Lecture on Post-Traumatic Stress Disorder (PTSD)

Introduction

• PTSD: A psychiatric disorder with specific signs and symptoms linked to traumatic events.
• Historical names: Railway spine, shell shock, combat stress reaction.
• Misconception: PTSD is not just any difficult life experience plus psychiatric pathology.

DSM Diagnostic Criteria - TRAUMA Acronym

1. T - Trauma

   • Exposure: Required for PTSD diagnosis. Event must be violent/life-threatening.
   • Examples: War, violence, crime, terrorism, accidents.
   • Statistics: Less than 10% develop PTSD from non-intentional trauma; nearly 50% from intentional trauma.
   • Forms: Single event (e.g., car crash) or chronic (e.g., childhood abuse).

2. R - Re-experiencing

   • Flashbacks: Sudden, sensory-driven experiences of the trauma.
   • Nightmares: Common, leading to poor sleep quality and avoidance of sleep.

3. A - Arousal

   • Hyperarousal: Increased awareness and anxiety about surroundings.
   • Hypervigilance: Constant environmental scanning for danger.
   • Symptoms: Muscle tension, irritability, sleep issues, etc.

4. U - Unable to Function

   • Impairment: Re-experiencing, hyperarousal, and avoidance disrupt daily life.
   • Consequences: Difficulty concentrating, maintaining relationships, and jobs.

5. M - Month

   • Chronicity: Symptoms must be present for at least one month.
   • Delayed onset: 80% show symptoms after a month.

6. A - Avoidance

   • Behavioral: Avoidance of trauma-related stimuli (people, places).
   • Emotional Numbing: Avoidance of emotions, leading to flattened affect.

Diagnostic Questions

• Have you experienced a life-threatening or violent event?
• Does the memory of this event interfere with your life?

Epidemiology and Risk Factors

• Prevalence: 3% at any time, 10% lifetime. Women affected twice as often.
• Age Patterns: Unlikely under 10 or over 55.
• Predictors: Pre-existing disorders, poor social support.

Prognosis

• Chronic without treatment: 50% have ongoing symptoms over five years.
• Trauma Type: Intentional vs. non-intentional affects symptom duration.

Treatment

• Trauma-Focused CBT: Most effective, especially exposure therapy.
• Medications: Serotonergic drugs and Prazosin (for nightmares).
  • Avoid Benzodiazepines: Worsen long-term outcomes.

Related Disorders

• Acute Stress Disorder: Immediate symptoms post-trauma, not always pre-PTSD.
• Other Disorders: Dissociative, personality, somatoform disorders linked to trauma.
  • Acronym PTSD: Stands for Personality disorders, Trauma-related, Somatoform, Dissociative disorders.

Conclusion

• PTSD: Requires a narrow definition but empathy for all trauma-related disorders.
• Encourage further learning and exploration of psychiatry.