Mental Health Book

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Post-Traumatic Stress Disorder

Aka: Post-Traumatic Stress Disorder, PTSD
  1. Pathophysiology
    1. Normal response to Trauma
      1. Intensity of response varies with event severity
      2. Re-experiencing symptoms: thoughts, dreams, images
      3. Intense emotional reactions
        1. Fear
        2. Bewilderment
        3. Anger
        4. Helplessness
        5. Despair
    2. Post-Traumatic Stress Disorder response to trauma
      1. Abnormal response to environmental triggers
      2. Classical conditioned response to trauma
        1. Traumatic event with serious threat to life
        2. Response to initial event
          1. Intense fear
          2. Helplessness
          3. Horror
      3. Hypothalamic-Pituitary axis involvement
        1. Excessive cortisol release
  2. Common Related Traumas
    1. Natural disaster
      1. Earthquake
      2. Flooding
      3. Hurricane
    2. Structure Fire or explosion
    3. Transportation or Motor Vehicle accident
    4. Other serious accident (home, work, recreational)
    5. Toxic substance exposure
    6. Physical assault or assault with a weapon
    7. Sexual Assault or other unwanted sexual experience
    8. War-related trauma (combat or war zone exposure)
    9. Captivity
    10. Life-threatening illness or injury
    11. Severe suffering
    12. Sudden violent death of someone else
    13. Serious injury, or sudden death of someone close
    14. Spontaneous Abortion
  3. Risk Factors
    1. Severity of trauma
    2. Genetic vulnerability (30% association in twins)
    3. History of previous trauma
    4. Preexisting psychiatric disorder
    5. Family History of psychiatric disorder
    6. Limited support systems
    7. Exposure to reactivating environmental events
  4. Symptoms
    1. Intrusive re-experiencing the trauma
      1. Recurrent intrusive thoughts, images, dreams
      2. Intense distress when remembering trauma
    2. Avoidance of reminders of trauma
    3. Increased autonomic arousal
      1. Insomnia
      2. Irritability or angry outbursts
      3. Poor concentration
      4. Hyper-vigilance
      5. Exaggerated startle response
    4. Emotional numbing
    5. Dissociative symptoms
  5. Screening Tools
    1. DREAMS Mnemonic
    2. SPAN Questionnaire
  6. Associated Features
    1. Major Depression
    2. Substance Abuse
    3. Aggressive outbursts
    4. Panic Attacks or Panic Disorder
    5. Profound demoralization and low self esteem
    6. Pervasive guilt, grief or suspiciousness
    7. Suicidal Ideation
    8. Somatic complaints
    9. Interpersonal and work related Impairment
    10. Sexual dysfunction
  7. Management: General Approach
    1. Assess for Chemical Dependency
    2. Reassurance
      1. PTSD is a reaction to the stress of trauma
      2. Predictable course and often resolves with treatment
    3. Anticipatory guidance
      1. Prepare patient for possible symptoms in future
      2. Be careful in somatizing or suggestible patients
    4. Trauma-focused psychotherapy
      1. Cognitive behavioral approaches
      2. Group Therapy
  8. Management: Medications
    1. Dissociative flashbacks or intrusive memories
      1. Propranolol (Inderal) 10-20 mg PO qid prn
    2. Nightmares of trauma
      1. Benzodiazepines prn at bedtime
      2. Cyproheptadine (Periactin) 4 mg PO qhs
    3. Hallucinations of the trauma
      1. Olanzapine (Zyprexa) 2.5 to 5 mg PO qd
    4. Avoidance, numbing sensation or diminished interests
      1. Selective Serotonin Reuptake Inhibitor (SSRI)
      2. Venlafaxine is effective
        1. Davidson (2006) Arch Gen Psychiatry 63:1158-65
    5. Hyperarousal or Irritability
      1. Propranolol (Inderal) 10-20 mg PO qid prn
      2. Buspirone (Buspar)
      3. Benzodiazepines
    6. Mixed PTSD Symptoms
      1. Divalproex (Depakote) 250-500 mg tid (or 750 mg qhs)
      2. Carbamazepine (Tegretol) 400-800 mg PO qd
  9. References
    1. Butler (1999) Am Fam Physician 60(2):524-30
    2. Bowles (2000) Am Fam Physician 61(6):1689-96

Post-Traumatic Stress Disorder (C0038436)

Definition (MEDLINEPLUS)

Post-traumatic stress disorder (PTSD) is a real illness. You can get PTSD after living through or seeing a traumatic event, such as war, a hurricane, rape, physical abuse or a bad accident. PTSD makes you feel stressed and afraid after the danger is over. It affects your life and the people around you.

PTSD can cause problems like

  • Flashbacks, or feeling like the event is happening again
  • Trouble sleeping or nightmares
  • Feeling alone
  • Angry outbursts
  • Feeling worried, guilty or sad

PTSD starts at different times for different people. Signs of PTSD may start soon after a frightening event and then continue. Other people develop new or more severe signs months or even years later. PTSD can happen to anyone, even children.

Medicines can help you feel less afraid and tense. It might take a few weeks for them to work. Talking to a specially trained doctor or counselor also helps many people with PTSD. This is called talk therapy.

NIH: National Institute of Mental Health
Definition (NCI) An anxiety disorder that develops in reaction to physical injury or severe mental or emotional distress, such as military combat, violent assault, natural disaster, or other life-threatening events. Having cancer may also lead to post-traumatic stress disorder. Symptoms interfere with day-to-day living and include reliving the event in nightmares or flashbacks; avoiding people, places, and things connected to the event; feeling alone and losing interest in daily activities; and having trouble concentrating and sleeping.
Definition (NCI) An anxiety disorder precipitated by an experience of intense fear or horror while exposed to a traumatic (especially life-threatening) event. The disorder is characterized by intrusive recurring thoughts or images of the traumatic event; avoidance of anything associated with the event; a state of hyperarousal and diminished emotional responsiveness. These symptoms are present for at least one month and the disorder is usually long-term.
Definition (MSH) A class of traumatic stress disorders with symptoms that last more than one month. There are various forms of post-traumatic stress disorder, depending on the time of onset and the duration of these stress symptoms. In the acute form, the duration of the symptoms is between 1 to 3 months. In the chronic form, symptoms last more than 3 months. With delayed onset, symptoms develop more than 6 months after the traumatic event.
Definition (PSY) Acute, chronic, or delayed reactions to traumatic events such as military combat, assault, or natural disaster.
Definition (CSP) acute, chronic, or delayed reactions to traumatic events such as military combat, assault, or natural disaster.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D013313
ICD9 309.81
ICD10 F43.1, F43.0, F43.10
SnomedCT 192415000, 47505003, 61157009, 192036009, 192414001
DSM4 309.81
English Post-traumatic stress disorder, Neuroses, Post Traumatic, Neuroses, Post-Traumatic, Neuroses, Posttraumatic, Post Traumatic Stress Disorders, Post-Traumatic Neuroses, Post-Traumatic Stress Disorders, Posttraumatic Neuroses, Posttraumatic Stress Disorder, Posttraumatic Stress Disorders, PTSD, Stress Disorder, Post Traumatic, Stress Disorder, Post-Traumatic, Stress Disorder, Posttraumatic, Stress Disorders, Post Traumatic, Stress Disorders, Post-Traumatic, Stress Disorders, Posttraumatic, POST TRAUMATIC STRESS DISORDER, Neurosis, traumatic, posttraumatic stress disorder, Posttraumatic stress disorder, NOS, Traumatic neuroses, Post-Traumatic Stress Disorder (PTSD), POSTTRAUMATIC STRESS DISORDERS, POST TRAUMATIC STRESS DIS, POSTTRAUMATIC STRESS DIS, STRESS DIS POSTTRAUMATIC, STRESS DIS POST TRAUMATIC, PTSD - Post-traum stress disor, Shell-shock, combat fatigue, traumatic neurosis, post-traumatic stress disorder (diagnosis), post-traumatic stress disorder, Post-traumatic stress disorder (disorder), Battle fatigue, Posttraumatic stress dis, Post-traumatic stress disorder (PTSD), Post-traumatic stress disorder, unspecified, Stress Disorders, Post-Traumatic [Disease/Finding], Post-Traumatic Stress Disorder, post traumatic stress syndrome, post-traumatic stress disorder (PTSD), Disorder;post traumatic stress, post-traumatic stress disorders, battle fatigue, post traumatic stress disorders, post-traumatic stress syndrome, posttraumatic stress disorders, Combat fatigue, Traumatic neurosis, PTSD - Post-traumatic stress disorder, Post-traumatic stress syndrome, Combat fatigue (disorder), Posttraumatic stress disorder (disorder), Posttraumatic stress disorder, disorder, post-traumatic stress, combat; fatigue, disorder; post-traumatic stress, disorder; stress, post-traumatic, fatigue; combat, neurosis; traumatic, post-traumatic stress; disorder, stress; disorder, post-traumatic, traumatic; neurosis, [X]Combat fatigue, Traumatic Neurosis, Posttraumatic stress disorder NOS, post traumatic stress disorder
Italian Disturbo post-traumatico da stress, Nevrosi da guerra, Neurosi post-traumatiche, PTSD, Disturbi post-traumatici da stress
Dutch oorlogstrauma, Posttraumatische stressstoornis, neurose; traumatisch, oorlog; vermoeidheid, posttraumatische stress; stoornis, stoornis; posttraumatische stress, stoornis; stress, posttraumatisch, stress; stoornis, posttraumatisch, traumatisch; neurose, vermoeidheid; oorlog, posttraumatische stressstoornis, Neurosen, posttraumatische, PTSD, Posttraumatische stress-stoornissen, Stress-stoornis, posttraumatische, Stress-stoornissen, posttraumatische
French Epuisement au combat, SSPT, Stress post-traumatique, Névroses post-traumatiques, Syndrome de stress post-traumatique, Troubles de stress post-traumatique, ESPT, TSPT, États de stress post-traumatique
German Kampfmuedigkeit, Posttraumatische Neurosen, Posttraumatische Stressfolgen, Post-traumatische Neurosen, Posttraumatische Belastungsstörung, Post-traumatische Belastungsstörung, Post-traumatische Stressfolgen, Posttraumatische Belastungsstörungen, Post-traumatische Belastungsstörungen, Post-traumatische Streßfolgen, Posttraumatische Belastungsstoerung, post-traumatisches Stresssyndrom, Neurosen, posttraumatische, PTSD, Belastungsstörungen, posttraumatische, Posttraumatische Streßfolgen
Portuguese Fadiga da batalha, Transtornos de Stress Pós-Traumáticos, Transtornos Pós-Traumáticos de Stress, Perturbação de stress pós-traumático, PTSD, Estresse Pós-Traumático, Neurose Pós-Traumática, Perturbações Pós-Estress Traumático, Stress Pós-Traumático, Transtornos de Estresse Pós-Traumáticos, Transtornos Pós-Traumáticos de Estresse
Spanish Estrés postraumático, [X]Combat fatigue, Combat fatigue, Post-traumatic stress disorder, fatiga de combate (trastorno), fatiga de combate, trastorno por estrés postraumático (trastorno), trastorno por estrés postraumático, trastorno por stress postraumático, trastorno por tensión postraumática, Trastorno por estrés postraumático, TEPT, Estres Postraumatico, Neurosis Postraumática, Trastornos de Estres Postraumatico, Trastornos por Estrés Postraumático, Trastornos Postraumáticos de Estrés, Estrés Postraumático, Trastornos de Estrés Postraumático, Neurosis Postraumatica, Trastornos Postraumaticos de Estres, Trastornos por Estres Postraumatico
Russian СТРЕСС ПОСТТРАВМАТИЧЕСКИЙ, СТРЕССОВЫЕ РАССТРОЙСТВА ПОСТТРАВМАТИЧЕСКИЕ, POSTTRAVMATICHESKIE STRESSOVYE RASSTROISTVA, STRESSOVYE RASSTROISTVA POSTTRAVMATICHESKIE, STRESS POSTTRAVMATICHESKII, NEVROZY TRAVMATICHESKIE, НЕВРОЗЫ ТРАВМАТИЧЕСКИЕ, ПОСТТРАВМАТИЧЕСКИЕ СТРЕССОВЫЕ РАССТРОЙСТВА
Japanese 戦争疲労症, ｾﾝｿｳﾋﾛｳｼｮｳ, ｶﾞｲｼｮｳｺﾞｽﾄﾚｽｼｮｳｶﾞｲ, ストレス性障害-心的外傷後, ストレス障害-心的外傷後, 外傷後神経症, ストレス性障害-外傷後, 外傷後の神経症, 外傷後ストレス性障害, 外傷後ストレス障害, 外傷後ノイローゼ, 外傷性神経症, 心的外傷後ストレス障害, ストレス障害-外傷後, 心的外傷後ストレス性障害, 神経症-外傷後
Swedish Stressyndrom, posttraumatiskt
Czech neurózy posttraumatické, stresové poruchy posttraumatické, Bojová únava, Posttraumatická stresová porucha
Finnish Posttraumaattiset stressihäiriöt
Korean 외상후 스트레스 장애
Croatian POSTTRAUMATSKI STRESNI POREMEĆAJ
Polish Zespół stresu pourazowego, Nerwice pourazowe
Hungarian Harctéri fáradtság, Posttraumás stress-betegség
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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