PTSD is defined as a disorder related to anxiety in response to being involved in a traumatic event. Often the event involves threat of injury or potential death such as physical assault, events at war or sexual violation.(1)
The Incidence of PTSD occurs in less than 10% of people who have been through a traumatic event. It is however one of the most commonly seen psychiatric disorders with a lifetime prevalence between 7.8% to 12.3%.
This number skyrockets to 58% in high risk populations such as combat veterans and emergency services (police, fire, ambulance). Women are also two times more likely to suffer PTSD. About 50% of cases are linked to women who have suffered sexual assault.(2)
Clinical Signs & Symptoms
- Exposure to traumatic life threatening event
- Re-experiencing of traumatic events, dreams flashback etc.
- Avoidance symptoms such as social withdrawal, or avoidance of stimuli associated with the event.
- Increased vigilance
- Depression
| Criterion A | Traumatic event |
| Criterion B | Re-experiencing |
| Criterion C | Avoidance |
| Criterion F | Unable to function |
| Criterion E | Month at least |
| Criterion D | Arousal |
- To meet criteria for PTSD, one must meet criterion A plus symptoms from each of the three symptom clusters A, B, C, and D. A fifth criterion concerns duration of symptoms (>1 mo) and a sixth assesses function (must be impaired).
- Based on Mnemonic: TRAUMA
Once diagnosis of PTSD has been made treatment should be initiated soon after. The use of pharmacologic and non-pharmacologic measures most commonly need to be taken. The use of SSRI( anti-depression) medication is most commonly prescribed in patients suffering PTSD particularly in the chronic.
It has been shown that patients that stop use of SSRI medication are more likely to have relapse of PTSD symptoms. It is hypothesised that long term use improves neurocognitive and psychological outcomes that may contribute to the overall resolution of the PTSD.
Other common medications prescribed include benzodiazepines for the patient suffering anxiety, beta blockers, monoamine oxidase inhibitors and antipsychotics.
Treatment also requires a team approach making use of several clinicians. Due to the likelihood of the patient having numerous psychiatric and physical disorders, the clinicians required is on a patient to patient basis depending on the severity of their PTSD.
Goals of treatment include reducing severity of the PTSD, reducing co-morbid conditions such as depression, substance abuse, improving functioning and restoring the normal developmental process of life, such as overcoming avoidance behaviour.
Protection against relapse by developing patients’ skills of anticipating such situations and the ability of problem solving to get through these events, and the integration of the traumatic event into a constructive approach of risk, safety prevention and protection. This is achieved through interventions such as group therapy, individual and family therapy, cognitive behavioural therapy, play therapy, art therapy, anxiety management, eye movement desensitization and reprocessing (EMDR), hypnosis, and relaxation techniques.(3-5)
Sources:
- Jaffe SE, Schub T. Post-Traumatic Stress Disorder. In: Pravikoff D, Pravikoff D, editors. Glendale, California: Cinahl Information Systems; 2013. p. 2p.
- Ferri FF. Ferri’s Clinical Advisor. Philadelphia: Elsevier; 2013. p. 312.
- Ursano RJ, Bell C, Eth S, Friedman M, Norwood A, Pfefferbaum B, et al. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Am J Psychiatry. 2004;161(11 Suppl):3-31.
- Davis LL, Frazier EC, Williford RB, Newell JM. Long-Term Pharmacotherapy for Post-Traumatic Stress Disorder. CNS Drugs. 2006;20(6):465.
- Gore A. Posttraumatic Stress Disorder 2013 [cited 2014 5th July]. Available from:https://emedicine.medscape.com/article/288154-overview.
