PTSD
(Posttraumatic Stress Disorder) This disorder follows a gross traumatic
event that was either experienced or that was witnessed from up close. The
initial stressful event would be such an experience as a rape at knife point,
a bloody lethal accident, witnessing a beheaded accident victim and others. Rescue
workers who have to remove dead bodies after earthquakes or in other similar settings
are often also affected. The response at the time of the event must involve the
intense emotions of horror, fear or helplessness. In the case of children this
may be witnessed as agitated behavior.
Criteria for diagnosing PTSD: Subsequently
to the event the following criteria must be fulfilled (Ref. 2): 1.
persistent re-experiencing of the traumatic event 2. constant
avoidance of stimuli that were associated with the traumatic event 3.
numbing of general responsiveness 4. there is increased
arousal state all the time meaning that any little happening or sound, which has
a resemblance to the original event makes the patient overreact emotionally 5.
this clinical syndrome must be present from the traumatic event onwards for at
least 1 month or more 6. the emotional reaction to the
traumatic event must have such devastating emotional consequences that the patients
cannot function properly in the work setting, in social settings or other important
areas of their lives | Symptoms
of PTSD: The patient is persistently anxious and has
insomnia (=difficulties to fall asleep). There are often nightmares that wake
the patient up and then it is difficult for the patient to fall asleep again.
The
lack of sleep leads to a higher vulnerability to develop depression alongside
the PTSD. The patients may become irritable or have anger outbursts. They find
it difficult to concentrate on a task at hand and to complete it. They feel that
their future is likely compromised with a shortened life span, expecting trouble
in the job world, trouble finding a marriage partner, and their friends see a
complete turnaround from the bubbly persons that they often were in the past to
an emotionally crippled individual. Any psychiatric problem that may have been
there in the past and was perhaps not completely resolved will now flare up and
likely will require medical intervention. Statistics and course:
In the average U.S. community PTSD occurs in about 7%. Studies among high risk
groups such as war veterans, victims of criminal violence or victims of disasters
such as volcanic eruptions show rates of 25% to 50%. Symptoms of PTSD usually
occur by 3 months after the traumatic event. 50% of the cases resolve their PTSD
within 3 months from the start of the symptoms. The symptoms with the same event
can differ tremendously depending on how close to the source of violence the patient
was, how long the exposure time was, how severe the physical and/or emotional
trauma was. There are many internal factors that influence the severity of PTSD
such as childhood trauma, history of mental illness in the past, present mental
state just prior to the traumatic event etc.. It also matters, what social and
family support there is for the patient. Treatment of PTSD:
If
the PTSD is still present more than 3 months after the beginning of symptoms,
a series of counseling with a psychologist or psychiatrist should be arranged
to prevent it from getting more entrenched. For patients who get flare
ups of an underlying psychiatric disease, an assessment by a psychiatrist should
be considered. Often depression and anxiety are developing along with the PTSD
and then antidepressant therapy with some of the SSRI antidepressants would be
indicated which enables the psychologist or psychiatrist to work through the PTSD,
which mainly needs counseling. Fluoxetine(brand name: Prozac), fluvoxamine(brand
name: Luvox), paroxetine(brand name: Paxil) or sertraline(brand name: Zoloft)
are some of the antidepressants that would be indicated. The psychological
techniques that have been found useful in treating PTSD are behavioral modification,
behavioral desensitization methods, cognitive therapy and analytical hypnotherapy
using ideomotor signals( Ref. 5). For some patients it takes months, for others
years to work through these painful emotional memories, but persistence and hope
will carry the patient through. Often other problems that were buried subconsciously
are being faced alongside the other therapy for the PTSD and the patient might
even feel better than before the PTSD occurred by the time the therapy can be
terminated. The prognosis (outcome) with treatment is
good. The symptoms to watch for in the untreated, but chronic PTSD case, are suicidal
thoughts from an undetected and denied reactive depression as a result of the
symptoms from the untreated PTSD. Intervention to prevent suicide is the most
important step in these cases. This is then followed by the therapies mentioned
above. More info
on PTSD see this link. |
