Trauma: Post traumatic stress disorder

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Risk of developing PTSD after a traumatic event is 8.1% for men and 20.4% for women

About

• Ongoing symptoms related to an extreme stress
• Symptom duration 1 month or longer
• Onset of symptoms is usually in the first month and always within 6 months
• ICD-10, DSM and other definitions

Aetiology

• Those with current PTSD may show abnormally low levels of cortisol compared with normal controls
• People with long-standing PTSD may have a smaller hippocampus than controls

At risk groups

• Victims of violent crime (e.g. physical and sexual assaults, sexual abuse, bombings, riots)
• Members of the armed forces, police, journalists and prison service, fire service, ambulance and emergency personnel, including those no longer in service
• Victims of war, torture, state-sanctioned violence or terrorism, and refugees
• Survivors of accidents and disasters
• Women following traumatic childbirth, individuals diagnosed with a life-threatening illness

Clinical

• Re-experience aspects of the traumatic event in a vivid and distressing way.
• Unwanted flashbacks in which the person acts or feels as if the event is recurring
• Nightmares; and repetitive and distressing intrusive images or other sensory impressions from the event.
• Reminders of the traumatic event arouse intense distress and/or physiological reactions.
• Avoidance of reminders of the trauma is another core symptom of PTSD
• Depression, generalised anxiety, shame, guilt and reduced libido
• Hypervigilance, hyperarousal, prominent startle response
• Emotional numbness and detachment
• Poor sleep and concentration impairs work and social life
• Use of alcohol, drugs, caffeine or nicotine to cope with their symptoms may eventually lead to dependence

Investigations

• Usually not indicated

Management

• GP assessment of severity and agreeing on a treatment plan
• Sympathetic support and managing any secondary injuries
• Short term anxiolytic and SSRIs may be useful
• Cognitive behavioural therapy - can help recall and confront and desensitise trauma and manage survivor's guilt