PTSD Flashcards
Define PTSD
Post-traumatic stress disorder (PTSD) may develop following exposure to 1 or more traumatic events involving actual or threatened death, serious injury, or sexual violence, lasting for more than 1 month:
- re-experiencing the event
- avoidance of thoughts and memories
- Persistent perceptions of heightened current threat
In what way may someone be exposed to actual or threatened death, serious injury, or sexual violation that may result in PTSD
Directly experiencing the traumatic event(s).
Witnessing, in person, the events(s) as it occurred to others.
Learning that the traumatic events(s) occurred to a close family member or close friend (the events(s) must have been violent or accidental)
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse) (does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related)
What are the risk factors for PTSD
Pre-trauma:
Female | Intellectual disability | lack of education | Hx traumatic events | Hx psychiatric disorder | personality disorder | poor SES
Peri-trauma: trauma severity | assault | rape | physical injury
Post-trauma: Acute stress disorder | ICU stay | brain injury | disability
Describe the dissociative subtype of PTSD
symptoms of depersonalisation (e.g., experience of being an outside observer) or derealisation (e.g., experience of unreality, distance, or distortion) are present
Describe delayed PTSD
full diagnostic criteria are not met until at least 6 months after the stressor.
What are the symptoms of PTSD
4 main symptoms (DSM-5) for >1 month:
1. Intrusions: flashbacks, nightmares, reactivity to external cues
2. Avoidance of external reminders and thoughts
3. Negative alterations in mood and cognition: inability to experience positive feelings
4. Arousal or reactivity alterations: hypervigilance, sleep disturbance, exaggerated startle response, irritability, reckless behaviour
+ detachment (numbing), dissociation, emotional dysregulation, interpersonal difficulties, negative self-perception, memory impairment
What are the symptoms of PTSD in children
Dreams of the trauma (may be nightmares of monsters)
Re-living trauma in play
Losing interest in things they previously enjoyed
Expressing the belief they will not live long enough to grow up
Stomach ache and headaches (somatisation)
What are the differentials for PTSD
Acute stress disorder
Generalised anxiety disorder
Depression
Specific phobia
Adjustment disorder
Brief psychotic disorder
Majro depressive disorder
What are the signs of PTSD on examination
Tachycardia
Sweating
Tachypnoea
Hypertension
Hyperactive
MSE:
Depersonalisation (experience of being an outside observer)
Derealisation (experience of unreality, distance, or distortion)
What investigations should be done for PTSD
Questionnaires:
PTSD checklist for DSM-5
Trauma screening questionnaire
Post-traumatic diagnostic scale
International trauma questionnaire
Bedside: urine toxicology
Bloods: TFTs, FBC
What is the management for severe PTSD with high risk
Urgent referral to crisis resolution and home treatment team
- Ensure patient safety
- Debriefing
- Assess emotional support sources (friends, family)
- Practical support: police reporting, sick note/absence letter, health insurance
- Follow ups: regular visits for 6 months
- Risk assess
What is the management for mild-moderate PTSD <1 month
Active monitoring + 1 month follow up
What is the management for severe PTSD or PTSD >1 month
Psycho
First line: trauma-focused CBT
- 8-12 sessions
- Knowledge on psychology, symptom management, identifying and disrupting cognitive distortions, exposure therapy
Second line: Eye-movement desensitisation and reprocessing (EMDR) - stimulates information processing to help integrate the event as a memory as attention is engaged with bilateral physical stimualtion
Bio
Second line: SSRI or SNRI e.g. paroxetine, venlafaxine
third line: risperidone
social
Sleep hygiene
Support groups: mind, rethink, mental health foundation
What are the complications of PTSD
Suicide (24x more likely to die from suicide attempt compared to those without ASD)
Self harm
Mood disorders e.g. depressive, anxiety, panic
Substance use disorders
Cardiovascular disease
Dementia
Autoimmune disease
Psychosis
Life-threatening infections
What is the prognosis for PTSD
Majority recover within the enxt few years
At leas 1/3 of patients remain symptomatic for >2 years (higher risk of substance abuse), 1/3 fully remit
Average duration of treated symptoms is 36 months (untreated = 64 months)
