4. Post-Traumatic Stress Disorder
• It is natural to feel afraid during and after a
traumatic situation
• Fear triggers many changes in the body to help
defend against danger or to avoid it.
• This “fight-or-flight” response is a typical reaction
meant to protect a person from harm.
• Nearly everyone will experience a range of
reactions after trauma, yet most people recover
from initial symptoms naturally.
• Not recovered ---------- ≥ PTSD
Natural Response
Natural Response
6. Epidemiology
Risk of developing PTSD after a traumatic event
8–13% for men,
20–30% for women.
Lifetime prevalence estimated as 7.8%
Cultural differences exist.
Some types of stressor are associated with
higher rates of PTSD (e.g. rape, torture, being a
prisoner of war).
Epidemiology
8. Disorders Usually First Diagnosed in Infancy, Childhood, or
Adolescence
Delirium, Dementia, and Amnestic and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
DSM IV DSM 5
11. Posttraumatic Stress Disorder is a
common problem that can occur
following trauma.
PTSD
MYTH #1
Myths related to
Posttraumatic Stress Disorder
12. Posttraumatic Stress Disorder Myths
PTSD affects someone immediately
after a traumatic ordeal.
If time has passed, someone is no
longer at risk for PTSD.
PTSD
MYTH #2
Myths related to
Posttraumatic Stress Disorder
13. Posttraumatic Stress Disorder Myths
Only
military veterans
experience PTSD
PTSD
MYTH #3
Myths related to
Posttraumatic Stress Disorder
14. Posttraumatic Stress Disorder Myths
Experiencing PTSD is a symptom of
mental weakness PTSD
MYTH #4
Myths related to
Posttraumatic Stress Disorder
19. Avoidance
symptoms
Staying away from places, events, or objects that are
reminders of the traumatic experience
Avoiding thoughts or feelings related to the traumatic
event
May cause a person to change his personal routine, eg:
avoid driving after a bad car accident
Symptoms Of PTSD
21. Cognition and
mood symptoms
• Trouble remembering key features of the traumatic event
• Negative thoughts about oneself or the world
• Distorted feelings like guilt or blame
• Loss of interest in enjoyable activities
Symptoms Of PTSD
22. DSM 5
CRITERIA IN DSM 5
Criterion A
(one required):
The person was exposed to:
death, threatened death, actual
or threatened serious injury, or
actual or threatened sexual
violence, in the following
way(s):
Direct exposure
Witnessing the trauma
Learning that a relative or
close friend was exposed to
a trauma
Indirect exposure to aversive
details of the trauma,
usually in the course of
professional duties (e.g., first
responders, medics)
Criterion B
(one required):
The traumatic event is
persistently re-experienced,
in the following way(s):
Intrusive thoughts
Nightmares
Flashbacks
Emotional distress after
exposure to traumatic
reminders
Physical reactivity after
exposure to traumatic
reminders
Criterion C
(one required):
Avoidance of trauma-related
stimuli after the trauma, in the
following way(s):
Trauma-related thoughts or
feelings
Trauma-related reminders
Criterion D
(two required):
Negative thoughts or feelings
that began or worsened after the
trauma, in the following way(s):
Inability to recall key features
of the trauma
Overly negative thoughts and
assumptions about oneself or
the world
Exaggerated blame of self or
others for causing the trauma
Negative affect
Decreased interest in activities
Feeling isolated
Difficulty experiencing positive
affect
Criterion E
(two required):
Trauma-related
arousal and reactivity that
began or worsened after the
trauma, in the following way(s):
Irritability or aggression
Risky or destructive behavior
Hypervigilance
Heightened startle reaction
Difficulty concentrating
Difficulty sleeping
Criterion F
(required):
Symptoms last for
more than 1 month.
Criterion G
(required):
Symptoms create distress or
functional impairment
(e.g., social, occupational).
Criterion H
(required):
Symptoms are not due to
medication, substance use, or
other illness.
Less =
acute stress
disorder
24. PTSD In Children & Adolescents
Children and teens can have extreme reactions to trauma,
but their symptoms may not be the same as adults.
PTSD In Children & Adolescents
Older children and teens
28. Bad
Risk Factors
low education
female gender
Living through dangerous events and traumas
low self-esteem
Getting hurt
Seeing another person hurt, or seeing a dead body
Childhood trauma
Feeling horror, helplessness, or extreme fear
Having little or no social support after the event
Dealing with extra stress after the event, such as loss of
a loved one, pain and injury, or loss of a job or home
Having a history of mental illness or substance abuse
29. Good
Risk Factors
Having a positive coping strategy, or a way of getting
through the bad event and learning from it
Being able to act and respond effectively despite feeling
fear
high IQ
male gender
psychopathic traits
Seeking out support from other people, such as friends
and family
Finding a support group after a traumatic event
Learning to feel good about one’s own actions in the
face of danger
37. Treatment
Pharmacological Treatment
When?
• severe ongoing threat,
• if the patient is too distressed or unstable to engage in psychological
therapy,
• fails to respond to an initial psychological approach
40. Treatment
Pharmacological Treatment
Sleep disturbance (including nightmares):
improved by mirtazapine (45mg/day
or specific hypnotics (e.g. zopiclone, zolpidem).
Anxiety symptoms/hyperarousal:
BDZs (e.g. clonazepam 4–5mg/day),
buspirone,
antidepressants,
propranolol.
Intrusive thoughts/hostility/impulsiveness:
some evidence for use of
carbamazepine,
valproate,
topiramate,
or lithium.
Psychotic symptoms/severe
aggression or agitation:
antipsychotic
(some evidence for olanzapine, risperidone,
quetiapine, clozapine, aripiprazole).
41.
42. Mental and behavioural disorders (F00-F99)
• F00-F09 Organic, including symptomatic, mental disorders
• F10-F19 Mental and behavioural disorders due to psychoactive substance use
• F20-F29 Schizophrenia, schizotypal and delusional disorders
• F30-F39 Mood [affective] disorders
• F40-F48 Neurotic, stress-related and somatoform disorders
• F50-F59 Behavioural syndromes associated with physiological disturbances and
physical
• factors
• F60-F69 Disorders of adult personality and behaviour
• F70-F79 Mental retardation
• F80-F89 Disorders of psychological development
• F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood
• and adolescence
• F99 Unspecified mental disorder
Acute stress reaction
Posttraumatic stress disorder
Adjustment disorders
Other reactions to severe stress
Reaction to severe stress, unspecified