PTSD

Question 1

What is the ICD10 definition of PTSD

Answer 1

PTSD arises as a delyaed/protracted response to a stressful event or situation (catastrophic/thretening) which is likely to cause stress in every one
Must last >1m
Often begins within 6months of trauma (most often 1st month

Question 2

Aetiology of PTSD

Answer 2

6.8% lifestyle prevalence, F>M in civilian
RF - FHx, female, traumatic events, neurotic personality type, low social class

Bio causes -
Genetics -FHX
Neuroanatomical - hyperactive amyglada, atrophied hippocampus

psychoscioal - traumatic events, neurotic traits, Fhx of psychiatric problems, local class

Question 3

Sx of PTSD

Answer 3

Last over 1 month -

1) re-experiencing intrusive memeories (flashbacks, nightmares, repetive imaged, phsical sensation)
2) Avoidance of triggers (avoid activities and situations reminiscent of trauma)
3) Hyperarousal state- hypervigilance, enhanced startle reflex, insomnia, irritability, cant relax

other - mental health issues -depression/anxiety/phobia
selfharm/destructive behaviour -drug/alcohol misuse
Physcal - headache, dizzy, chest pain, stomach aches
anhedonia, emotional numbness

impairing of ADLs

Question 4

Ix of PTSD

Answer 4

Full history -even of the trauma
ADLS
Trauma screening questionnaire -10Q, measure re-experiencing and hyperarousal

Question 5

Mx of PTSD

Answer 5

Classify vis-a-vis of functional impairment (mild/moderate/severe)

Mild PTSD, sx<1m - watchful waiting + treat co-morbid conditions (eg depression)

Moderate/severe
CBT with trauma focus -combination of exposure therapy and trauma focused therapy
NB-immediate post trauma debriefing increase PTSD chances

Eye movement desensitisation and reprocessing (EMDR) ( less evidence)
Offer if 3m> IF NOT COMBAT RELATED
pt recalls experience in lot of detail as eyes follow at therapists finger that moves side to side

Pharma -
1st line SSRI (sertraline,) SNRI (venflaxine
2nd - atypical antipsychotics

prog-majority recover but can last many years and change personality