Post-traumatic Stress Disorder: Difference between revisions
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Revision as of 18:30, 4 April 2011
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Original Editors - Samantha Sowder from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[1][2][3][edit | edit source]
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[4][5][edit | edit source]
-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[6][7][8][9][edit | edit source]
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-morbidities[10][edit | edit source]
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[11][12][13][edit | edit source]
-benzodiazepines
-antipsychotics
-sedatives
-antidepressants (including SSRIs)
Diagnostic Tests/Lab Tests/Lab Values[14][15][edit | edit source]
Increased arousal may be measured through studies of autonomic functioning such as heart rate, electromyography, and sweat gland activity.3
The DSM-IV criteria for diagnosis of PTSD:
-History of experienced, witnessed, or confronted event(s) presenting death, injury, or threat to the physical integrity of self or another with a reaction of intense fear, helplessness, or horror.
-Re-experiencing the event in at least one of the following ways:
-recollections, dreams, illusions, flashbacks, or a sense of reliving the experience
-distress or physical arousal produced by reminders of the event
-Persistent avoidance of reminders of the event and a subjective sense of numbing, detachment, or emotional unresponsiveness.
-Two or more symptoms of increased arousal:
sleep disturbances
irritability
poor concentration
hyper-vigilance
exaggerated startle response
-Significant distress or impairment in carrying out activities of daily life, with symptoms enduring for at least one month.
The disorder is considered acute if symptom duration is less than 3 months, chronic if more than 3 months, and delayed onset if symptom onset is at least 6 months after the traumatic experience.
Etiology/Causes[16][17][18][edit | edit source]
“Even well-adjusted and psychologically healthy people may develop PTSD when exposed to an extremely traumatic event.”4
Factors influencing the development of PTSD:
-biological factors
-personality
-childhood experiences
-social support
-severity of experienced trauma.
PTSD has been linked to abnormal activity of the cortisol and norepinephrine in the urine, blood, and saliva.1 There is also evidence that areas of the brain including the amygdala and hippocampus, which play a role in memory, regulation of stress hormones, and control of emotional responses may be damaged in those with PTSD.1
An individuals personality, attitude, and coping mechanisms can all influence their susceptibility to developing PTSD. Studies have found the following characteristics to be associated with people who have the disorder:
-high levels of general anxiety
-psychological problems prior to trauma
-stressful life situations at the time of, or after trauma occurs
-general sense of not being able to control one’s life
-inability to find any positivity during unpleasant situations
Childhood experiences connected to PTSD:
-poverty
-experiences of trauma at a young age
-age less than 10 at time of parent’s divorce.
Persons at increased risk:
-rescue workers
-relief workers
-emergency service personnel
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[19][20][21][edit | edit source]
“One survey found that post-traumatic stress symptoms lasted an average of three years with treatment but five and a half years without it.”1
-Drug Therapy
-Psychotherapy:
Exposure techniques
Insight therapy
Family therapy
Group therapy
Psychological debriefing/critical incident stress debriefing
Cognitive restructuring
Stress inoculation training
-Prevention
Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
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Resources
[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
see adding references tutorial.
- ↑ Comer RJ. Abnormal Psychology. 6th ed. New York, NY: Worth Publishers; 2007.
- ↑ 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.
- ↑ Hockenbury DH, Hockenbury SE. Psychology. 3rd ed. New York, NY: Worth Publishers; 2003.
- ↑ Comer RJ. Abnormal Psychology. 6th ed. New York, NY: Worth Publishers; 2007.
- ↑ Hockenbury DH, Hockenbury SE. Psychology. 3rd ed. New York, NY: Worth Publishers; 2003.
- ↑ Comer RJ. Abnormal Psychology. 6th ed. New York, NY: Worth Publishers; 2007.
- ↑ 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.
- ↑ Hockenbury DH, Hockenbury SE. Psychology. 3rd ed. New York, NY: Worth Publishers; 2003.
- ↑ 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.
- ↑ Comer RJ. Abnormal Psychology. 6th ed. New York, NY: Worth Publishers; 2007.
- ↑ Comer RJ. Abnormal Psychology. 6th ed. New York, NY: Worth Publishers; 2007.
- ↑ 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.
- ↑ 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.
- ↑ Comer RJ. Abnormal Psychology. 6th ed. New York, NY: Worth Publishers; 2007.
- ↑ Fleener, PE. Post Traumatic Stress Disorder Today: Post Traumatic Stress Disorder DSM-TR-IVTM Diagnosis & Criteria. Available at http://www.mental-health-today.com/ptsd/dsm.htm. Accessed March 13, 2011.
- ↑ Comer RJ. Abnormal Psychology. 6th ed. New York, NY: Worth Publishers; 2007.
- ↑ 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.
- ↑ Hockenbury DH, Hockenbury SE. Psychology. 3rd ed. New York, NY: Worth Publishers; 2003.
- ↑ Comer RJ. Abnormal Psychology. 6th ed. New York, NY: Worth Publishers; 2007.
- ↑ 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.
- ↑ 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.
