Post-Traumatic Stress Disorder
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Posttraumatic Stress
Disorder
Posttraumatic Stress Disorder
Prevalence 3.6-8.0% of U.S. adults
May occur at any age; triggered by trauma
Women more likely affected
Minority groups have much higher rates of PTSD than do non-Hispanic white persons
30% of the men and women who have spent time in the war zones
Pathophysiology
Reduced hippocampal volume among those exposed to combat trauma, sexual assault, or MVAs
Increased regional cerebral blood flow to limbic and paralimbic areas esp. right amygdala, decreased blood flow to Brocas area in the left temporal lobe
Sympathetic nervous system activation
Autonomic hyperresponsiveness to both neutral and trauma-related stimuli
Elevated urinary catecholamine levels
Downregulation of beta- and alpha-2 adrenergic receptors
Increased reactivity to the alpha-2 antagonist, yohimbine
Hypothalamic-Pituitary-Adrenocortical mobilization
Lower urinary cortisol levels
Elevated lymphocyte glucocorticoid receptor levels
Dexamethasone supersuppression
Other theories of causation
Acoustic startle-response
Shorter latency and increased amplitude of the acoustic-startle-eyeblink reflex
Significant loss of the normal inhibitory modulation of the startle reflex
Resistance to habituation of the startle response
Fear conditioning
Appraisal
DSM-IV-TR
The person experienced or witnessed an event that involved death or serious injury, or the threat of death or serious injury; response to the event involved intense fear, horror, or a sense of helplessness
Relived experiences of the event, such as having distressing images and memories, upsetting dreams, flashbacks, or physical reactions
DSM-IV-TR Contd
Persistent avoidance of situations or things that remind the person of the traumatic event or feeling of emotional numbness
Feeling as if constantly on guard or alert for signs of danger, which may cause difficulty sleeping or concentrating
Symptoms last longer than one month
Acute: duration less than 3 months
Chronic: duration 3 months or more
Delayed: onset of symptoms is at least 6 months after stress
Course of PTSD
Signs and symptoms typically begin within three months of a traumatic event
May be delayed for more than six months or even years later
Severity and duration varies
Symptoms may come and gomay have more symptoms during times of higher stress
Some people recover within six months, others may not do so for much longer
Longitudinal Course
PTSD can persist for decades
Symptoms may worsen rather than improve over time
Approximately 40% of patients with lifetime PTSD are unlikely to recover whether or not they have ever received treatment
Series of remissions and relapses
Some people able to lead productive and fulfilling lives; others may develop a persistent incapacitating mental illness
Prognosis of PTSD
Best prognosis depends on how soon the symptoms develop after the trauma, and on early diagnosis and treatment
Some individuals who do not receive care recover over a period of years
More than 1/3 of patients never fully recover
Rarely, individuals may have worsening symptoms and kill themselves
Consequences of PTSD
Physiological outcomes
Physical complaints
Depression
Other anxiety disorders
Conduct disorders
Dissociation
Eating disorders
Consequences of PTSD Contd
Social outcomes
Interpersonal problems
Low self-esteem
Alcohol and substance use
Employment problems
Homelessness
Trouble with the law
Consequences of PTSD Contd
Self-destructive behaviors
Substance abuse
Suicidal attempts
Risky sexual behaviors leading to unplanned pregnancy or STDs, including HIV
Reckless driving
Self-injury
Treatment
Three major approaches
Cognitive-behavioral therapy
Pharmacotherapy
Individual and group dynamic psychotherapy
Cognitive-behavioral therapy
The most successful treatment for PTSD