Post traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event which results in psychological trauma.”

1. Post traumatic stress
disorder.
PRESENTEE-NAVDEEP KAUR

3. INTRODUCTION
 Post traumatic stress disorder (PTSD) is a severe
anxiety disorder that can develop after exposure to any event
which results in psychological trauma.”
This event may involve the threat of death to oneself or to
someone else, or someone else's physical, sexual, or
psychological integrity, overwhelming the
individual's psychological defenses.

4. CONT.
Post Traumatic Stress Disorder (PTSD), once called shell
shock or battle fatigue syndrome, is a serious condition that
can develop after a person has experienced or witnessed a
traumatic or terrifying event in which serious physical
harm occurred or was threatened.

5. DEFINITION
Post Traumatic Stress Disorder is described as the
development of characteristic symptoms following exposure
to an extreme traumatic stress or involving a personal threat
to physical integrity of others”.
For e.g. being kidnapped or taken hostage, being tortured,
experiencing disasters etc

6. CONT..
Post-traumatic stress disorder (PTSD) is a debilitating
condition that affects people who have been exposed to a
major traumatic event. PTSD is characterized by upsetting
memories or thoughts of the ordeal, "blunting" of emotions,
increased arousal, and sometimes severe personality
changes.

7. INCIDENCE AND PREVALENCE
The life time incidence of PTSD is 9-15%
The life time prevalence of PTSD is about
- 8%
-10-12% among women
- 5-6% among men
PTSD can appear at any age
Most prevalent in young adults
Lifetime prevalence significantly high in women

8. CAUSES OF PTSD
PTSD is believed to be caused by either physical trauma or
psychological trauma or more frequently a combination of
both. Possible sources of trauma include:
 Experiencing or witnessing childhood or adult physical,
emotional or sexual abuse

9. CONT.
Physical assault
Adult experiences of sexual
assault, Accidents
Drug addiction
Illnesses
Medical complications

10. Cont..
Employment in occupations
exposed to war (such as
soldiers) or disaster (such as
emergency service workers).
Violent assault
Kidnapping
Sexual assault
Torture

11. Cont.
Experiencing a disaster
Violent automobile
accidents
Getting a diagnosis of a
life-threatening illness
Prisoner of war or
concentration camp victim

12. Cont..
Children may develop PTSD
symptoms by experiencing
sexually traumatic events like age-
inappropriate sexual experiences.
A preliminary study found that
mutations in a stress-related gene
interact with child abuse to
increase the risk of PTSD in adults

13. Neuro-Endocrinology
PTSD symptoms may result when
a traumatic event causes an
overactive adrenaline response,
which creates deep neurological
patterns in the brain.
PTSD
displays biochemical changes in
the brain and body that differ from
other psychiatric disorders such as
major depression.

14. People with PTSD also show:
A low secretion of cortisol and
high secretion of catecholamine in
urine, with a nor
epinephrine/cortisol ratio
consequently higher than
comparable non-diagnosed
individuals.

15. Brain catecholamine levels
are low, and corticotrophin-
releasing factor (CRF)
concentrations are high.
Together, these findings
suggest abnormality in
the hypothalamic-pituitary-
adrenal (HPA) axis.

16. sLow cortisol levels may
predispose individuals to PTSD.
Because cortisol is normally
important in
restoring homeostasis after the
stress response, it is thought that
trauma survivors with low cortisol
experience a poorly contained—
that is, longer and more
distressing—response, setting the
stage for PTSD.

17. Neuro-Anatomy
Genetics
There is evidence that
susceptibility to PTSD is
hereditary.

18. RISK FACTORS
Although most people (50-90%) encounter trauma over a
lifetime, only about 8% develop full PTSD.
Early childhood developmental experience
Childhood trauma
Trauma severity
Chronic adversity
Familial stressors increase risk for PTSD
Being punished severely during childhood.
Childhood asocial behavior and depression

19. Cont.
•Female gender
•Middle-aged (40 to 60 years old)
•Little or no experience coping with traumatic events
•Ethnic minority
•Lower socioeconomic status
•Children in the home
•Women with spouses exhibiting PTSD symptoms
•Pre-existing psychiatric conditions
•Primary exposure to the event including injury, life-threatening situation, and
loss
•Living in a traumatized community

20. SIGN AND SYMPTOMS OF PTSD

21. RE-EXPERIENCING
Flashbacks—re-living the trauma
over and over, including physical
symptoms like a racing
heart or sweating
Bad dreams
Frightening thoughts
Hallucinations
Re-experiencing symptoms may
cause problems in a person’s
everyday routine. They can start
from the person’s own thoughts
and feelings.

22. AVOIDANCE
Staying away from places, events,
or objects that are reminders of the
experience
Feeling strong guilt, depression,
or worry
Losing interest in activities that
were enjoyable in the past
Having trouble remembering the
dangerous events.

23. Cont.
Things that remind a person
of the traumatic event
can trigger avoidance
symptoms. These symptoms
may cause a person to
change his or her personal
routine.
For example, after a bad car
accident, a person who
usually drives may avoid
driving or riding in a car. .

24. HYPERAROUSAL
Being easily startled
Feeling tense or "on edge"
Having difficulty sleeping, and/or
having angry outbursts.
Hyperarousal symptoms are
usually constant, instead of being
triggered by things that remind one
of the traumatic event. They can
make the person feel stressed and
angry.
These symptoms may make it
hard to do daily tasks, such as
sleeping, eating, or concentrating

25. Cont..
The person may also suffer
physical symptoms, such as:
- Increased blood pressure
and heart rate
- Rapid breathing
- Muscle tension
- Nausea
- Diarrhea

26. EMOTIONAL NUMBING AND DYSPHORIA
Numbing symptoms (such as
loss of interest and feeling
emotionally numb)
Dysphoric symptoms: these
include symptoms of
emotional numbing, as well
as anger, sleep disturbance,
and difficulty concentrating.

27. COMMON SYMPTOMS
Hyper alertness
 Fear and anxiety
 Nightmares and flashbacks
 Avoidance of recall situations
 Anger and irritability
 Guilt
 Depression
 Increased substance abuse
 Negative world view
 Decreased sexual activity

28. PROTECTIVE FACTORS
High school degree or
college education
Older age at entry to war
Higher socioeconomic
status
A more positive paternal
relationship as pre-military
protective factors

29. DIAGNOSTIC CRITERIA
The diagnostic criteria for PTSD, per the Diagnostic and Statistical
Manual of Mental Disorders IV (DSM IV-TR), may be summarized as:
a) Exposure to a traumatic event
b) Persistent re-experience (e.g. flashbacks, nightmares)
c) Persistent avoidance of stimuli associated with the trauma (e.g.
avoidance of experiences that the fear will trigger flashbacks and
re-experiencing of symptoms , fear of losing control)

30. Cont.
d) Persistent symptoms of increased arousal (e.g. difficulty
falling or staying asleep, anger and hyper vigilance).
e) Duration of symptoms for more than 1 month.
f) Significant impairment in social, occupational, or other
important areas of functioning (e.g. problems with work
and relationships.)

31. The third edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-III) outlined three forms of the
disorder:
Acute: onset within six months of the event and lasting less
than six months
Chronic: symptoms lasting six months or more
Delayed: onset at least six months after the event

32. DIAGNOSTIC CRITERIA DSM-5
A. Exposure to actual one threatened death, or serious injury in one
or the following way-
Directly experiencing the traumatic event.
Witnessing, in person, as event occurs to others.
Learning the traumatic event occurred to close family member or
friend.
Experiencing repeated or extreme exposure to aversive details of
the traumatic event.
B. Presence of intrusion symptom associated with traumatic event,
beginning after the treatment occurred-:
Recurrent distressing memory of traumatic event.

33. Recurrent distressing dream.
Dissociative reactions(flashbacks)
Prolonged psychological distress at exposure to internal or
external cues.
Marked physiological reactions.
C. Persistent avoidance of stimuli:
- Avoidance or efforts to avoid distressing memories, thoughts or
feelings.
- Avoidance or efforts to avoid external reminders(place,
conversation)

34. D. Negative alterations in mood associated with the
traumatic event:
Inability to remember important aspect of traumatic event
Persistent negative beliefs or expectations.
Persistent distorted cognitions about the cause or
consequences of the traumatic event.
Persistent negative emotional state.
Diminished interest in significant activities.
Persistent inability to experience positive emotions.

35. E. Marked alteration in arousal and reactivity associated with traumatic
event.
Irritable behavior and angry ouburst.
Self destructive behavior.

36. DIFFERENTIAL DIAGNOSIS
 Difficult to distinguish from
related disorders exhibiting
phenomenological similarities.
 Borderline personality disorder,
dissociative disorder, generalized
anxiety disorder etc.
 Careful review of time course
relating symptoms to traumatic
event.
 Patients with dissociative behavior
do not have avoidance behavior.

37. TREATMENT

38. TREATMENT
The treatment for PTSD includes:
Pharmacotherapy
Psychotherapy

39. PHARMACOTHERAPY

40. PSYCHOTHERAPY
Cognitive-behavior therapy
 Group therapy
 Exposure therapy
 Eye movement and desensitization
reprocessing (EMDR)
 Group therapy
 Family therapy

41. Cognitive therapy
The behavioral techniques in cognitive
therapy are -
scheduling activities
self- reliance training
role playing
diversion techniques
Therapists encourage patients to relax and
remove them from the source of stress.
Encourage patients to review and abreact
emotional feelings.
Encourage patients to plan for the future
recover

42. EXPOSURETHERAPY
The patient re-experiences the
traumatic event through imaging
techniques .
Ceases anxiety associated with
traumatic memory and corrects
belief that memory must be
avoided
Encourage self control by
exposure exercises
Teach methods of stress
management including relaxation
techniques

43. Eye movement desensitization reprocessing(emdr)
Most preferable method
Patient focuses on lateral moment
of clinician’s finger.
Maintain mental image of the
traumatic event.
Patient work through the
traumatic event while in state of
deep relaxation

44. Group therapy
Consist of 5-6 people with
therapist.
 Identify and recognizes that
others have similar problems.
 Gain support and empathy from
fellow group members.
 Sharing of traumatic experiences.
 Support from other group
members

45. Family therapy
Aimed at increasing
family’s coping.
Individual stability and
change.
Good network of support.
Recover faster.

46. ACTIVITIES
Relaxed activities should be
given:
 Breathing exercise
 Meditation
 Yoga
 Prayer
 Listening music
 Drawing
 Finger painting

47. PROGNOSIS
Good prognosis:
 Rapid engagement of treatment
 Early and ongoing social support
 Avoidance of re-traumatization
 Absence of other psychiatric
disorders
 Absence of substance abuse

48. COMPLICATONS
Alcohol abuse
 Drug abuse
 Depression
 Anxiety
 Fear of things that are not usually
frightening to others (phobia)
 Involvement in antisocial
activities (prostitution) in case of
women experiencing sexual assault

49. NURSING MANAGEMENT
Nursing management includes:
 Nursing assessment
 Nursing diagnosis
 Nursing interventions
 Client education

50. NURSING ASSESMENT
Post traumatic stress disorder will
be identified on the basis of
following features:
Exposure of traumatic event
Re-experience of traumatic event
Persistent avoidance of stimuli
associated with persistent
symptoms of increased arousal.
Duration of disturbances
Disturbances causing significant
distress or impairment.

51. NURSING DIAGNOSIS
1. Dysfunctional grieving related to loss of self following
the traumatic event as evidenced by avoidance and
depression.
2. Inability to express feelings related to fear of intensity as
evidenced by helplessness and hopelessness.
3. Feeling of fear, anxiety and unsafe related to generalized
traumatic experience as evidenced by nightmares and
flashbacks

52. CONT..
4. Decreased ability to deal with stress related
to unresolved grief following the trauma as
evidenced by emotional numbing.
5. Risk of violence related to hostile and aggressive behavior as
evidenced by hyperarousal.
6. Disturbance in interpersonal relationship related to lack of trust and
difficulty in expressing feelings as evidenced by less social
interaction.

55. references
Townsand MC. Psychiatric mental health nursing. 8th ed Jaypee; New
Delhi;p.559-578.
Sreevani R. Mental health nursing. 3rd ed Jaypee ;New Delhi; p.
Ahuja Neeraj. A Short Textbook of Psychiatry. 7th ed Jaypee; New Delhi;
p.112
Online References
post traumatic stress disorder
-https://www.google.co.in
-https://en.wikipedia.org/wiki/Posttraumatic_
stress_disorder