P OST -T RAUMATIC S TRESS D ISORDER (PTSD) By: Tayler Hughes, Egal Warsame, Xavier Strozewski,...
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Transcript of P OST -T RAUMATIC S TRESS D ISORDER (PTSD) By: Tayler Hughes, Egal Warsame, Xavier Strozewski,...
POST-TRAUMATIC STRESS DISORDER(PTSD)By: Tayler Hughes, Egal Warsame, Xavier Strozewski, Melissa Ramirez, Alisha Mokwinski
WHAT IS IT?
An Anxiety disorder Characterized by intrusive memories of the
traumatic event , emotional withdrawal, and heightened autonomic arousal.
May result in insomnia , hyper vigilance, loss of control over anger or aggression.
PTSD patients often experience a decreased interest in others and a sense of estrangement.
May also suffer anhedonia- the inability to feel positive emotions
http://www.youtube.com/watch?v=n4nxTIFI0xA&feature=related
http://www.youtube.com/watch?v=ZGWSSUNXn4A&feature=related
SYMPTOMS OF PTSD
Affective: Anhedonia; emotional numbing Behavioral: hypervigilance; passivity;
nightmares; flashbacks; exaggerated startle response
Cognitive: intrusive memories; inability to concentrate; hyperarousal
Somatic: lower back pain; headaches; stomach ache and digestion problems; insomnia; regression in some children; losing already acquired developmental skills, such as speech or toilet training.
http://www.youtube.com/watch?v=mZU2A2lsEB8
RELEVANT STUDY The case of Rwanda Study of PTSD was done on survivors of the Rwandan
genocide. The study was done soon after the genocide had occurred. A survey was conducted by UNICEF which looked at 3000
Rwandan children aged 8-19 years They showed:
95% had witnessed violence 80% had suffered a death in their immediate family 62% had been threatened with death
According to UNICEF: 60% didn’t care if they grew up Many were parentless and stilled lived in the place where the
trauma occurred This left many with repeating flashbacks and constant trauma of
the genocide
STRESSOR
The person has been exposed to a traumatic event in which both of the following have been present:
The person has experienced, witnessed, or been confronted with an event that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
The person’s response involved intense fear, helplessness, or horror.
INTRUSIVE RECOLLECTION The traumatic event is persistently re-experienced in at
least one of the following ways Recurrent and intrusive distressing recollections of the
event, including images, thoughts, or perceptions. Recurrent distressing dreams of the event. Acting or feeling as if the traumatic event were
recurring(includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated).
Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
AVOIDANT/NUMBING Persistent avoidance of stimuli associated with the
trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
Efforts to avoid thoughts, feelings, or conversations associated with the trauma
Efforts to avoid activities, places or people that arouse recollections of the trauma
Inability to recall an important aspect of the trauma Markedly diminished interest or participation in
significant activities Feeling of detachment or estrangement from others Restricted range of affection Sense of foreshortened future
HYPER-AROUSAL Persistent symptoms of increasing arousal (not
present before the trauma), indicated by at least two of the following:
Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hyper-Vigilance
noun 1. state or quality of being vigilant; watchfulness
Vigilant: adjective
1. keenly watchful to detect danger; wary: a vigilant sentry. 2. ever awake and alert; sleeplessly watchful.
DURATION
Duration of the disturbance (symptoms) is more than one month
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Functional Significance
TWO TYPES Acute: if duration of symptoms is less than
three months
Chronic: if duration of symptoms is three months or more
GENDER VARIATION A number of epidemiologic survey studies
have shown that PTSD is twice as common in women as in men. In addition there are gender differences in… The type of trauma exposure Presentation of illness Comorbidities
Some of these differences are clearly societal and non biologically based, it is also clear that biologic systems altered in PTSD may modulated by sex hormones.
Rachael Yehuda PhD of the Einstein Medical Center, Bronx, NY discussed the neuroanatomic, neuroendocrine and immune- related bases for various gender differences seen in PTSD .
There are also differences between men and women in the presentation of PTSD.
Women are more likely to have symptoms of numbing and avoidance and men are more likely to have the associated features of irritability and impulsiveness.
Men are more likely to have comorbid substance use disorders
Women are more likely to have comorbid mood and anxiety disorders, although many disorders comorbid with PTSD are commonly seen in both men and women.
Comorbid: pertaining to two diseases which occur together, such as ADHD and depression
SYMPTOMS IN MEN VS. WOMEN
Men:IrritabilityImpulsiveness
Substance Abuse Disorders
Women:NumbingAvoidanceAnxiety/Affective Disorders
MEN VS. WOMEN Different types of traumas carry
different risks for developing PTSD This is one of the reasons why men
and women differ in prevalence rates
Rape is experienced more often by women and carries one of the highest risks for PTSD
Other forms of sexual abuse and interpersonal violences are also more often followed by PTSD than natural disasters or other accidents
Socialization Differences: Girls tend to internalize problems,
boys externalize
BRESLAU ET. AL (1991)
Did a longitudal study of 1007 young adults who had been exposed to community violence Found a prevalence rate of 11.3% in women and
6% in men Horowitz et. Al (1995) reviewed a number of
studies and found that women have a risk up to five times greater than males to develop PTSD after violent or traumatic events.
COGNITIVE There are differences in the way individuals cognitively
process experiences and there may be a difference in attributional styles
PTSD patients tend to feel that they have a lack of control over their lives and the world is unpredictable They often experience guilt regarding the trauma
Intrusive memories are memories that come to consciousness at random Can be triggered by sounds, smells and/or sights
Ex. War Veterans having flashbacks
Alberto Rizzo developed a therapeutic tool using virtual reality. It is called virtual Iraq and has changeable variables to change the experience for the patient. This method is based off of flooding, or over-exposure, causing the patient to become accustomed to the trauma.
COGNITIVE
Development of PTSD is associated with a tendency to take personal responsibility for failures and to cope with stress by focusing on the emotion Versus facing the problem
Sutker et. Al(1995) Found that Gulf War Veterans who had a sense of
purpose and commitment to the military had less chance of suffering from PTSD
BIOLOGICAL Twin studies show possible genetic
predisposition to PTSD Focuses on the neurotransmitter
noradrenalin Noradrenalin controls emotional arousal. High levels of noradrenalin cause people to
express emotions more openly than others.
SOCIOCULTURAL Research suggests that experiences with
racism and oppression are predisposing factors for PTSD.
ROYSIRCAR (2000) Cites research that among Vietnam War
veterans, 20.6% of black and 27.6% of Hispanic veterans met the criteria for a current diagnosis of PTSD, compared to the 13% in white veterans.
He takes it a step farther in researching Rwandan children, and argues that the threat of death was the factor evidencing the strongest influence on intrusive thoughts and avoidance of behaviour This just means avoiding situations that can
trigger anxiety and panic.
RESEARCH Research in Bosnia supports this in 1998
when close to 73% of girls and 35% of boys suffered from PTSD
Kaminer et. Al (2000) stated that the higher rate in girls came from fear of rape
Social learning may play a role in PTSD Children may develop PTSD by observing
domestic violence
CULTURE In many cultures, it is common for survivors to
initiate treatment with someone due to Somatic Complaints Those that have no medical explanation Generally consist of gastrointestinal problems,
constipation, heartburn, nausea, vomiting, colitis, migraines, headaches, back aches, and skin disorders
thought that these problems, although real to the sufferer, may be brought on by stress or emotional factors. Somatic complaints are difficult to treat because there are no underlying medical issues that are causing them
According to the DSM, somatic symptoms of PTSD are typical
KLEINMAN (1987) It is irrational and ethnocentric to assume that
non-western forms of this disorder are atypical The form commonly seen in the West being assumed
as the “norm” Non-Western survivors exhibit Body Memory
Symptoms: Lllll One example of this is dizziness experienced by a
woman, found to be a body memory of her repeated experience of being forced to drink large amounts of alcohol and then being raped
Sexual abuse is a traumatic experience and that the memory of it can be stored in your physical body. This can be true even if you have no conscious recollection of the abuse.
TREATMENT Psychotherapy (Talk Therapy) Medications People have different ways of overcoming
PTSD and the treatment should always be done through the health care provider.
PSYCHOTHERAPY Also known as “talk therapy” Occurs with a one-on-one conversation and lasts
between 6 and 12 weeks. During psychotherapy, the psychiatrist will use
other therapy tactics to help the patient. Different therapy options:
Exposure Therapy-It a tactic that involves the patient to face their fear and trauma in a safe way
Cognitive Restructuring- helps people make sense of bad memories by helping the patient look at the memory in a realistic way
Stress Inoculation Training- tries to reduce symptoms by teaching the person a way to reduce anxiety and helps look at their memories in a healthy way
MEDICATION Two medications were approved by the FDA
Sertraline(Zoloft) Paroxetine(Paxil)
These drugs are antidepressants that help treat depression
It helps control symptoms such as sadness, worry, anger, the feel of emptiness
Side effects for these drugs include: Headaches Nausea Sleeplessness or drowsiness Agitation Sexual problems
SOURCES
http://www.medscape.org/viewarticle/418733 DSM Book http://answers.yahoo.com/question/index?qid
=20080305151704AAs8BEu