PTSD — Post-traumatic stress Disorder

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What is PTSD?

PTSD is a mental disorder that can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, or other threats on a person’s life.

A person with PTSD is at a higher risk for other metal disorders.

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Symptoms

Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event.

Young children are less likely to show distress, but instead may express their memories through play.

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Who develops PTSD?

Most people who have experienced a traumatic event will not develop PTSD. People who experience interpersonal trauma (for example rape or child abuse) are more likely to develop PTSD, as compared to people who experience non-assault based trauma, such as accidents and natural disasters. About half of people develop PTSD following rape.

Children are less likely than adults to develop PTSD after trauma, especially if they are under 10 years of age.

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Diagnosis

Diagnosis is based on the presence of specific symptoms following a traumatic event.

Screening

A number of screening instruments are used for screening adults for PTSD, such as the PTSD Checklist for DSM-5 (PCL-5) and the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5).

There are also several screening and assessment instruments for use with children and adolescents. These include the Child PTSD Symptom Scale (SS), Child Trauma Screening Questionnaire, and UCLA Posttraumatic Stress Disorder Reaction Index for DSM-IV.

In addition, there are also screening and assessment instruments for caregivers of very young children (six years of age and younger). These include the Young Child PTSD Screen, the Young Child PTSD Checklist, and the Diagnostic Infant and Preschool Assessment.

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Classification

PTSD was classified as an anxiety disorder in the DSM-IV, but has since been reclassified as a “trauma- and stressor-related disorder” in the DSM-5.

The DSM-5 diagnostic criteria for PTSD include four symptom clusters: re-experiencing, avoidance, negative alterations in cognition/mood, and alterations in arousal and reactivity.

ICD-10 classifies it under “Reaction to severe stress, and adjustments disorders.”

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Treatments

Counseling

The approaches with the strongest evidence include behavioral and cognitive-behavioral therapies such as prolonged exposure therapy, cognitive processing therapy, and eye movement desensitization and reprocessing (EMDR).

In addition, brief eclectic psychotherapy (BEP), narrative exposure therapy (NET), and written narrative exposure therapies also have a evidence.

A meta-analytic comparison of EMDR and cognitive behavioral therapy (CBT) found both protocols indistinguishable in of effectiveness in treating PTSD; however, “the contribution of the eye movement component in EMDR to treatment outcome” is unclear. A meta-analysis in children and adolescent also found that EMDR was as efficacious as cognitive behavioral therapy.

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Medication

While many medications do not have enough evidence to their use, three (fluoxetine, paroxetine, and venlafaxine) have been shown to have a small benefit over placebo. With many medications, residual PTSD symptoms following treatment is the rule rather than the exception.

Patients with a lot of nightmares can be prescribed Prazosin. Not much is known about how it affects the brain while sleeping, but studies have shown it has a good effect on some people.

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