PTSD

Question 1

Who does PTSD affect?

Answer 1

-7.4%% of those in the armed forces
-3% of general population

Question 2

What causes PTSD?

Answer 2

-Develops following a stressful event of an exceptionally threatening or catastrophic nature
-Involves the autonomic system and hypothalamic-pituitary-adrenal axis
-Noradrenaline is the main neurotransmitter involved
-Reconsolidation appears to be an key process (the means by which the brain reconstructs memories and associated emotional responses)

Question 3

What risk factors are there for developing PTSD?

Answer 3

Those that are likely to be exposed to traumatic events:
-Refugees and asylum seekers
-First responders
-Military personnel
-Previous psychiatric disorders
-Female sex
-Postnatal period

Question 4

How does PTSD present?

Answer 4

-Often presentation occurs late after the event
-Re-experiencing symptoms:
–Flashbacks
–Nightmares (frequent, repetitive)
–Distressing images
–Reminders of the event provoke distress
-Avoidance / rumination symptoms:
–Avoiding reminders (eg people) and suppressing memories
–Excessive rumination
-Hyperarousal / emotional numbing:
–Hypervigilance for threat
–Exaggerated startle response
–Irritability
–Difficulty concentrating
–Sleep problems
–Difficulty experiencing emotions
–Feeling detached from others
–Giving up previously significant activities

Question 5

What are the differential diagnoses for PTSD?

Answer 5

-Depression
-Specific phobias
-Acute stress reaction
-Adjustment disorders
-Personality disorders
-Neurological injury / disease
-Psychosis
-Complicated grief reaction

Question 6

What treatments would you consider?

Answer 6

-Recent event and mild symptoms –> watchful waiting
-Trauma-focused CBT for those with severe symptoms
-EMDR (eye movement desensitisation and reprocessing) and stress management are alternative therapies
-Relaxation and non-directive therapy should also be offered
-Treat PTSD before co-morbid psychiatric conditions eg depression (unless very severe)

Question 7

What is EMDR?

Answer 7

-An integrative psychotherapy approach
-One technique uses eye movements to help the brain process traumatic events
-Aim is to reduce distress in a short period of time

Question 8

What drug treatments are there for PTSD?

Answer 8

-Always 2nd line to psychological therapy
-Mirtazapine recommended by NICE