PTSD BY SONNY CLINE M.A., M.DIV. PA C HISTORY PTSD: Post Traumatic Stress Disorder The term was coined in the mid 70 s during the anti Vietnam war protest. The condition was more pronounced in those returning from this war, however extreme exhaustion and emotional shutdown was seen during WWII, and there are reports of reactions to traumatic war events as far back as 490 BC. PTSD DEFINED An anxiety condition resulting from exposure to a traumatic event in which the person experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to physical integrity of self or others. Secondly the person s response involved intense fear, helplessness or horror.
TYPICAL EVENTS CAUSING PTSD Assault Domestic Abuse Rape Severe Accidents War Terrorism CRITERIA FOR DIAGNOSIS The traumatic event is re experienced in one or more of the following ways. recurrent or intrusive distressing recollections of the event recurrent distressing dreams of the event acting or feeling if the event were recurring intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event CONTINUED CRITERIA Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by 3 or more of the following: efforts to avoid thoughts, feelings, or conversations associated with the trauma efforts to avoid activities, places or people that arouse recollections of the trauma inability to recall an important aspect of the trauma markedly diminished interest or participation in significant activities feeling of detachment or estrangement from others restricted range of affect sense of foreshortened future (don t see a life for themselves)
CRITERIA CONTINUED Persistent symptoms of increased arousal (not present prior to the event) as indicated by 2 or more of the following: difficulty falling or staying asleep irritability or outbursts of anger difficulty concentrating hypervigilance exaggerated startle response CRITERIA CONTINUED Duration must be more than one month The disturbance causes clinically significant distress or impairment in social, occupational, or relational functioning Acute = Duration of symptoms < 3 months Chronic = Duration of symptoms 3 months or more AREAS OF THE BRAIN AFFECTED BY PTSD The disorder itself implicates the hippocampus, amygdala and frontal cortex. The stress response seems to implicate the thalamus, hypothalamus and locus coeruleus.
AREAS OF THE BRAIN AFFECTED TREATMENTS Cognitive Behavioral Therapy Exposure Therapy Group Therapy EMDR Medications MEDICATIONS SSRI s: Studies have consistently shown that serotonergic dysregulation can create avoidance, hypervigilance and other associated symptoms. Selective serotinin reuptake inhibitors (SSRIs) have the broadest range of efficacy in reducing all 3 clusters of symptoms. Examples included Paxil, Prozac, Zoloft, Celexa, Lexapro. Adrenergic Agents such as Inderal (daytime), Tenex, Clonidine (nightmares), and others in this category. These agents are especially helpful for symptoms of hypervigilance, startle reactions, and rage responses. Benzos: These were actually one of the primary drugs used for treatment, however their use has been decreased due to dependence and addiction. Examples include Xanax, Ativan, Klonopin.
MEDICATIONS CONTINUED Anticonvulsants: Medications such as Tegretol, Depakote, Lamictal, Trileptal. These drugs have been used to manage anger and rage mostly. Atypical Antipsychotics: Very specialized use in small doses. Drugs such as Zyprexa, Seroquel, Risperdal and others. COMPLICATIONS Drug addiction Alcohol addiction GENETICS / SUSCEPTIBILITY This is poorly understood however there do seem to be some studies from the Vietnam Vets that support a genetic predisposition. Certainly we know that between 60% to 90% of adults are exposed to some type of traumatic event in their lifetime yet only about 8% develop full PTSD. (From a national comorbidity study done in 1995)
PHOTO HANGING ON THE WALL IN THE UN PHOTO FROM JAPANESE TSUNAMI EXHIBIT AT UN