PTSD Flashcards
Px
Triad- re exper, avoidance, hyperarousal.
Delayed or protracted resp to stressful threatening or catastrophic event. Cant process or rationalise trauma so keep getting the stress.
Symps- flashbacks, dreams, numbness, emot blunt, detachment, anhedonia, avoidance. Also hypervigilance, enhanced startle reac, insomnia.
-ICD10-
Onset us within 6 months, or present for at least 1 month.
Cliniccally sig distress and imapirment.
2 or more persis symps of incr psych sensitiv and arousal not present before stressor eg diffic sleep, irritable or angry, low conc, hypervigilance, exagg startle resp.
Also presis reliving of stressor.
Actual or pref avoidance of simil sits.
Loss of mem of stressor.
Aetiology
-predisposing- Childhood trauma, personality traits, poor social supp, female, recent stressful life change, alc, poor class and education, low self esteem, mood and anx disorder -bio- NA and endog opioid and HPA systems hyperactive. Reduced hippocampal vol. genetic.
Prevalence
Risk after trauma 8-13% men, 20-30% women.
Lifetime prevalence 8%.
War, torture, rape high levels.
Mx
Watchful wait if symps mild and under 4 wk.
-bio- SSRI eg paroxetine, sertraline. Unlicensed eg TCA, MAOI, SNRI, mirtazepine, other SSRI.
Mirtaxepine, prazosin or zopiclone for sleep.
BDZ, buspirone or propranolol for anx.
Lithium, valproate, carbamazepine for intrusive thoughts and impulsiveness.
SGA for psychosis, agitation, aggression.
-psycho-
Trauma focused CBT.
Eye movem desensitisation and reprocessing.
Psychodynamic.
Family therapy.
Stress incoulation and coping.
Hypnotherapy.
Supportive therapy.
Comorbidity
Mood disorder
AD
Substance abuse
Somatisation disorder.
Diffs
Acute stress reac, enduring personality change after catastrophic event (at least 2yr), adjustment disoder, other ADs, substance induced, dep.
Prognosis
50% recover in 1st yr.
30% chronic.
-good facs- soc supp, good coping mechs, no further trauma.
