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.
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.
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.