhood physical abuse
(c) A serious threat of violence
Interpersonal violence
(a) War
(b) Witnessing death
(c) Witnessing dead bodies
Participation in organized violence
(a) Motor vehicle accident (MVA)
(b) Natural disasters
Other
c. Specific considerations regarding armed conflict and combat:
(1) Correlation seen with presence of and extent of injuries
(a) Strong correlation with TBI
(2) Develops over several months:
(a) One study of hospitalized soldiers showed increased prevalence of 4.2% at one month versus 12.2% at 4 months of exposure
(3) Another study of US 1,648 US Marines showed that experiencing a TBI during deployment was a strong predictor of PTSD symptom development
just a note
d. Pathophysiology of PTSD development is unknown
(1) Studies using MRI have shown decreased volume in several areas of the brain
(a) Left amygdala (fear center)
(b) Hippocampus (memories)
(c) Anterior cingulate cortex
*(2) Other reported findings in studies include increased central norepinephrine levels
Clinical Manifestations
(1) Some response to trauma is considered to be normal but in patients with PTSD the symptoms go beyond the realm of normal with multiple impairments:
(a) Affective dysregulation (anger common)
(b) Cognitive impairment
(c) Several behavior responses in response to regular stimuli:
1) Flashbacks
2) Severe anxiety symptoms
3) Fleeing
4) Combative behaviors
(2) These symptoms lead to compensatory behaviors by the individual
(a) We call this an avoidance of triggering experiences
1) Avoidance leads to furthering of symptoms such as emotional numbing, diminished interests in activities and detachment from others
Assessment
(1) Multiple screening tools are available and in use today
(2) Common screening questions employed by primary care providers include
(a) How do you feel when you recall the event?
(b) Do you experience dreams or flashbacks about it?
(c) Do you find yourself avoiding people or activities you associate with the event?
(d) Do you find yourself forgetting things from that period?
(e) Do you find yourself carefully looking around when you are in a public place?
(f) Do you have nightmares about the event?
(g) Do you try hard to not think about the event?
(h) Do you ever feel numb or detached from people around you?
(i) Do you feel guilty or unable to stop blaming yourself or others about the event?
Focus of the Independent Duty Corpsman is screening for PTSD
Symptoms must be present for at least four weeks following trauma for psychiatry to make the diagnosis
Treatment
(1) Therapy and medication are both useful and can be used either alone or in combination
(a) Psychotherapy
1) Exposure therapy
2) CBT (Cognitive Behavioral Therapy)
3) EMDR (Eye Movement Desensitization and Reprocessing
(b) How does psychotherapy work? What is the goal?
1) Helps the patient integrate the events in an adaptive way
(c) Since marital problems and substance abuse are commonly seen in patients with PTSD should also consider referral sources for counseling
(d) Medications used in PTSD
1) Antidepressant medications (SSRIs) are the first line therapy of choice
a) Ie: Sertraline
2) Other adjuncts may be used based on symptoms
a) Prazosin for nightmares
b) Beta blockers for tremors and sympathetic responses
c) Antipsychotics for comorbid psychosis if needed
3) Avoid benzodiazepines due to safety and dependency issues
Prognosis
(1) Sooner therapy leads to better prognosis
(2) Do not wait to refer
(a) If you suspect PTSD then refer
(3) Be aware that the treatment course will likely be long, no quick fixes here
