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Posttraumatic Stress Disorder (PTSD)

Patients may develop anxiety after exposure to extreme trauma (such as an actual or threatened death or injury to the patient or another person). If the reaction occurs shortly after the trauma, it's called acute stress disorder, and if the reaction is delayed or recurrent, it's called posttraumatic stress disorder (PTSD).

In PTSD the patient actively avoids stimuli that trigger memory of the event, resulting in increased vigilance, arousal, and startle response. PTSD affects 5% to 10% of Americans at some time in their lives; women are more likely to be affected than men.

Causes

Preexisting psychopathology can predispose the patient to this disorder. However, this disorder can develop in anyone, especially if the stressor is extreme. Individuals with a past psychiatric history and neurotic and extroverted characteristics are at increased risk. Genetics are also an influence, but environmental effects aren't.

It's theorized that PTSD impairs the alpha2-adrenergic receptor response that inhibits a stress-induced release of norepinephrine. This results in a progressive behavioral sensitization to stimulus cues from the original trauma, with responses of increased sympathetic activity.

Signs and symptoms

Signs and symptoms of post-traumatic stress disorder typically appear within three months of the traumatic event. However, in some instances, they may not occur until years after the event and may include:

  • Flashbacks and distressing dreams associated with the traumatic event.
  • Distress at anniversaries of the trauma.
  • feelings of emotional numbness
  • In young children, delayed or developmental retrogression in such areas as toilet training, motor skills and language.
  • being easily startled
  • Hopelessness about the future - no hope of a family life, career or living to old age.
  • difficulty sleeping
  • Efforts to avoid thoughts, feelings and activities associated with the trauma.

If you have one or even a few of these symptoms, you do not necessarily have PTSD. Not everyone who experiences a trauma will develop PTSD. Among those who do develop PTSD, symptoms vary in severity and impact.

Generally, a diagnosis of PTSD is made if the symptoms last for more than one month. Only a qualified professional can make the diagnosis, so it's important to talk to your health care provider if you are concerned about any of these symptoms. Symptoms of PTSD usually begin within three months of the traumatic event.

Signs and tests

There are no tests that can be done to make the diagnosis of PTSD. The diagnosis is made based on a certain set of symptoms that persist after a history of extreme trauma. Your doctor will do psychiatric and physical examinations to rule out other illnesses.

Treatment

Acute stress reactions are usually self-limiting and may be helped with short-term use of benzodiazepines and supportive/expressive psychotherapy. PTSD is chronic and recurrent and requires drug and behavior therapies. Tricyclic antidepressants, monoamine oxidase inhibitors, phenelzine, and serotonin reuptake inhibitors reduce anxiety, symptoms of intrusion, and avoidance behaviors. Trazodone, a sedating antidepressant, is helpful for insomnia. Symptoms in some patients in uncontrolled trials improved with carbamazepine, valproic acid, and alprazolam.

Psychotherapy is used to overcome avoidance behaviors and demoralization and to help the patient master fears that the trauma will recur. Stepwise focus seems to be most effective in dismantling avoidance behaviors.

Support groups are highly effective and are provided through many Veterans Administration centers and crisis clinics. These groups provide a forum in which victims of this disorder can work through their feelings with others who have had similar conflicts. Some group programs include spouses and families in their treatment processes. Rehabilitation programs in physical, social. and occupational areas also are available for victims of chronic PTSD.

Many patients also need treatment for alcohol or drug abuse.

Prevention

Counseling and crisis intervention soon after the event are important for people who have experienced extremely stressful situations. They could help prevent longer-term forms of PTSD and should be part of public health responses to groups at risk, such as disaster victims.


 

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