POST-TRAUMATIC

STRESS DISORDER

LEARNING OUTCOMES

1. What is PTSD???2. Who is at risk for PTSD???3. When does PTSD start???& How

long does it last???4. Symptoms5. Consequences

Physiological outcomes Psychological outcomes Self-destructive behaviors

1. Treatment Psychotherapy Pharmacotherapy

INTRODUCTION

Disorder driven by pathogenic memories of past danger.

Symptoms must last for more than a month Acute stress disorder, which occurs earlier than

PTSD

PTSD is an anxiety disorder that develops in response to a stressful event or situation of exceptionally threatening or catastrophic nature

What is PTSD?

EPONYMS OF PTSD Civil War-Irritable heart World War I-shell shock

/Effort syndrome World war II – combat stress

syndrome Vietnam War- brought the

concept of PTSD. Gulf war syndrome PTSD entered the DSM-III in

1980

Traumatic events that may trigger PTSD include: violent personal assaults

Sexual assault Physical attack Abuse Stabbing

natural disastersAccidentsMilitary combat.

Traumatic events

COMMON FEATURE SHARED BY ALL SYNDROMES

Fatigue, fainting Shortness of breath, Palpitations, Headache, dizziness, Excessive sweating, Disturbed sleep, Difficulty in

concentration Forgetfulness

EPIDEMIOLGY Lifetime prevalence -8 percent in general population 5 to 15 percent -subclinical forms of the disorder. Among high-risk groups -5 to 75 percent. 10 to 12 percent among women 5 to 6 percent among men. Higher in women, single, divorced, widowed, socially

withdrawn, of low socioeconomic level

Sexual assault-higher impact Sudden unexpected death of

a loved one and road traffic accidents

Men -more traumatic events Women - higher impact

events.

COMORBIDITY

Depressive disordersSubstance-related disordersAnxiety disorders Bipolar disorders

WHO IS AT RISK?

Every One!!!

People with military combat experience or civilians who have been harmed by war

People who have been raped, sexually abused, or physically abused

People who have been involved in or who have witnessed a life-threatening event

People who have been involved in a natural disaster, such as a tornado or an earthquake

Who is at risk for PTSD??

RISK FACTORS FOR PTSD AMONG THOSE EXPOSED TO TRAUMA

Female, neuroticism Lower social support Lower IQ Pre-existing

psychiatric illness Family history of

mood, anxiety, or substance abuse disorders

Neurological soft signs

PREDICTORS Previous exposure to trauma Peritraumatic responses Negative interpretations of one's acute responses Borderline, paranoid, dependent, or antisocial

personality disorder traits Presence of childhood trauma Inadequate family or peer support system Recent stressful life changes Recent excess alcohol intake

GENETICS 1/3rd of variance in

symptoms is genetic Trauma exposure-little or

no effect on measures of IQ &neurocognitive functioning

Similarity in the test scores between co-twins implies genetic influence on cognitive performance

Above average cognitive ability -protect

PSYCHODYNAMIC FACTORS Trauma has reactivated a previously quiescent, yet

unresolved psychological conflict The subjective meaning of a stressor may determine its

traumatogenicity. Traumatic events can resonate with childhood traumas. Inability to regulate affect can result from trauma. Somatization and alexithymia may be among the after

effects of trauma. Common defenses -denial, minimization, splitting,

projective , dissociation, and guilt Mode of object relatedness involves projection and

introjection

COGNITIVE FACTORS Affected persons cannot process or rationalize the

trauma that precipitated the disorder. They continue to experience the stress and attempt to

avoid experiencing it by avoidance techniques. Less decline in vividness, emotional intensity, and

accuracy of traumatic memories. Exhibit difficulty retrieving specific memories Difficulties of attentional control

EMOTIONAL STROOP PARADIGM

Delayed naming of the word's colour

Heightened stroop interference for trauma words in PTSD

FEAR CONDITIONING

MOWRER'S TWO-FACTOR CONDITIONING THEORY

Traumatic stimuli (UCS) fear&arousal UCS+CS fear response stimulus

generalization variety of stimuli become triggers avoidance of CS negative reinforcement by operant conditioning prevents extinction of conditioned fear responses maintains the problem.

 

NORADRENERGIC SYSTEM

Nervousness, increased blood pressure and heart rate, palpitations, sweating, flushing, and tremors -symptoms of adrenergic drugs.

Increased 24-hour urine epinephrine concentrations in veterans

Increased urine catecholamine concentrations in sexually abused girls

Platelet alpha2- and lymphocyte beta 2 adrenergic receptors are downregulated

STRUCTURAL CHANGES

Lower average volume in the hippocampal region

Structural changes in the amygdale

SYMPTOMS

The symptoms of PTSD can start after a delay of weeks, or even months. They usually appear within 3 months after the traumatic event.

Some people get better within 6 months. Others may have the illness for much longer.

When does PTSD start??& How long does it last???

Re-experiencing the event through flashbacks or nightmares

Avoiding people, places or thoughts that bring back memories of the trauma

Feeling angry & unable to trust people Social withdrawal Numbness Insomnia Lack of concentration

Symptoms

CONSEQUENCES

1)Physiological outcomes2)Psychological outcomes

3)Self-destructive behaviors

Neurobiological changes (alterations in brainwave activity and in functioning of processes such as memory and fear response)

Psychophysiological changes Hyper-arousal of the sympathetic nervous system, Sleep disturbances Increased neurohormonal changes that result in

increased stress & depression Headache Stomach or digestive problems Dizziness

1)Physiological outcomes

Depression Other anxiety disorders (such as phobias,

panic, and social anxiety) Splitting off from the present Eating disorders

2)Psychological outcomes

Low self esteem Alcohol and drug abuse Suicidal attempts Self-injury Risky sexual behaviors

leading to unplanned pregnancy or STDs, including HIV

3)Self-destructive behaviors

TREATMENT

PTSD is treated by a variety of forms of psychotherapy (talk therapy) and pharmacotherapy (medication).

There is no single best treatment, but some treatments are quite promising, especially cognitive behavioral therapy (CBT).

Treatment

COGNITIVE BEHAVIORAL THERAPY (CBT)

A Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying beliefs and behaviors, with the aim of influencing disturbed emotions.

CBT includes a number of techniques such as:

I. Cognitive restructuringII. Exposure therapyIII. Eye movement desensitization

and reprocessing (EMDR)

Cognitive restructuring aims at replacing dysfunctional thoughts with more realistic & helpful ones.e.g.

“I’ll never be normal again..I am gonna die”“I’ll get better..It will just take time”Or “I feel scared..But I am safe”

I. Cognitive Restructuring

In exposure therapy your goal is to have less fear about your memories.

By talking about your trauma repeatedly with your therapist, you'll learn to get control of your thoughts and feelings about the trauma.

You'll learn that you do not have to be afraid of your memories anymore.

II. Exposure Therapy

EMDR is a new therapy for PTSD. In EMDR, patients are instructed to focus on the

traumatic memory while they visually track something that is moving from side to side (such as the therapist’s finger).

Thus, the therapist supplies positive emotional beliefs to replace the negative ones.

III. EMDR

MEDICATION The use of medication in addition

to psychotherapy has been shown to be beneficial in the treatment of PTSD.

The most widely used drug treatments for PTSD are the selective serotonin reuptake inhibitors (SSRIs), such as Prozac & Zoloft

N.B. Drug trials for PTSD are still at a very early stage