By John W. Barnhill , MD, New York-Presbyterian Hospital
Post-traumatic stress disorder (PTSD) consists of intense and unpleasant dysfunctional reactions that begin after an extremely traumatic event. Life-threatening events or serious injuries can cause intense and long-lasting distress. It is possible for the affected person to relive the event, have frequent nightmares, and avoid anything that might remind them of the event. Treatment may include psychotherapy (supportive and exposure therapy) and antidepressants.
Many people are lastingly affected when something terrible happens. In some, the effects are so persistent and severe that they are debilitating and a disorder. As a rule, the events most likely to cause PTSD are those that invoke feelings of fear, helplessness, or horror. Combat, sexual assault, and natural or man-made disasters are common causes of PTSD. However, it can be caused by any overwhelming and possibly fatal experience, such as physical violence or an automobile accident. These events can be experienced directly (for example, being seriously injured or threatened with death) or indirectly (witnessing others being seriously injured, dying, or being threatened with death, or learning about traumatic events that have occurred with close family members or friends ). It is possible that the person experienced a single traumatic event or, as is often the case, multiple traumatic events.
It is not known why the same traumatic event can cause lifelong PTSD in some people but cause no symptoms in others. Furthermore, it is not known why some people witness or experience the same trauma many times over years without having PTSD, but develop it at some point after an apparently similar episode.
Post-traumatic stress disorder affects approximately 9% of people at some point in their lives, including childhood (Acute and Post-Traumatic Stress Disorders in Children and Adolescents). Approximately 4% of adults suffer from this disorder annually. It lasts for more than a month and may be a continuation of the acute stress disorder or appear separately up to six months after the event. This disorder may not go away completely, but it usually gets less severe over time, even without treatment. Some people, however, are severely disabled by the disorder. PTSD symptoms People with post-traumatic stress disorder (PTSD) often experience symptoms from each of the following four categories:
Intrusive symptoms (the event invades thoughts repeatedly and uncontrollably) =
Avoid anything that reminds them of the event
Negative effects on thinking and mood
Changes in alertness and reactions
Intrusion symptoms The traumatic event may recur repeatedly in the form of involuntary unwanted memories or recurring nightmares. Some people have flashbacks, during which they relive events as if they were actually happening instead of simply remembering them. Avoid the event The person may also have intense reactions to things that remind them of the event. For example, a war veteran's symptoms might be triggered by fireworks, while a victim of armed robbery might be triggered by seeing a gun in a movie. The person persistently avoids anything—activities, situations, or people—that might remind them of the trauma. For example, she may avoid entering a park or office building where she was bullied, or she may avoid talking to people of the same race as the person who assaulted her. They may even try to avoid thinking, feeling, or talking about the traumatic event. Negative Effects on Thinking and Mood People may not be able to remember significant parts of the traumatic event (a condition called dissociative amnesia). The person may feel emotionally numb or disconnected from other people. Negative effects on thinking and mood Depression is common and the affected person shows less interest in activities they used to enjoy. The impression that the person has about the event can be distorted, which leads him to blame himself or others for what happened. Feelings of guilt are also frequent. For example, the person may feel guilty for having survived situations in which others have died. She may feel only negative emotions, such as fear, horror, anger, or embarrassment, and may not feel happiness, satisfaction, or love.
Changes in alertness and reactions The person may have difficulty falling asleep or concentrating. She may become overly vigilant for the presence of risk warning signs. It is possible that she is easily startled. It is possible that the person becomes less able to control his reactions, resulting in reckless behavior or tantrums. Some people develop ritual acts with the intention of alleviating their anxiety. For example, victims of sexual violence may take showers repeatedly to try to remove the feeling of being dirty. Many people with PTSD use alcohol or drugs to try to relieve their symptoms and end up with a substance use disorder. PTSD diagnosis The physician's assessment, based on specific criteria Doctors diagnose post-traumatic stress disorder (PTSD) when The person was directly or indirectly exposed to the traumatic event. Symptoms have been going on for a month or more. Symptoms cause significant distress or significantly impair activity performance. The person has some symptoms from each of the symptom categories associated with PTSD (intrusion symptoms, avoidance symptoms, negative effects on thinking and mood, and changes in alertness and reactions). The doctor also checks to see if the symptoms could have been caused by the use of a medication or another disorder. PTSD often goes undiagnosed because it causes such varied and complex symptoms. Additionally, the presence of a substance use disorder can distract from the presence of PTSD. When diagnosis and treatment are delayed, PTSD can become chronically debilitating.
PTSD treatment
Psychotherapy
Pharmacotherapy
Treatment of other disorders, such as substance use or major depressive disorder
Psychotherapy Is the main treatment for post-traumatic stress disorder (PTSD). Learning about PTSD can be an important first step in treatment. PTSD symptoms can be extremely confusing, and it is often very helpful for people with PTSD and their loved ones to understand that it can include seemingly unrelated symptoms. Stress management techniques such as breathing and relaxation are important. Exercises that reduce and manage anxiety (eg, yoga, meditation) can ease symptoms and prepare the person for treatment that involves stressful exposure to trauma memories. Mainstream thinking favors the use of structured and focused psychotherapy, usually a type of cognitive behavioral therapy (CBT) called exposure therapy that helps to erase the fear left behind by the traumatic event.
In exposure therapy, the therapist asks the affected person to imagine being in situations associated with the previous trauma. For example, the therapist might ask the person to imagine that they are visiting the park where they were assaulted. It is possible that the therapist will help the person to reimagine the traumatic event itself. Due to the occurrence of anxiety, often intense, associated with traumatic memories, and for the exposure to proceed at the right pace, it is important that the person feels supported. The person who has been traumatized can be especially sensitive to being traumatized again, and therefore treatment can become stagnant if it is given too quickly. Often, treatment can change from exposure therapy to more open and supportive treatment, thereby helping the person to feel more comfortable with exposure therapy.
More comprehensive and exploratory psychotherapy can also facilitate a return to a happier life when, for example, the person focuses on relationships that may have been damaged by PTSD.
Other types of supportive and psychodynamic psychotherapy may also be helpful as long as they do not shift the treatment focus away from exposure therapy. Eye movement desensitization and reprocessing therapy (EMDR) is a type of treatment in which the person is asked to follow the movement of the therapist's finger with their eyes while imagining being exposed to trauma. Some experts believe that the eye movements themselves help with desensitization, but EMDR therapy is likely to be effective because of the exposure rather than the eye movements.
Antidepressants are considered the first-line treatment for PTSD, even for people who don't have major depressive disorder as well. Selective serotonin reuptake inhibitors and other antidepressants, such as mirtazapine and venlafaxine, are often recommended. To treat insomnia and nightmares, doctors sometimes prescribe drugs, such as olanzapine and quetiapine (also used as antipsychotic drugs) or Prazosin (also used to treat high blood pressure).
However, these medications do not treat PTSD itself. More information about PTSD National Institute of Mental Health, Post-traumatic stress disorder: General information about many aspects of post-traumatic stress disorder, including treatment, therapies, and educational programs
https://www.msdmanuals.com/pt-br/casa/dist%C3%BArbios-de-sa%C3%BAde-mental/ansiedade-e-transtornos-relacionados-ao-estresse/transtorno-de-estresse-p%C3%B3s-traum%C3%A1tico
Comments