Characteristics requires symptoms of: o Re-experiences, avoidance, and

Characteristics& Treatment:·        PTSD – anxiety disordero  After traumatic exposure (physical harm orthreat)·        Traumatic events:o  Violent assaultso  Natural or human disasterso  Accidentso  Military·        Frightening thoughts and memories of event(numbness) o  With people close to·        Sleep problems, detached, or easilystartled·        Victims of violent crimes/veterans = 3 –58% (Anderson)o  Iraq and Afghan vets have high stress§  56%2+ mental diagnoses§  18– 24 yr olds have greatest risk·        Higher that veterans 40+·        DSM-III (1980) – shift in understandingo  Reaction to trauma – short-termo  Long term effects (“Traumatic neurosis”) –abnormal §  Explainedby hereditary, early experiences or existing disorder·        Diagnosis requires symptoms of:o  Re-experiences, avoidance, andhyperarousal o  Treatment of symptoms: selective serotoninreuptake inhibitors (SSRIs)§  Otherdrugs used for victims of type II trauma, complex PTSD, stress disorders,personality changes·        Symptoms – dissociation, reoccurrence, self-harmbehaviors·        both mood and anxiety disorders at sametime is common (comorbidity)o  Researchers at the Medical U of SC –increase from 4-5 weeks·        Fluoxetine used in combat PTSDo  Greater improvements than placebo·        Topiramate in civilian PTSDo  Reduced re-experiencing symptoms·        Guanfacine in vets with complex PTSDo  No effect on symptomso  Didn’t support use of alpha 2 agonists ·        Tiagabine in adultso  Not different from placebo – no worseningsymptoms·        Antipsychotics in combat PTSDo  Patients don’t respond to antidepressants(Anderson)o  Reduced psychotic and PTSD symptoms·        Trauma-focused CBT, EMDR, stressmanagement, and group therapyo  Improved symptomso  TFCBT and EMDR better than stressmanagement (Anderson)§  Stressmanagement better than others ·        PTSD – relationship between emotional andphysical abuse and healtho  Affects health o  Mental and somatic o  Other psychiatric or medical conditions –76.6% patients§  Treatmentshould address all o  Sleep disturbances§  Nightmaresin 70% patients·        PTSD in different trauma survivors:o  Earthquakes, tsunamis, breast cancer patients,parents of heart transplant patients, maternal problems and child injury,homeless youth, children in car accidents, heroin addicts, other childhoodrisksHistory:·        50% U.S. women and 60% men w/ traumaexperience (Koenen)o  10% women and 5% men developed PTSD·        Research to find cause/risko  no attention on genetics – new diagnosis·        called shell shock, gross stress reaction,etc.o  1980 – DSM-III = diagnosiso  Early cause – trauma-related andenvironmental risk factors (Koenen)o  Until 1990s – only in certainsubpopulations and rare (Koenen)§  Studiesproved commonness·        Research complicated b/c of comorbidity = twochronic diseases simultaneously·        PTSD – polygenetic disordero  No geneo  Many genes contribute to PTSD risk·        Family studies (if genetic) – PTSD infamily members lead to higher prevalence of PTSD in individual (Koenen)·        Twin studies – Vietnam era twin registryo  Genetic influences on symptomso  Similar in non-veteran twins·        Association studies – explain differencesin risko  Select genes for phenotype§  Identifiedtwo are more versions of alleleso  Correlate variation in alleleso  5 studies – dopaminergic system(neurotransmitter in fear conditioning)·        Candidate gene studies – PTSD have higheroccurrence for other mental disorderso  Genetics for PTSD can only be expressed byexposure ·        Etiology of PTSD – genetic variants inc.

our understanding of PTSD developmental systemso  Better knowledge will help in developmentof predictive tests following a traumatic event ·        Gene expression studies – how genesrespond to environment·        Gene expression signatures differentiatebetween those with PTSD and those withouto  Test which trauma survivors are at higherrisk for PTSD after traumatic event·        Genetic studies – targets for therapeuticdrugs given after traumatic evento  Hallmark symptom – reexperiencing trauma·        Memory consolidation – amygdala and stresshormones o  Drug interventions to prevent PTSD ·        Genetic studies – why some respond todrugs and some don’t o  Pharmacogeneticso  Genes influence response to pharmologicalagents used to prevent PTSDTreatment:·        PTSD lifetime prevalence in population =7-8% o  Common illnesso  Higher in combat veterans and vulnerablepopulations·        PTSD complications amplify effectso  Substance abuse, depression, interpersonalconflicts, etc.o  Amplifies effects on individual, family,and society·        PTSD described in literature o  Homer – Odysseyo  Stephen Crane – The Red Badge of Courage §  acutestress disordero  Kurt Vonnegut – Slaughterhouse Fiveo  nonclinical view of acute and long-termeffects of trauma·        Different names earlier:o  Soldiers heart – Civil Waro  Traumatic war neurosis and shell shock –WWIo  Battle fatigue or combat stress disordero  All implied psychological orconstitutional (physical/mental) weakness·        DSM-III (1980)o  Described as PTSD o  Nature and degree of trauma as causativeagento  Later versions refined stressor criterionand symptoms·        Considered as chronic condition that couldbe managed rather than treatedo  Trial proven psychotherapies andtreatments lead to remission·        Veterans Health Administration andDepartment of Defense – cognitive processing therapy (CPT) and prolongedexposure (PE) most common·        Medications proven less effective intreatmento  Do have role in psychotherapy support·        CPT and PE – main approach in military andvet population·        Vets and active duty military reluctant toparticipateo  stigma with mental health treatment,multiple weekly appointmentso  many reluctant to engage to psychologicaltreatment unlike treatment for life-threatening diseaseso  not willing to attend mental healthclinicso  prefer treatment within primary care·        lack of definitive treatments for PTSDo  Collaborative Care Management (CoCM) –little effect§  Combinedwith mental health profession (STEP-UP trial) – more effective ·        CPT and PE:   o  Relief from symptoms that can causedistress but not to the level of diagnosiso  Sustained symptom remission for many§  Maynot be for those whose symptoms don’t remito  Need for replication and enhancementso  Help in developing a patient acceptabletreatmento  Help reduce long-term psychologicalconsequences of trauma                                 Works CitedAnderson, Jane M. “Post-Traumatic Stress Disorder Recognizedin Victims of Many   Traumas.” Journalof Controversial Medical Claims, vol. 14, no. 2, May2007, pp. 1–11.

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, doi:10.17744/mehc.39.4.

01.Blankenship,David M. “Five Efficacious Treatments for Posttraumatic Stress Disorder: An Empirical Review.” Journal of Mental Health Counseling, vol. 39, no. 4, 2017, pp. 275–288., doi:10.

17744/mehc.39.4.01.

Koenen,Karestan C. “Genetics of PTSD: A Neglected Area?” Psychiatric Times,1 Aug. 2005, p.

32. Academic OneFile, http://link.galegroup.

com/apps/doc/A135855600/AONE?u=j101912026&sid=AONE&xid=8d099df8.Accessed 25 Jan. 2018.

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