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Post-traumatic stress disorder

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

WHAT IS IT?

 

WHAT IS IT?
- 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.

 

 

CAUSES
- 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.

 

 

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

 

 

SYMPTOMS
- 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.

 

 

TREATMENT
- 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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