Presentation
- Re-experiencing symptoms (Flashbacks) [2]: Reliving the trauma again and again, including physical symptoms like chest pain, palpitations or sweating. Negative dreams. Scary thoughts.
- Symptoms of neglecting that painful memory [3]: Patient remains away from places, objects and events that remind the patient of the experience. Patient feels emotionally numb. Develops strong guilt, depression, or anxiety. Loses interest in activities that were once enjoyable. Has trouble in remembering the dangerous event.
- Hyperarousal symptoms: Gets easily startled. Feels tense or "on the edge" [4]. The patient has sleeping difficulties or develops frequent anger out-bursts. Hyperarousal symptoms are usually constant unlike other symptoms which are triggered by the things which remind the individual of the traumatic event. They tend to make the person feel pressurized and tensed. These symptoms affect the daily routine like sleeping, eating, or focusing on one’s work and chores. It is natural to have some of these things upset one after a traumatic event. It is called acute stress disorder. But when it persists even after 6 months of the event and lasts for over a month, it is termed as posttraumatic stress disorder.
- Children tend to have different response to traumatic event. Bedwetting, when they use to be dry before the event. The child may forget how to or is unable to talk. The child acts out the scary event during playtime. The child unusually clings [5] to a parent or other adults and avoids being left alone.
Entire Body System
- Nightmare
The majority of patients (72%) receiving nabilone experienced either cessation of nightmares or a significant reduction in nightmare intensity. [ncbi.nlm.nih.gov]
[…] of prazosin in veterans with nightmares related to PTSD, there was a decrease in nightmares and an improved quality of sleep. 30 Prazosin is generally well tolerated but can cause hypotension and dizziness. [healio.com]
PTSD starts within 6 months of a highly upsetting event Life-threatening events can cause intense, long-lasting upset, worry, and nervousness You may relive the event in your mind, have nightmares, or avoid anything that reminds you of the event Treatment [msdmanuals.com]
- Fatigue
Sub-category Cronbach α was 0.92 for snoring and 0.63 for fatigue. However, when “sleepiness behind the wheel” was excluded, Cronbach α for fatigue increased to 0.86. [jcsm.aasm.org]
The Art and Science of Caring for Others without Forgetting Self-Care Compassion Fatigue: An Introduction The MASTERS Process: Transforming Your Career and Life J. Eric Gentry, PhD, LMHC Compassion Fatigue: A Crucible Of Transformation Frank M. [giftfromwithin.org]
A literature review for 1994-2011 was conducted for the following keywords: secondary traumatic stress, compassion fatigue, vicarious traumatization, posttraumatic stress disorder, and nurse. [ncbi.nlm.nih.gov]
Fatigue is a nicer word than shock. Shellshock! Battle fatigue.” Here Carlin introduces what I call the Carlin principle : the more syllables, the less truth. [mcsweeneys.net]
- Military Personnel
Abstract Military personnel who have experienced combat trauma are at risk for developing posttraumatic stress disorder (PTSD). [ncbi.nlm.nih.gov]
E-mail: rjm{at}wjh.harvard.edu See all Hide authors and affiliations Science 18 May 2012: Vol. 336, Issue 6083, pp. 872-874 DOI: 10.1126/science.1222069 Abstract The most methodologically rigorous epidemiological study on American military personnel deployed [science.sciencemag.org]
- Rigor
E-mail: rjm{at}wjh.harvard.edu See all Hide authors and affiliations Science 18 May 2012: Vol. 336, Issue 6083, pp. 872-874 DOI: 10.1126/science.1222069 Abstract The most methodologically rigorous epidemiological study on American military personnel deployed [science.sciencemag.org]
This study rigorously assessed attentional bias towards aversive and pleasant visual imagery associated with the presence or absence of a familiar service canine in 23 veterans with chronic military-related posttraumatic stress disorder. [ncbi.nlm.nih.gov]
- Crying
Sadness Anger Shame Guilt Anxiety/fear Behaviors: Avoiding participating in new activities or going places Refusal to sleep alone or trouble falling/staying asleep Asking a parent to be present or available Recreating the traumatic event through play Crying [anxietybc.com]
[…] include: having or seeking out support from others having or developing coping strategies the person's ability to feel good about how they act when faced with difficulty When to see a doctor Many people experience symptoms after a traumatic event, such as crying [medicalnewstoday.com]
She lets out a victorious war-cry as well. In the actual game Metroid: Zero Mission, Samus' eyes are briefly seen through her visor as Ridley flies down to battle. [metroid.wikia.com]
Gastrointestinal
- Nausea
Nausea and headaches usually stop occurring within a few weeks of starting the medications. For dry mouth, chew gum or suck on ice cubes. If you experience drowsiness, take your medication before bedtime. [psychguides.com]
[…] section, people with PTSD may also experience physical symptoms, such as increased blood pressure and heart rate, fatigue, muscle tension, nausea, joint pain, headaches, back pain or other types of pain. [psychiatry.org]
The main side effects include headache which decreases with continued use, nausea, sleeplessness or feeling drowsy, jitteriness and sexual problems. [symptoma.com]
Cardiovascular
- Tachycardia
[…] mechanical ventilation. 135 The two groups did not differ with regard to rates of mortality (whether during their stays in the intensive care unit or their overall hospitalization) or in the incidence of adverse events (organ dysfunction, hypertension, and tachycardia [ncbi.nlm.nih.gov]
As an example, sepsis is usually associated with fever and hyperdynamic circulation including tachycardia and peripheral vasodilatation, which are also characteristic for thyroid storm. [doi.org]
Skin
- Sweating
Re-experiencing symptoms (Flashbacks): Reliving the trauma again and again, including physical symptoms like chest pain, palpitations or sweating. Negative dreams. Scary thoughts. [symptoma.com]
This learning process affects your thoughts and your body, for example by causing your heart to race or excessive sweating. You can treat anxiety by addressing the thoughts and physical reactions that are happening in your mind and body. [mhanational.org]
There may be intense emotional or physical reactions, such as sweating, heart palpitations or panic when reminded of the event. [beyondblue.org.au]
He or she may even experience physical sensations of re-experiencing, such as muscles freezing, profuse sweating, racing pulse or heartbeat, yelling, or running away when psychological or physical cues trigger the traumatic event. [theoakstreatment.com]
As well as strong emotions, there may be physical symptoms such as sweating, heart palpitations or panic attacks. Feeling emotionally numb. Some people experience ‘dissociation’ – a feeling of watching from a distance as events unfold. [sane.org]
Psychiatrical
- Fear
[…] related to mood and is associated with fear response. [symptoma.com]
The objective herein is to determine whether extinction of fear responses is impaired in PTSD and whether such impairment is related to dysfunctional activation of brain regions known to be involved in fear extinction, viz., amygdala, hippocampus, ventromedial [ncbi.nlm.nih.gov]
The amygdala appears to be active in fear acquisition, or learning to fear an event (such as touching a hot stove), as well as in the early stages of fear extinction, or learning not to fear. 4 Storing extinction memories and dampening the original fear [web.archive.org]
- Anxiety Disorder
KEYWORDS: Autobiographical memory; Future thinking; PTSD; Self-views; Social anxiety disorder [ncbi.nlm.nih.gov]
In addition, studies are being conducted on the “natural history” (what course the illness takes without treatment) of many anxiety disorders, combinations of anxiety disorders, and anxiety disorders accompanied by other mental illnesses such as depression [web.archive.org]
The authors searched for common and disorder-specific functional neurobiological deficits in several anxiety disorders. The authors also compared these deficits to the neural systems engaged during anticipatory anxiety in healthy subjects. [doi.org]
- Anger
Depressive symptoms improved on the Hamilton depression scale and the Beck Depression Inventory, as did anger reactions measured by the State-Trait Anger Experience Inventory. [doi.org]
Depressive symptoms, anger reactions, and interpersonal functioning also improved. Treating interpersonal sequelae of PTSD appears to improve other symptom clusters. [ncbi.nlm.nih.gov]
Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered. Diagnosis criteria that apply to adults, adolescents, and children older than six include those below. Read more details here. [adaa.org]
- Suicidal Ideation
Most people who attempt suicide report a history of suicidal ideation. 10 In fact, current suicidal ideation increases suicide risk, 11,12 and death from suicide is especially correlated with the worst previous suicidal ideation. 3 Suicidal ideation is [mdedge.com]
Abstract Individuals with posttraumatic stress disorder (PTSD) are more prone to suicidal ideation and behavior. [ncbi.nlm.nih.gov]
Clum GA, Weaver TL (1997) Diagnostic morbidity and its relationship to severity of ideation for a nonpsychiatric sample of chronic and severe suicide ideators. [doi.org]
Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan war veterans. J Trauma Stress. 2009;22:303-306. Abstract Lemaire CM, Graham DP. Factors associated with suicidal ideation in OEF/OIF veterans. [web.archive.org]
- Depersonalization
RESULTS: Model A, the depersonalization/derealization model, had 5 classes: dissociative subtype/high PTSD; high PTSD; anxious arousal; dysphoric arousal; and a low symptom/reference class. [ncbi.nlm.nih.gov]
Depersonalization means that someone is experiencing something as if they are an observer to themselves, observing from outside of their body. [verywellmind.com]
The dissociative sub-type involves depersonalization or derealization rather than just additional dissociation, and is clinically different from severe PTSD. [traumadissociation.com]
Two specifications: Dissociative Specification In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli: Depersonalization. [brainline.org]
Neurologic
- Irritability
Symptoms include detachment, difficulty sleeping, irritability, dreaming about the traumatic event and reenacting it during playtime. [childmind.org]
Bidragets oversatte titel Posttraumatic stress disorder is correlated to irritable bowel syndrome. [research.regionh.dk]
Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered. Diagnosis criteria that apply to adults, adolescents, and children older than six include those below. Read more details here. [adaa.org]
Neuropsychiatric assessment revealed a diagnosis of PTSD with hyperarousal (irritability and insomnia) and numbing. He committed suicide approximately 8 months after his honorable discharge from the USMC. [ncbi.nlm.nih.gov]
- Insomnia
Cognitive Behavior Therapy for Insomnia provided insomnia symptom relief psychoeducation and self-monitoring of PTSD symptoms prepared the patient to enter exposure therapy. [ncbi.nlm.nih.gov]
There are highly efficacious behavioral interventions available for both insomnia and nightmares ( Table 2 ). [healio.com]
Nabilone was used to treat a mean of 3.5 indications per patient, most commonly nightmares, insomnia, and chronic pain. [doi.org]
- Headache
Patients most likely to meet criteria for posttraumatic stress disorder reported significantly higher levels of stress, depression, anxiety, and suicide ideation as well as more severe headaches, chest pains, dizziness, and poorer health care. [ncbi.nlm.nih.gov]
[…] again developing repeated physical or emotional symptoms when the child is reminded of the event Children with PTSD may also show the following symptoms: worry about dying at an early age losing interest in activities having physical symptoms such as headaches [aacap.org]
Nausea and headaches usually stop occurring within a few weeks of starting the medications. For dry mouth, chew gum or suck on ice cubes. If you experience drowsiness, take your medication before bedtime. [psychguides.com]
PTSD often exists simultaneously with other physical symptoms of high stress such as digestive disorders, headaches, chest pain and dizziness. [tm.org]
- Difficulty Concentrating
Symptoms of PTSD include intrusive thoughts, flashbacks, nightmares, extreme distress when reminded of the trauma, sleep disturbances, difficulty concentrating, hyper-alertness, and loss of interest in usual activities. [med.upenn.edu]
Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: (1) difficulty falling or staying asleep (2) irritability or outbursts of anger (3) difficulty concentrating (4) hypervigilance [behavenet.com]
concentrating startling easily and having exaggerated response to startling events constant feeling of being on guard irritability bouts of anger difficulty falling or staying asleep Cognition and mood negative thoughts about yourself distorted feelings [healthline.com]
These symptoms may include difficulty falling or staying asleep that may be due to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response or difficulty concentrating [cirp.org]
A child who meets the criteria for PTSD shows symptoms commonly grouped in three areas: intrusive memories, such as bad dreams and play that reenact the event; avoidance and numbing, such as difficulty maintaining relationships, difficulty concentrating [childmind.org]
- Excitement
Welcome Georgio and Vieve So excited to have you join our Belvoir herd. Thanks you Donna and Bob Vandermoude -Dyment for your generous gift. [ptsdassociation.com]
This represents an exciting extension of interpersonal psychotherapy to an anxiety disorder. [ncbi.nlm.nih.gov]
The identification of a PTSD biomarker has exciting implications for limiting or preventing symptoms of the disorder. [sciencedaily.com]
Panic attacks can cause: agitation excitability dizziness lightheadedness fainting a racing or pounding heart headaches There is no specific test to diagnose PTSD. [healthline.com]
Posttraumatic stress disorder consists of recurrent disturbing flashbacks, avoidance of memories of the event, and increased excitement continuing for more than one month after the occurrence of traumatic event. [symptoma.com]
Workup
Not everyone who faces stressful event develops the disorder. Usually symptoms develop within first three months, sometimes they may develop after many years. Symptoms should last for more than one month to be diagnosed as posttraumatic stress disorder and a person must have all of the following for at least 1 month:
- At least one re-experiencing symptom [6].
- At least three symptoms of negligence or avoidance.
- Minimum of two positive symptoms of increased arousal.
Posttraumatic stress disorder is seen in conjunction with depression and anxiety disorders that must be treated accordingly.
Treatment
The mainstay for the treatment includes psychotherapy and medications. As every individual is different, treatment needs to be individualized. If someone with is going through continuous trauma, such as being in a stressed and bothersome relationship, then both the problems need to be treated simultaneously. Other ongoing problems can be panic disorder, depression and substance abuse which need attention and the necessary treatment.
Psychotherapy involves talking one’s mind out regarding all the experiences of the traumatic event with a mental health professional in order to treat the mental illness. Psychotherapy can occur either one-on-one or in a group. Psychotherapy usually lasts for 6 to 12 weeks, but can take more time. Few psychotherapies target the negative memories directly. Other therapies focus on accompanying problems relating to the social aspect, family and job. The doctor or therapist may apply more than one therapy depending on individual's needs.
Cognitive behavior therapy (CBT) [7] is widely used and consists of exposure therapy, cognitive reconstruction and stress inoculation therapy. CBT helps people face fear, it helps develop a healthy outlook to the traumatic event and helps people recall their memories in a healthy way.
Selective serotonin reuptake inhibitors (SSRIs) are used primarily in depression, sertraline [8] and paroxetine are used for PTSD. The main side effects include headache which decreases with continued use, nausea, sleeplessness or feeling drowsy, jitteriness and sexual problems. Other group of drugs like benzodiazepines which reduce anxiety and antipsychotics are also used in PTSD.
Treatment after mass trauma
Most people will have PTSD like symptoms in the initial days. Most people can be helped to uplift their confidence with basic support, such as providing a safe shelter, seeing a doctor if injured or diseased, getting basic needs of food and clean water, contacting one's family and friends, learning what is being done to help. As communities try to readjust after a community disaster, people also experience ongoing stress from loss of employment or education, economical stress - trouble paying finances, finding shelter, and getting medical care. This delay in community recovery will cause delay in recovery in patients from PTSD. In the first few weeks after a mass disaster, brief versions of CBT [9] are helpful for some people who face severe distress.
Prognosis
Prognosis is good as most of the memories of the events are erased by repeated cognitive behavioural therapy. Play therapy for children and talking out with mental health professionals removes all the remnant memories of the disturbing event.
Etiology
Scientists have found genes that contribute to memories of the fear. Stathmin is a protein needed to form fear memories. Gastrin-releasing peptide (GRP) is a signaling chemical in the brain that peaks during such traumatic emotional events. GRP controls the fear response and accounts for healing of the traumatic memories and lack of GRP leads to the development of lasting and grandeur memories of the frightening experience. 5-HTTLPR gene controls levels of serotonin which is a neurotransmitter related to mood and is associated with fear response.
Risk factors for the disorder are experiencing dreadful events, history of mental illness, getting hurt, seeing close relatives being hurt or killed, feeling extremely helpless, or extreme fear and anxiety. Having lack of social support after the event, facing rising levels of stress after the event, such as permanent loss of a loved one, pain due to the event and physical injury of oneself, or loss of work or shelter may also lead to the condition.
Supportive factors that may reduce the risk of developing posttraumatic stress include calling for help from friends and family, finding a support group after the act or the event took place. One should be able to react and respond instead of being afraid.
Epidemiology
Women are more commonly affected than men. More than 60% of men and women have one such experience in their life which gives a posttraumatic stress disorder-like effect. Around 80% of people both men and women have comorbid symptoms along with PTSD. Rape in women commonly leads to the condition whereas sexual abuse in men may produce lasting stress.
Pathophysiology
The amygdala appears to be responsible for acquisition of fear or learning to fear an event (such as coming in contact with a hot object). Storing memories of such events that will again bring on the original fear response leads to posttraumatic stress. This type of fear involves the prefrontal cortex (PFC) area of the brain.
Individual differences in brain areas will still lead to the disorder without actually causing symptoms; this is called as subclinical posttraumatic stress disorder. Other factors like head injury or
history of mental illness or childhood trauma, further increase a person's risk by affecting the development and functioning of the brain.
Personality traits and cognitive factors, such as tendency to look at challenges in a positive or negative way, optimistic or pessimistic attitude and social factors such having a good family support and using a support group, influence an individual's response to traumatic stimuli.
Prevention
One can prevent such an occurrence by early identification of such patients and early initiation of cognitive behavioural therapy. The condition occurs as the event repeatedly hampers the mind for over a month, but if the victim is given therapy early after the event there will not be any occurrence of the disorder at all.
Summary
In patients with posttraumatic stress disorder, the fight or flight reaction to perceived danger is changed or damaged. People with the condition feel afraid even when not in danger. Posttraumatic stress disorder (PTSD) usually develops after a person is exposed to one or more traumatic events, such as sexual abuse, physical injury, warfare or threats of death, death or threat to life of loved ones, that result in feelings of intense fear and horror, or helplessness.
Posttraumatic stress disorder consists of recurrent disturbing flashbacks, avoidance of memories of the event, and increased excitement continuing for more than one month after the occurrence of traumatic event [1]. The disorder was first noticed in war veterans, but later it was found in association with a variety of traumatic events, such as rape, child abuse, torture, being kidnapped, accidents of cars, mugging train derailment, blasts due to bombs, airplane crashes, or natural disasters such as floods or earthquakes.
Patient Information
Posttraumatic stress disorder (PTSD) may develop after a person has experienced one or more traumatic dreadful events, such as sexual assault, warfare, serious physical injury, natural disasters or threats of death that result in feelings of intense fear, horror, and powerlessness.
It is diagnosed when symptoms such as avoidance or non-recalling of memories of the event, recurrent disturbing memories of flashbacks, and hyper-arousal, continue for over a month after the occurrence of traumatic event.
The mainstay in the treatment includes psychotherapy and antidepressant drug therapy. Cognitive behavioral therapy is widely used too which helps the individual fight fear and develop healthy memories of the event.
References
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- Mulick PS, Naugle AE. Behavioral Activation in the Treatment of Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder. International Journal of Behavioral Consultation and Therapy. 2009; 5 (2): 330–339.