Post-traumatic Stress Disorder

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Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Samantha Sowder from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Definition/Description^1,2,4

Post-traumatic stress disorder (PTSD) is an anxiety disordered characterized by psychological symptoms that continue to be experienced long after a traumatic event.  Any physical or psychological trauma can trigger PTSD, but there is most often an involvement of actual or threatened serious injury to the person or someone close to them.  The most common traumatic events leading to PTSD are combat, natural disasters, and abuse and victimization, including sexual assault and terrorism. The psychological pattern, characterized by persistent and chronic symptoms that arise in certain individuals in response to such events define this disorder.  The three primary symptoms of PTSD are frequent recollections of the event, which have become intrusive to daily life, avoidance of stimuli or situations triggering memories of the event, with a resulting emotional numbness or unresponsiveness, and increased physical arousal with anxiety, including extreme irritability or angry outbursts.

Prevalence^1,4

-Up to 80% of all acute stress disorders develop into PTSD.¹

-Approximately 3.5% of people/year in the US experience PTSD and 7% in their lifetime and studies of at-risk individuals have resulted in rates ranging from 3% to 58% lifetime prevalence. 

-Two times as many women as men develop the disorder with 20% of women exposed to trauma and 8% of men.

-Research is examining the influence of race and culture with findings suggestive of increased incidence and risk in Hispanic Americans.

Characteristics/Clinical Presentation^1,2,4,5

Symptoms of PTSD can include: 

-re-experiencing the traumatic event (recurring thoughts, memories, dreams, nightmares, flashbacks)

-avoidance 

-reduced responsiveness

-increased arousal, anxiety, and guilt

-feelings of detachment and dissociation

-dazed feeling

-difficulty remembering

-feeling that surroundings, thoughts, or body are strange and unnatural

-hyper-alertness

-difficulty concentrating

-sleep disturbances

Children and teens may have other signs and symptoms than those described above:

-new/unusual bedwetting

-inability to talk

-acting out traumatic events during playtime

-heightened need for attention

-extreme dependence on parent/adult

-extreme disruptive behaviors

-lack of guilt in not preventing harm to others

-need for revenge

Symptoms associated with anxiety, stress, and tension: 

-excitability

-dizziness

-fainting

-heart palpitations

-fever

-headaches

Symptoms may present themselves immediately following trauma or may be delayed months or years.

Associated Co-morbidities¹

The following are commonly seen in patients with PTSD:

-substance abuse

-depression

-suicidal tendencies

-panic disorder

-generalized anxiety disorder

The traumatic events that result in the development of PTSD may also result in physical trauma. 

Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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1. Comer RJ.  Abnormal Psychology.  6th ed.  New York, NY: Worth Publishers; 2007.
2. National Institute of Mental Health.  Health Topics: Post-Traumatic Stress Disorder (PTSD).  Available at www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/complete-index.shtml. Updated August 31, 2010.  Accessed March 6, 2011.
3. Fleener, PE. Post Traumatic Stress Disorder Today: Post Traumatic Stress Disorder DSM-TR-IV^TM Diagnosis & Criteria.  Available at http://www.mental-health-today.com/ptsd/dsm.htm.  Accessed March 13, 2011. 
4. Hockenbury DH, Hockenbury SE. Psychology. 3rd ed.  New York, NY: Worth Publishers; 2003. 
5. National Center for Biotechnology Information, U.S. National Library of Medicine. PubMed Health: Post-traumatic Stress Disorder PTSD.  Available at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923/.  Updated February 14, 2010.  Accessed March 13, 2011. 
6. Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD) (Review).  The Cochrane Library 2009, Issue 1. Available at http://info.onlinelibrary.wiley.com/userfiles/ccoch/file/CD003388.pdf.  Accessed March 16, 2011.