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Post-traumatic stress disorder

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VOL: 102, ISSUE: 15, PAGE NO: 23



- Post-traumatic stress disorder (PTSD) is caused by exposure to a traumatic event that results in the person experiencing extreme fear, horror or a sense of helplessness. It can manifest itself both physically and mentally.



- The condition was first recognised in the First World War when soldiers experienced psychological difficulties as a result of battle. At the time it was known as ‘shell shock’.



- Recently it has been accepted that other experiences can precipitate PTSD, such as accidents, witnessing violent deaths, rape and other situations in which a person feels extreme emotions.



- PTSD is more common in women and can occur at any age.



- It is not fully understood why some people go on to develop PTSD after experiencing a traumatic event while others do not. However, there are certain predisposing factors:



- Previous experience of depression or anxiety;



- Family history of mental health problems;



- History of abuse as a child;



- MRI scans have shown that people with PTSD can have structural differences in their hippocampus, which is responsible for memory. This could contribute to symptoms such as flashbacks;



- Hormonal differences. Production of hormones such as adrenaline is a normal response to danger but people with PTSD may continue to produce these hormones after the event.



- PTSD is diagnosed through an assessment of the symptoms experienced by the patient.



- It is normal to experience symptoms of stress after a traumatic event but in PTSD the symptoms persist. They include:



- Intrusive thoughts;



- Flashbacks;



- Depression;



- Anxiety;



- Nightmares;



- Avoidance of stimulus that may trigger memories of the event, such as war films;



- Outbursts of anger;



- Reluctance to discuss the event;



- Feelings of alienation and a numbing of emotion;



- Memory loss regarding elements of the event;



- Lack of interest in daily life;



- Difficulties with concentration;



- Sleeping difficulties;



- Excessive alertness to potential danger;



- Feelings of guilt;



- Alcohol and drug abuse;



- Relationship difficulties;



- Compromised immune system.



- In 2005 NICE issued guidance on the treatment of PTSD. Recommendations include:



- Trauma-focused cognitive behavioural therapy (CBT);



- Eye-movement desensitisation and reprocessing (EMDR);



- Psychological therapies are suggested as first-line treatment;



- Antidepressants, especially selective serotonin re-uptake inhibitors, can alleviate symptoms. Sleeping tablets can help with insomnia. Benzodiazepines can be used to treat anxiety but must be used with caution due to their addictive properties;



- Children should be offered trauma-focused CBT tailored to their age and experience.

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