PTSD Flashcards
what is the ICD-10 definition?
Arises as a delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.
Predisposing factors, such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness, may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence.
What are typical features in PTSD?
- episodes of repeated reliving of the trauma in intrusive memories (“flashbacks”),
- dreams or nightmares, occurring against the persisting background of a sense of “numbness”
- emotional blunting,
- detachment from other people,
- unresponsiveness to surroundings,
- anhedonia,
- avoidance of activities and situations reminiscent of the trauma.
What autonomic hyperarousal Sx may be seen in PTSD?
- hypervigilance,
- an enhanced startle reaction,
- increased blood pressure,
- sweating
- insomnia
- increased heart rate
- poor concentration
Typically when is the onset of PTSD?
The onset follows the trauma with a latency period that may range from a few weeks to months.
What is the pathophysiology of PTSD?
MRI indicates that the anterior cingulate area, it fails to inhibit amygdala activation +/- decrease in amygdala threshold to fearful stimuli.
Psychological management of PTSD?
• TRAUMA FOCUSED TREATMENT CBT and Eye movement desensitisation and reprocessing (EMDR)
EMDR uses a patient’s rapid, rhythmic eye movements to reduce the anxiety and stress associated with traumatic thoughts/images and therefore processes the emotions associated with this.
• Other interventions:
o Hypnotherapy
o Stress management
Medical Mx of PTSD?
Medication is second line treatment to therapy but can be used in COMBINATION if patient is too distressed by using therapy.
• SSRIs e.g. paroxetine
• Tricyclic antidepressants e.g. amitriptyline
• Mirtazapine
• Second gen/atypical antipsychotic
How many patients with PTSD recover within a year?
50%
