Post Traumatic Stress Disorder Acute Stress Disorder Dr. A. Hadjebi.
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Transcript of Post Traumatic Stress Disorder Acute Stress Disorder Dr. A. Hadjebi.
Post Traumatic Stress Disorder
Acute Stress Disorder
Dr. A. Hadjebi
History
U. S. civil war : Soldier's heart syndrome 1900 s : Traumatic neurosis due to the
influence of psychoanalysis World war I : shell shock World war II : combat neurosis or
operational fatigue Vietnam war : post traumatic stress
disorder
History
PTSD: DSM-III (1980) ASD; DSM-IV (1994) PTSD in DSM-III: reexperience(1),psychic
numbing(2), other items(1), no duration criteria
PTSD in DSM-III-R is similar to DSM-IV-TR In ICD-10 PTSD & ASD are stress related
disoders
Epidemiology
Life time prevalence (8%) 30% of Vietnam veterans 25 % subclinical form of disorder In women : life time prevalence 10- 12% In men : life time prevalence 5- 6% PTSD is most prevalent in young adults Men's trauma : combat experience Women's trauma : assault or rape
Epidemiology
PTSD most likely to occur in single , divorced , widowed , socially withdrawn , low socioeconomic level
First degree biological relatives of persons with a history of depression have an increased risk for developing PTSD following a traumatic event
Comorbidity
About 2/3 having at least tow other disorders
Common comorbid conditions include : depressive disorders , substance related disorders , other anxiety disorders and bipolar disorders
Etiology
Stressor Risk factors Psychodynamic factors Cognitive – behavioral factors Biological factors
Noradrenergic system
Opioid system
Corticotropin – releasing factor and the
HPA axis
Psychological aspects of PTSD
Emotional response to trauma reminder Base line physiological activity Exaggerated startle reflex.
Diagnostic criteria for PTSD Exposure to a traumatic event The traumatic event is persistently
reexperienced Persistent avoidance of stimuli associated
with the trauma Persistent symptoms of increased arousal Duration of the disturbance is more than 1
month
Diagnostic criteria for PTSD
Significant distress or impairment in social, occupational or …
Specify if : acute : < 3 months
chronic : > or = 3 months With delayed onset
Diagnostic criteria for ASD
The disturbance last for a min. of 2 days and a max. of 4 weeks and occurs within
4 weeks of the traumatic events
PTSD in children and adolescents
Child risk factors include :
- demographic factors ( age,
socioeconomic status )
- life events
- psychiatric comorbidity
- parental psychopathology
- parental marital status
Gulf war syndrome Health problems- Irritability- Chronic fatigue- Shortness of breath- Muscle and joint pain- Migraine headaches- Digestive disturbances- Rash- Hair loss- Forgetfulness- Difficulty concentrating
Differential diagnosisorganic; head trauma, epilepsy,
alcohol use disorder Pain disorder Substance abuse Other anxiety disorders Mood disorders Borderline disorders Dissociative disorders malingering
Course and prognosis 30 % recover completely 40 % mild symptoms 20 % moderate symptoms 10 % remain unchanged Good prognosis is predicted by : - rapid onset of the symptoms - short duration of the symptoms - good premorbi functioning - strong social supports - absence of other psychiatric, medical or
substance – related disorders
Course and prognosis The very young and very old have more
difficulty with traumatic events than do these in midlife
PTSD that is comorbid with other disorders is often more severe and perhaps more chronic and difficult to treat
Social support influence the development, severity and duration of PTSD
Treatment
Psychotherapy
Pharmacotherapy
Psychotherapy
Psychodynamic psychotherapy Cognitive – behavior therapy Group therapy Family therapy
pharmacotherapy
SSRIs : Sertraline and Paroxetine Buspirone TCA: Impramine, Amitriptyline Some studies indicate that pharmacotherapy
is more effective in treating the depression, anxiety and hyperarousal than in treating the avoidance and emotional numbing
Other drugs ; MAOIs ( Phenelzine ), Trazodone, Anticonvalsants, (carbamazapine, valpoarate ), clonidine, propranolol
Recommendation
Strongly recommend selective serotonin reuptake inhibitors (SSRIs) as first line agents for the treatment of PTSD.
Recommend tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) as second-line treatments for PTSD.
Consider an antidepressant therapeutic trial of at least 12 weeks before changing therapeutic regimen.
Recommendation
Consider prazosin to augment the management of nightmares and other symptoms of PTSD.
Recommend medication compliance assessment at each visit.
Since PTSD is a chronic disorder, responders to pharmacotherapy may need to continue medication indefinitely; however it is recommended that maintenance treatment should be periodically reassessed
Group Name Global imp.
Reexp. Avoid. Hyperarousal
SSRI
Fluoxetine
* * * *
Sertraline
* * *
Paroxetine
* * * *
TCAs * *
MAOIs * * *
Group Name Global imp.
Reexp. Avoid. Hyperarousal
Sympatholytic
* *
Prazosin
*
Propranolol
Novel Antidep.
Trazod. * * *
Nefaz. * * *
Group Name Global imp.
Reexp. Avoid. Hyperarousal
Anticonvul.
CBZ * *
Valpro. *
BDZ * *
Atyp.antipsy.
* *
Special considerations on sep. 11. 2001
3500 deaths and injuries 45% of adults reported symptoms of
stress , such as distressing recollections of the event, insomnia, nightmare,…
90% reported minor degrees of symptoms Susceptibility to symptoms was associated
with : female, nonwhite, having previous psychological illness, being close to disaster site
Special considerations on sep. 11. 2001
Over 80 % of parents reported that their children had one or more symptoms
Survey of Manhattan residents conducted 5 to 8 weeks after the world trade center collapsed:
- 9.8% (90000 ) people had PTSD or clinical depression
- 3.7% ( 34000 ) people met the criteria for both diagnosis