Post-Traumatic and Acute Stress Disorder

Question 1

What are the 4 features of PTSD and how long must they be present for to make a diagnosis?

Answer 1

Re-experiencing (flashbacks, nightmares, repetitive and distressing intrusive images)
Avoidance (avoiding people, situations, circumstances resembling/associated with the original event)
Hyperarousal (hypervigilance for threat, exaggerated startle response, sleep problems, irritability, difficulty concentrating)
Emotional numbing (lack of ability to experience feelings, feeling detached)

Symptoms should be present for more than 1 month

Question 2

Other than the defining features, what symptoms can be present in a case of PTSD?

Answer 2

Depression
Drug or alcohol misuse
Anger
Unexplained physical symptoms

Question 3

How is PTSD treated? (mild and severe)

Answer 3

Mild + <4 weeks symptoms - watchful waiting
Severe - trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR) therapy, or drug treatment (venlaxafine or SSRI e.g. sertraline). In very severe cases, risperidone may be used

Question 4

What is acute stress disorder and how is it different to PTSD?

Answer 4

An acute stress reaction that occurs in the FIRST 4 weeks after a person has been exposed to a traumatic event

PTSD is diagnosed after 4 weeks

Question 5

What are the features of acute stress disorder?

Answer 5

Intrusive thoughts (flashbacks, nightmares)
Dissociation (‘being in a daze’, time slowing)
Negative mood
Avoidance
Arousal (hypervigilance, sleep disturbance)

Question 6

What is the management of acute stress disorder?

Answer 6

Trauma-focused CBT is first-line

Benzodiazepines second-line (care due to addictive potential and may hamper patients’ adaptation/recovery)