Exposure to traumatic events:
Directly experiencing the traumatic event.
Witnessing
Learning about it from a famimly memeber
experiencing repeated and extreme exposure to aversive details.
symptom clusters
Intrusion
Avoidance
Negative alterations in cognition and mood.
Hyper-arousal Sx
Intrusion
Recurrent, involuntary and intrusive memories
Recurrent distressing dreams with content relating to
Dissociative reactions in which they feel they are reliving the event
Intense or prolonged psychological / marked physiological distress with exposure to internal or external cues
Avoidance
avoidance or efforts to avoid internal or external
distressing memories, thoughts , feelings
people, objects, places
Negative alterations
Dissociative amnesia
negative beliefs about oneself
persistent negative emotional state (horror, fear, guilt)
Diminished interest and partipation in significant activities.
Detachement and estrangement
inability to experience + emotions
Hyperarousal
Irritable behaviour or angry outburst
Self-destructive
Hypervigillence
Problems with concentration
Sleep disturbances
Other ways PTSD can present
With common comorbidities such as anxiety, depression, SUD, borderline PD or
antisocial PD, BPMD, and somatic Sx and related disorders.
● Increased risk of suicidality
● Present to casualty with injuries from the actual traumatic event (e.g. MVA, stabbing,
domestic violence)
Management of PTSD
Risk assessment
Investigations
Psychological: firstline
Trauma focused CBT- prolonged exposure therapy (relive in a safe enviroment, becomes less distressful), virtual reality exposure.
Cognitive processing therapy
Eye movement desensitisation and reprocessing
Collateral: baseline functioning, exclusions of other diagnosis, or co-morbids
Biological:
SSRI/SNRI- Sertraline, Paroxetine, fluoxetine venlafaxine
a-blocker- prazosin- help with sleep and nightmares
SGA- adjuvant
avoid benzos
Social- occupational, family, living circumstances, exposures at home
