Kembara Xtra - Medicine - Post traumatic Stress Disorder
People who have encountered or seen a traumatic event, or who have been threatened with death, sexual violence, or major injury, may develop posttraumatic stress disorder (PTSD), a psychiatric disease. The condition can manifest at any age. It manifests with three essential qualities in children above the age of six, adolescents, and adults: - Intrusion symptoms such as nightmares, flashbacks, and upsetting memories - Avoiding everything connected to the distressing experience and/or becoming less receptive overall - Enhanced arousal PTSD symptoms may be acute, lasting less than three months. - Chronic: 3 months or longer of symptoms - Delayed: 6 months after exposure to trauma, 5% of instances; - Although they can be postponed for years, PTSD symptoms typically appear 3 months after a traumatic event. Epidemiology The likelihood of developing PTSD was evaluated for around 29 different categories of traumatic experiences, including sexual relationship violence, interpersonal violence, exposure to organized violence, involvement in organized violence, and other traumatic situations that could have been fatal. The three factors that were most frequently linked to PTSD were unexpected loss of a loved one, rape, and other sexual assaults. 16% of kids and teens who experience trauma go on to acquire PTSD. Incidence Each year, PTSD is diagnosed in 7.7 million American adults over the age of 18 (3.5% of this age group). Prevalence The overall population has a 7% to 9% lifetime prevalence of PTSD. more typical in women than in men. Pathophysiology and Etiology The amygdala and hippocampus are dysfunctional, with possible atrophy from overexposure to catecholamines, and serotonergic dysregulation, glutamatergic dysregulation, and increased thyroid activity are also present in the biological dimensions. Learning theory: A life-threatening fear is typically conditioned by exposure to an event; any internal or external cue that makes the fear reaction "fight or flight" strong. Cognitive theories: According to these ideas, acute trauma is encoded in intricate memory structures. These memories come to life, bringing with them strong feelings and thoughts that are uncomfortable and dysfunctional. Traumatic memories override protective mechanisms, according to psychodynamic theory. Reliving the horrific incident and the accompanying terror is an attempt to make sense of it in a less terrifying way. Genetics Compared to dizygotic twins, monozygotic twins exposed to combat in Vietnam had a higher likelihood of the cotwin developing PTSD. Pretrauma risk factors include being female, being younger, having a history of mental illness, and being sexually abused. Posttrauma risk factors include the severity of the trauma, the trauma's emotionality, the perception of imminent danger, and the trauma's perpetration. Following exposure to trauma-related stimuli, the post-trauma environment includes: - Perceived injury severity - Medical complications - Perceived social support - Persistent dissociation from traumatic event The most effective treatments for preventing PTSD include trauma-focused cognitive-behavioral therapy (CBT) and modified extended exposure, which are given to individuals displaying signs of discomfort within weeks of a potentially traumatic experience. Accompanying Conditions Smoking (especially when there has been an assault), major neurocognitive disorders, dementia, or amnesia, major depressive disorder, alcoholism, substance abuse, panic disorder, agoraphobia, or social phobia, obsessive-compulsive disorder, traumatic brain injury, and forgetfulness. Child Safety Considerations Separation anxiety and oppositional defiant disorder are frequent co-occurring disorders. Diagnosis DSM-5 criteria are used to make the diagnosis: Criteria A: Trauma exposure (one of the following): - Firsthand knowledge of a horrific occurrence Criteria A: Personal witnessing of a traumatic event; Criteria B: Learning of a traumatic event involving a close friend or family member; Criteria C: Repeated exposure to details of a catastrophic event; Criteria D: Intrusive symptoms related to the traumatic experience, including one of the following: Criterion C: Avoidance of stimuli linked to the trauma (one of the following): - Recurrent, involuntary, and intrusive distressing memories of the event - Recurrent distressing dreams connected to the event - Dissociative reactions that simulate a recurrence of the event - Intense or prolonged distress to stimuli that resemble an aspect of the event Criterion D: Negative cognitive and mood changes related to the trauma (at least two of the following): - Avoidance of memories, thoughts, or feelings about the event - Avoidance of external cues that provoke memories, thoughts, or feelings about the event Criteria E: hyperarousal (2 of the following): - Inability to recall details of the event - Persistent and exaggerated negative opinion of oneself, others, or the world - Distorted beliefs about the cause or consequences of the event - Negative emotional state - Diminished interest in important activities - Feeling distant from others - Inability to experience positive emotions - Trouble falling asleep or staying asleep - Reduced concentration - Hypervigilance - Angry or irritated outbursts - Exaggerated startle reaction - Self-destructive behavior Criterion F: The relevant criterion symptoms should last for at least a month. Criteria G: Clinically substantial discomfort or functional impairment Criteria H: pertinent criteria not attributable to drug effects or other health issues Child Safety Considerations Reactions can include excessive clinging, sobbing, whimpering, screaming, immobility and/or aimless motion, trembling, and terrified facial expressions. ● Children who are older may exhibit excessive disengagement, chaotic conduct, and/or a lack of focus. Regressive actions, sleep issues, nightmares, irrational worries, irritability, unwillingness to go to school, angry outbursts, physical altercations, somatic complaints without a medical cause, and a reduction in academic performance. Additionally, emotional numbness, worry, guilt, and despair are frequently experienced. It has been demonstrated that parental PTSD is a reliable predictor of pediatric PTSD. HISTORY Intrusion, avoidance, mood and cognitive swings, and hyperarousal symptoms had to have persisted for more than a month. clinical assessment Patients could come in with physical wounds from the distressing experience. Examination of the mental state: - Beliefs and perceptions (such as phobias, hallucinations, and delusions) - Disorganized appearance and bad hygiene - Agitation and a severe startle response to stimuli - Emotional numbness - Orientation might be compromised. - Memory: forgetfulness, particularly with regard to the specifics of the traumatic incident - Lack of focus - Lack of self-control - Modified speech flow and rate - Depression, anxiety, guilt, and/or fear may shift as well as mood and affect. Child Safety Considerations Following trauma, an elevated heart rate is linked to the onset of PTSD. Differential diagnoses include substance addiction, personality/dissociative/conversion disorders, schizophrenia, obsessive-compulsive disorder, generalized anxiety disorder/adjustment disorder, obsessive-compulsive disorder, and obsessive-compulsive disorder. Factitious condition, sometimes known as whining Laboratory Results The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is used to diagnose patients based on DSM-5 criteria. Test for Screening Trauma (TSQ) A better prognosis is achieved by combining psychotherapy and medication therapy as soon as possible following the trauma. Medication FDA-approved medications for the treatment of PTSD include paroxetine and sertraline, but other SSRIs are also helpful. Initial Line SSRIs may help with depression, panic attacks, startle reaction, and sleep disruption: - FDA-approved sertraline, 50 to 200 mg daily - Paroxetine: the recommended starting dose is 10 mg per day; it may be increased up to 1 week apart in increments of 10 mg. - Fluoxetine: 20 mg daily/BID not to exceed 80 mg/day (shows some benefit for each of the three symptom clusters). Sleep disruption is a common symptom of PTSD and can be treated with common sedatives such trazodone (50 to 300 mg at night), mirtazapine (7.5 to 30.0 mg every other day), or amitriptyline (25 to 100 mg every other day). Nightmares and overnight hyperarousal can be treated with prazosin (2–15 mg QHS), clonidine (0.1–0.2 mg QHS), and amitriptyline (25–100 mg QHS). Next Line Refractory or persistent symptoms: Think about adding: Consider switching to an SNRI, such as venlafaxine XR 37.5 to 300.0 mg/day, duloxetine 60 to 120 mg/day, or desvenlafaxine 50 to 100 mg/day, if you have depression. Depression: mirtazapine 15 to 45 mg/day. Although it requires quarterly LFTs, nefazodone 300 to 600 mg/day in divided doses can be quite successful. Recurrent or intrusive thoughts Aripiprazole (5–15 mg/day), risperidone (0.5–2.0 mg/day), olanzapine (2–10 mg/day), and quetiapine (50–400 mg/day) are first- and second-generation antipsychotic drugs. Less prone to extrapyramidal symptoms (EPS) in 2nd-generation Rx: mental acuity decline Clonidine (start at 0.05 mg BID/TID and gradually increase to as much as 0.45 mg/day divided doses); guanfacine (start at 1 to 3 mg/day divided doses) (both clonidine and guanfacine now come in long-acting versions). Likewise, take into account the second-generation antipsychotics quetiapine, risperidone, and olanzapine; divided dosages are frequently more beneficial. Anxiety: Benzodiazepines (particularly short-acting) should be avoided due to the danger of substance misuse and dubious usefulness in PTSD (7)[A]. Valproic acid 500 to 2,000 mg/day, carbamazepine 200 to 600 mg/day, and topiramate 50 to 200 mg/day are anticonvulsants that can be used to treat impulsivity and explosiveness. Think about using risperidone 0.25 to 0.50 mg TID PRN or hydroxyzine 25 to 50 mg TID/QID PRN. Further Treatments The most effective PTSD treatments so far are exposure therapies: - Behavioral and CBT: It has been demonstrated that early CBT, which includes virtual exposure, hastens recovery. According to the U.S. Department of Defense, CBT is the gold standard of therapy for treating PTSD. - In one study, 1-week intensive CBT was just as effective as 3-months of weekly CBT. Long-term exposure therapy Reliving upsetting memories and reminders of trauma can help with habituation and effective emotional processing of memory. - Studies have indicated that EMDR, or eye movement desensitization and reprocessing, helps PTSD patients. Stress-reduction methods include: - Prompt symptom relief (for instance, rebreathing in a bag to treat hyperventilation). - Early stress recognition and relief - Techniques for relaxation, meditation, and exercise are also beneficial in lowering the response to stressful circumstances. Telemedicine-based collaborative care (psychiatric, psychology, case management, nursing). Child Safety Considerations There is scant data to back up the use of medications to treat pediatric PTSD. Constant Care It is possible to extend the initial stabilization phase. Continuous trauma exposure may prevent the improvement from taking place. Patients with complicated PTSD who have experienced childhood sexual abuse are sometimes difficult to treat because they have a lot of trouble controlling their emotions and building relationships. Building trust and a rapport with the therapist to handle the trauma investigation might take years for patients with complicated PTSD. Prognosis: After three months, symptoms usually go away on their own in 50% of cases; nevertheless, symptoms can linger and affect daily functioning over the long term. Rapid treatment initiation, early and persistent social support, avoiding retraumatization, and the absence of additional psychiatric problems or substance misuse are all factors that are linked to a positive prognosis. Complications include a higher incidence of impulsive conduct, suicide, and homicide as well as panic disorder, agoraphobia, obsessive-compulsive disorder, social phobia, specific phobia, major depressive disorder, and somatization disorder. Sexual assault victims are particularly vulnerable to mental health issues and suicidal thoughts.
0 Comments
Leave a Reply. |
Kembara XtraFacts about medicine and its subtopic such as anatomy, physiology, biochemistry, pharmacology, medicine, pediatrics, psychiatry, obstetrics and gynecology and surgery. Categories
All
|