Post-Traumatic Stress Disorder (PTSD):

Post-Traumatic Stress Disorder (PTSD) is a psychological disorder that occurs in individuals who have experienced a traumatic event or witnessed challenging circumstances. It affects both men and women, but women are often more susceptible to it.

Symptoms in adults include the following:

1. Intrusive memories: Symptoms of intrusive memories may include:

• Repeated distressing memories of the traumatic event
• Flashbacks where the event feels like it's happening again
• Disturbing nightmares related to the traumatic event
• Intense emotional distress or physical reactions to something that reminds them of the event

2. Avoidance:

• Attempting to avoid thinking about or talking about the event
• Avoiding places, activities, or people that remind them of the event.

3. Changes in reactions:

• Emotional outbursts and fits of anger
• Reckless or self-destructive behavior, such as excessive drinking or speeding
• Difficulty concentrating or sleeping

4. Negative changes in thinking and mood:

• Negative thoughts about oneself, others, or the world
• Feelings of isolation and difficulty maintaining social relationships
• Blaming oneself or others wrongly
• Persistent fear or guilt
• Loss of interest in previously enjoyed activities

Symptoms in Children:

In children under the age of 6:

• Bedwetting
• Inability to speak or forgetting how to speak
• Attempting to reenact the event during play
• Strong attachment to one of the parents

As for older children, they may exhibit symptoms similar to those in adults

In general:

Symptoms usually start within 3 months of the traumatic event

Types of Events Leading to Post-Traumatic Stress Disorder:

• Serious accidents
• Sexual or physical assault
• Abuse such as domestic violence
• Serious health issues like intensive care hospitalization
• Birth experiences like losing a child
• Death of a loved one
• War or exposure to torture

Is everyone who experiences a bad event susceptible to this disorder?

This disorder occurs in about 1 in 3 people who have experienced a traumatic event.

Risk factors:

• Persistent feelings of weakness and fear
• Lack of a supportive social environment
• Family history of mental illness
• Substance abuse

Diagnosis:

To diagnose post-traumatic stress disorder, a person must have the following symptoms for at least one month, most of the time, and they should significantly affect their professional and social life:

• At least one symptom of intrusive memories
• At least one symptom of avoidance
• At least two symptoms of negative changes in thinking and mood
• At least two symptoms of changes in arousal and reactivity

Treatment:

There are two main types of treatment: psychological therapy and medication

Psychological Therapy:

The American Psychological Association (APA) strongly recommends four psychological therapeutic interventions for the treatment of post-traumatic stress disorder:

1. Cognitive-Behavioral Therapy (CBT):

Focuses on the relationship between thoughts, feelings, and behaviors, targeting current problems and symptoms. It aims to change behavioral patterns, thoughts, and emotions that lead to performance difficulties

2. Cognitive Processing Therapy (CPT):

A specific type of cognitive-behavioral therapy that helps patients learn how to challenge unhelpful beliefs related to the trauma and change them

3. Cognitive Therapy (CT):

Modifies the negative assessment of the event and its memories, aiming to disrupt distressing behavioral and/or thought patterns that interfere with daily life

4. Prolonged Exposure Therapy:

Teaches individuals how to gradually confront memories, feelings, and situations associated with the trauma. By facing what has been avoided, the person is supposed to learn that the memories and cues related to the trauma are not dangerous and do not need to be avoided

Pharmacotherapy:

Selective Serotonin Reuptake Inhibitors (SSRIs):

The only medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of post-traumatic stress disorder are:

1. Sertraline

• Dose: 50 - 200 mg
• Available under the brand name Lostrile

2. Paroxetine

• Dose: 20 - 60 mg

While SSRIs are typically the first-line treatment in post-traumatic stress disorder, there may be specific cases for patients based on their medical history. Examples of these special cases include:

A patient suffering from comorbid post-traumatic stress disorder and bipolar disorder: may experience mood instability. This can be mitigated using mood stabilizers such as Lithium or Dovaken (Valproic acid) before prescribing SSRIs.

For a patient experiencing post-traumatic stress disorder concurrently with psychosis: it is advisable to administer Respond (Risperidone) and Domiquel (Quetiapine)

In the case of a patient with post-traumatic stress disorder and nightmares: Prazosin or Mogam (Nitrazepam) is preferred.

If the desired therapeutic effect is not achieved: a switch to another SSRI medication is considered.

In case of a partial response: SSRIs used are combined with second-generation antipsychotics:

Respond (Risperidone) and Domiquel (Quetiapine)

After switching from SSRIs to two drugs: Transition to second-generation antipsychotics (SGAs) as a monotherapy

1. Respond (Risperidone):

• Start with a dose of 0.5 mg once nightly
• After one week, increase the dose by 0.5 mg or 1 mg weekly
• Maximum dose: 4 mg/day

2. Domiquel (Quetiapine):

• Start with a dose of 25 mg once nightly
• After one week, if the response is inadequate, increase the dose by 50 mg weekly
• Maximum dose: 800 mg/day

 

References:

1. Association AP. What is Posttraumatic Stress Disorder 2023 [Available from: https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd.
2. Health TNIoM. Post-Traumatic Stress Disorder 2023 [Available from: https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd.
3. NHS. Causes - Post-traumatic stress disorder 2022 [Available from: https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/causes/.
4. Association AP. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) 2023 [Available from: https://www.apa.org/ptsd-guideline/treatments/medications.
5. Stein M. Posttraumatic stress disorder in adults: Treatment overview 2023 [Available from: https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-treatment-overview?search=post%20traumatic%20stress%20disorder&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.