Posttraumatic stress disorder (PTSD)


Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person’s life.

A psychiatric disorder that has an identifiable cause.

Many types of traumatic experiences can lead to PTSD such as rape, physical assault, accidents, disasters, homicides, and suicides.

Following an accidental injury 8-39% of patients have PTSD over the following weeks and months.

Diagnosis requires exposure to a dramatic or stressful event.

Diagnosis is based on self reporting symptoms.

Diagnosis requires symptoms must be apparent for at least one month, and the patient must experience significant distress or impaired social, occupational, or other areas of functioning.

Patients must either directly experience a traumatic event, witness someone else directly experiencing an event, learn the event occurred to a close family member or friend, or experience repeated extreme exposure to aversive details of the event.

12 month prevalence in the US is 3.5% and lifetime prevalence is 8.7%.

A disorder in which 1 or more traumatic events give rise to 4 symptom clusters: recurrent and painful reexperiencing of the event, phobic avoidance of trauma-related situations and memories, emotional numbing and withdrawal, and hyperarousal.

Although characterized as a traumatic disorder, the causal event is psychological.

Some studies have indicated neuroanatomical changes in PTSD patients such as increased size and activity of the amygdala, decreased volume of the prefrontal cortex, and decreased volume of the hippocampus.

Neurobiologic changes may exist including heightened sympathetic nervous system responses and alterations in the hypothalamic-pituitary-adrenal axis being the most often noted.

Most perceived as being the result from exposure to disturbing events such as military combat, sexual assault, or man made or natural disasters.

At least 50% of the population experiences a traumatic event, and approximately 20% of such patients go on to develop PTSD.

In a twins study discordant for exposure in Vietnam, combat veterans with PTSD had smaller hippocampi than combat veterans without PTSD (Gilbertson MW).

US veterans with PTSD associated with the development of dementia.

32-34% of patients suffer from PTSD after traffic accidents.

5 years after a traffic accident 8% of patients have PTSD.

Up to 62% of patients with substance dependence experience comorbid PTSD, and up to 65% of patients with PTSD have a comorbid substance abuse disorder.

Higher rates of comorbid psychiatric illness including: pressure, anxiety, substance-abuse, attention deficit hyperactivity disorder and borderline personality disorder.

Patients often experience other medical problems including chronic pain, sleep problems, sexual dysfunction, and cognitive dysfunction.

Associated with functional impairments and quality-of-life deficits.

There is a 2-3 increase in suicide attempts among such patients.

Associated with more and longer hospitalizations and greater use of mental health care.

Estimated that, on average, a person with PTSD will endure 20 years of active symptoms and will experience almost only 2 day a week of work impairment.

Lifetime prevalence in the range of 8%, with women affected twice as often as men.

Lifetime prevalence 6.8%.

Lifetime prevalence amid is 3.6% versus 9.7% in women.

Women are somewhat less likely than men to experience the true Maddock event, could have a lifetime prevalence rates aproximally twice that of men.

Sexual assault is the leading cause of posttraumatic stress disorder in women; an estimated 50% of women who were sexually assaulted develop the condition.

The 12 month prevalence is 1.8% in men versus 5.2% in women, and the estimated six-month prevalence in boys is 3.7% and 6.3% in girls.

Usually develops within the first three months following a trauma, although more delayed presentation may occur.

The high prevalence rate in childhood is related to truancy, vandalism, alcohol use, and running away.

The estimated lifetime prevalence among Vietnam War veterans is calculated at 30.9% for men and 26.9% for women (Kulka RA et al).

Rates of attempted suicide as high as 19%.

Associated with higher rates of hypertension, bronchial asthma, peptic ulcer, as well as other cardiovascular, digestive, musculoskeletal, endocrine, respiratory, nervous systems as well as increased rates of infectious disease for up to 20 years following exposure to major trauma.

One of every eight patients having suffered a myocardial infarction or other acute coronary event develops PTSD.

Patients that develop PTSD following a cardiac event have a doubled risk of having another acute episode or dying within 1-3 years, compared to cardiac patients who did not develop PTSD (Edmondson D et all).

Rates of recognition may be low with clinical diagnosis occurring in as few as 4% of individuals with the disorder.

Symptoms and symptom patterns vary over time.

Symptoms resolved within three months in approximately 50% of cases.

Some patients can remain symptomatic for years.

Norepinephrine levels are higher in the CNS in patients with PTSD then the general population and are associated with greater severity of symptoms.

Common symptoms include intrusive thoughts, tachycardia, hypertension, nightmares, and avoiding reminders of the triggering event.

Increased CNS noradrenergic state contributes to the disruption of normal rapid eye movement sleep, in turn contributes to nightmares.

Treatment guidelines recommend various psychotherapies as first-line treatment.

Cognitive behavioral therapy based on relationships among thoughts, emotions and behaviors is relatively brief form of psychotherapy that is problem focused on action oriented.

Approaches in cognitive behavior therapy including exposure therapy, cognitive therapy, and cognitive processing therapy.

Antidepressants are the primary pharmacologic therapy.

Two serotonin re-uptake inhibitors ( SRIs) sertraline and paroxetine are approved for the treatment of PTSD.

SRIs appeared to be less effective in men than in women, and less effective in chronic disease than in an acute PTSD.

Prazosin a lipid soluble Alpha one-adrenergic receptor antagonist that crosses the blood brain barrier and decreases sympathetic outflow of the brain, is recommended for treatment of PTSD associated nightmares.

Second generation antipsychotics (SGAs) such as risperidone, commonly used for SLI resistant PTSD, , but its use did not reduce symptoms compared with placebo with a six month treatment trial (Krystal JH et al).

Prolonged exposure therapy a cognitive behavioral therapy involving exposure to past memories of trauma has been previously regarded as the primary therapy for PTSD.

The International Consensus Group on Depression and anxiety recommends prolonged exposure is the most appropriate form of cycle therapy for PTSD.

There is a low level of chronic traumatic encephalopathy (CTE)  related  neuropathic changes found that autopsy PTSD in contrast to the large proportion of high levels of CTE related neuropathic features of the multifocal microscopic foci in football players.

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