PTSD & Acute Stress Disorder Tx:

Increased stress and anxiety following exposure to traumatic or Support, encouragement to discuss the event, education about coping
stressful event mechanisms
Stressors/trauma are significant and would be considered Pharmacotherapy
overwhelming to almost everyone SSRIs 1st line Zoloft, paxil
Natural catastrophe, rape, war, torture, etc. Buspirone
Epidemiology TCAs: Imipramine and amitriptyline
Lifetime prevalence of 9-15%, 8% of population Psychotherapy model of crisis intervention
Veterans
30% Vietnam DSM-5 Acute Stress Disorder
13% Iraq Table 11.1-4
Young adults more exposed to the precipitating situations > 9 Sx from 5 Categories
Men combat experience Intrusion Sx
Women-- assault, rape Negative Mood
Etiology Dissociative Sx
Response to stressor with intense fear/horror Avoidance Sx
Arousal Sx
PTSD Risk factors Sx typically appear immediately after trauma
Possible predisposing vulnerability factors Duration must be 3days 1 month after trauma
Trauma as a child
Borderline, paranoid, dependent, antisocial personality Adjustment Disorders
disorder traits Emotional response to external stressful event for at least 3 months
Inadequate family or peer support system Ex: financial issues, medical illness, relationship
Female Epidemiology
Genetic vulnerability to psychological illness 2-8% of general population
Recent stressful life changes MC in Women 2:1
Perception of a natural cause rather than human Single women at risk
Recent excessive alcohol intake Onset: Adolescents
Known similarities between PTSD, MDD, & Panic Disorder One of the most common psychiatric disorders found in hospitalized pts
Other possible contributing factors: for med/surg issues
Psychodynamic Etiology
Hypothesizes that event reactivated a previously Precipitated by 1 or more stressor, associated with dev stages
quiescent yet unresolved psychological conflict Psychodynamic factors: nature of stressors, meaning, pre-exist
Cognitive-behavioral vulnerability
Affected person cannot process or rationalize the Family and genetic factors
trauma that precipitated the disorder
Biologic DSM-5 Criteria for Adjustment Disorders
Neurotransmitters - norepinephrine, dopamine, A. Development of emotional/behavioral symptoms in response to a
endogenous opioids, Benzodiazepine stressor occurring within 3 months of onset of stressor
Factors of the HPA axis B. Clinically significant symptoms as evidenced by 1 of below:
DSM-5 Criteria for PTSD 1. Marked distress out of proportion to severity/intensity of
Table 11.1-3 (3 pages in text book) stressor
Must be > 6yo 2. Significant impairment in social/work functioning
Symptoms in 3 domains: C. Disturbance not attributable to other mental disorder
Intrusion symptoms following the trauma D. Symptoms do not represent normal bereavement
Flashbacks E. Once stressor is terminated the symptoms do no persist for more than
Must experience 1 intrusion sx to meet criteria* an additional 6 months
Avoiding stimuli associated with the trauma Specifiers
Avoiding thoughts of the trauma, anhedonia, With depressed mood
limited memory of events, blunted affect, Low mood, tearfulness, hopelessness
detachment, derealization With anxiety
Experiencing symptoms of increased arousal Nervousness, worry, separation anxiety
Insomnia, irritability, hypervigilance, exaggerated With mixed anxiety/depressed mood
startle With disturbance of conduct
Course & Prognosis: With mixed disturbance of emotions and conduct
Symptoms develop 1 week to 30 years after Unspecified
Symptoms fluctuate in intensity Maladaptive reactions not classifiable otherwise
Good prognosis in patients with: Prognosis:
rapid onset of symptoms, Favorable with appropriate treatment
short duration of symptoms, Most pts return to normal level of function in 3 mos
good previous functioning, Recent research demonstrates risk of suicide in adolescents with
strong social supports, adjustment disorder
absence of other disorders/risk factors 60% had documented suicide attempts in one study
Untreated Treatment:
30% recover completely Psychotherapy
40% have mild symptoms Crisis intervention
20% have moderate symptoms Pharmacotherapy
10% unchanged or worse symptoms No studies to show efficacy, but may be helpful for symptomatic relief