Post-traumatic stress disorder (PTSD)

• What is Post-Traumatic Stress Disorder (PTSD)
• Statistics on Post-Traumatic Stress Disorder (PTSD)
• Risk Factors for Post-Traumatic Stress Disorder (PTSD)
• Progression of Post-Traumatic Stress Disorder (PTSD)
• Symptoms of Post-Traumatic Stress Disorder (PTSD)
• Clinical Examination of Post-Traumatic Stress Disorder (PTSD)
• How is Post-Traumatic Stress Disorder (PTSD) Diagnosed?
• Prognosis of Post-Traumatic Stress Disorder (PTSD)
• How is Post-Traumatic Stress Disorder (PTSD) Treated?
• Post-Traumatic Stress Disorder (PTSD) References

What is Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a psychological disease. This condition is commonly associated with an extraordinarily stressful event which is re-lived by the person who experienced it in an episodic manner throughout life, causing them to re-experience the stress and anxiety associated with their first encounter.

Statistics on Post-Traumatic Stress Disorder (PTSD)

The incidence of this condition is normally related to the occurrence major traumatic events that are most often political in nature. Following any military conflict, many soldiers suffer PTSD from their witness of fellow soldiers being killed in active service. Because of this association, there remains an incidence of 1-3% in general population, rising up to 30% in Vietnam war veterans.

Risk Factors for Post-Traumatic Stress Disorder (PTSD)

PTSD is most related to the personal intensity of the experience, if the experience during occurred during childhood or if the patient has suffered previous psychiatric ilness.

Progression of Post-Traumatic Stress Disorder (PTSD)

The condition may occur at any age, the onset related to the experience of a traumatic event. Such an event may include the witness of traumatic death, serious accidents, natural disasters or being the victim of violent crime, rape, torture or terrorism. Symptoms will usually begin within 6 months of experiencing the traumatic event.

Symptoms of Post-Traumatic Stress Disorder (PTSD)

Typical clinical features include:

• Flashbacks: repeated vivid reliving of the trauma in the form of intrusive memories, often triggered by a reminder of the trauma;
• Insomnia usually accompanied by nightmares, the nocturnal equivalent of flashbacks;
• Emotional blunting, emptiness or numbness, alternating with:
  • Intense anxiety at exposure to events that resemble an aspect fo the traumatic event, including anniversaries of the trauma;
  • Avoidance of activities and situations reminiscent of the trauma;
  • Emotional detachment from other people;
  • Hypervigilance with autonomic hyperarousal and an enhanced startle reaction.

How is Post-Traumatic Stress Disorder (PTSD) Diagnosed?

There are no relevant investigations for this condition. The diagnosis is made on clinical history alone.

Prognosis of Post-Traumatic Stress Disorder (PTSD)

The best prognosis, or outcome, depends on how soon the symptoms develop after the trauma, and on early diagnosis and treatment. Prognosis depends on how soon symptoms are recognised and the disorder is correctly diagnosed therefore allowing for immediated treatment.

The symptoms of this condition will usually begin within six months of the traumatic event and resolve within 12 months in the greater majority of cases. The symptoms may persist for a longer period of time in some cases.

How is Post-Traumatic Stress Disorder (PTSD) Treated?

There are two main forms of therapy for this condition: psychotherapy and medication.

Psychotherapy

This is the main form of treatment for PTSD. The patient is encouraged to share their fears and difficulties with their condition on regular intervals, tailored to the individual. The psychotherapy is mainly supportive, providing an outlet for the patient to release their frustrations. This form of therapy may be less successful on long-term cases of PTSD. There have been suggestions that debriefing people after the experiencing of a traumatic event may reduce the risk of developing this condition, but these claims have been largely unproven.

Medication

In patients who cannot be managed by psychotherapy alone, the use of antidepressant medications has been proven to improve the outcome of counselling in such patients. Commonly used drugs include the SSRIs, including nefazodone and the SNRIs such as venlafaxine.

Post-Traumatic Stress Disorder (PTSD) References

1. Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. Book
2. Longmore M, Wilkinson I, Torok E. Oxford Handbook of Clinical Medicine (5th edition). Oxford: Oxford University Press; 2001. Book
3. Post-traumatic stress disorder [online]. Bethesda, MD: Medline Plus; 2003 [cited 9 July 2003]. Available from: URL link
4. Sadock BJ, Sadock VA (eds). Kaplan and Sadock’s Pocket Handbook of Clinical Psychiatry (3rd edition). Philadelphia, PA: Lippincott Williams and Wilkins; 2001. Book