Saturday, December 4, 2010

Stress deh!


Post traumatic stress disorder or PTSD is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. It is included death of the lovely one, physical sexual and psychological abuse, man-made or natural disaster and so on, overwhelming the individual's ability to cope.

From both criteria from ICD-9 and DSM-IV, the symptoms need to be last more than one month and cause significant impairment in social, occupational, or other important areas of functioning.

There are also some factors that influence the vulnerabilities of PTSD:

Pre-Trauma factors - 
  • A history of prior traumatization
  • Underdeveloped protective skills
  • Personality negative thought patterns
  • Biology/ hereditery factor
  • Family characteristics
  • Recent life stressors
  • Initial distress at the time of trauma
Post-Trauma Factors - 
  • Recovery environment - lack of support from family, friends and community
  • Secondary victimization
  • Conspiracy of silence
  • Ineffective coping
  • Lack of treatment or ineffective treatment

Diagnosis -
According to  Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV-TR), it can be summerize as:

Exposure to a traumatic event
This must have involved both loss of physical integrity or risk of serious damage, to self or others, and an intense negative emotional response.

Persistent re-experiencing
One or more of these must be present in the victim: flashback memories, recurring distressing dreams, and any objects or subjects that be remainder to the traumatic event cause intense psychological and physical disturbance.

Persistent avoidance and emotional numbing
This involves a sufficient level of avoidance of stimuli associated with the trauma, such as certain thoughts or feelings, or talking about the events, avoidance of behaviors, places, or people that might lead to distressing memories, inability to recall major parts of the trauma or decreased involvement in significant life activities.

Persistent symptoms of increased arousal not present before
These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or hypervigilance.

Duration of symptoms for more than 1 month
If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with Acute stress disorder.

Significant impairment
The symptoms must lead to clinically significant distress or impairment to life activity, such as social relations, occupational activities and others.

Management -

Psychological therapy - basic counselling and education, cognitive behavioral therapy(changing behavioral or negative thinking of the patients) and also Eye movement desensitization and reprocessing (EMDR) is specifically targeted as a treatment for PTSD.

Medication - 
SSRIs (selective serotonin reuptake inhibitors) are considered to be a first-line drug treatment include citalopram, escitalopram, fluoxetine, and fluvoxamine. 
Beta blockers -Propranolol - similarly to clonidine, may be useful if there are significant symptoms of "over-arousal"
Alpha-adrenergic agonists -clonidine- to reduce traumatic stress symptoms that it may have benefit in preventing PTSD.
Benzodiazepines- can be used with caution for short-term anxiety relief, hyperarousal, and sleep disturbance.

1. Lecture note on Post Traumatic Stress disorder management by dr Bambang Hastha Yoga.
2. Wikipedia

No comments:

Post a Comment