Characteristics
& Treatment:

·        
PTSD – anxiety disorder

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o  
After traumatic exposure (physical harm or
threat)

·        
Traumatic events:

o  
Violent assaults

o  
Natural or human disasters

o  
Accidents

o  
Military

·        
Frightening thoughts and memories of event
(numbness)

o  
With people close to

·        
Sleep problems, detached, or easily
startled

·        
Victims of violent crimes/veterans = 3 –
58% (Anderson)

o  
Iraq and Afghan vets have high stress

§  56%
2+ mental diagnoses

§  18
– 24 yr olds have greatest risk

·        
Higher that veterans 40+

·        
DSM-III (1980) – shift in understanding

o  
Reaction to trauma – short-term

o  
Long term effects (“Traumatic neurosis”) –
abnormal

§  Explained
by hereditary, early experiences or existing disorder

·        
Diagnosis requires symptoms of:

o  
Re-experiences, avoidance, and
hyperarousal

o  
Treatment of symptoms: selective serotonin
reuptake inhibitors (SSRIs)

§  Other
drugs used for victims of type II trauma, complex PTSD, stress disorders,
personality changes

·        
Symptoms – dissociation, reoccurrence, self-harm
behaviors

·        
both mood and anxiety disorders at same
time is common (comorbidity)

o  
Researchers at the Medical U of SC –
increase from 4-5 weeks

·        
Fluoxetine used in combat PTSD

o  
Greater improvements than placebo

·        
Topiramate in civilian PTSD

o  
Reduced re-experiencing symptoms

·        
Guanfacine in vets with complex PTSD

o  
No effect on symptoms

o  
Didn’t support use of alpha 2 agonists

·        
Tiagabine in adults

o  
Not different from placebo – no worsening
symptoms

·        
Antipsychotics in combat PTSD

o  
Patients don’t respond to antidepressants
(Anderson)

o  
Reduced psychotic and PTSD symptoms

·        
Trauma-focused CBT, EMDR, stress
management, and group therapy

o  
Improved symptoms

o  
TFCBT and EMDR better than stress
management (Anderson)

§  Stress
management better than others

·        
PTSD – relationship between emotional and
physical abuse and health

o  
Affects health

o  
Mental and somatic

o  
Other psychiatric or medical conditions –
76.6% patients

§  Treatment
should address all

o  
Sleep disturbances

§  Nightmares
in 70% patients

·        
PTSD in different trauma survivors:

o  
Earthquakes, tsunamis, breast cancer patients,
parents of heart transplant patients, maternal problems and child injury,
homeless youth, children in car accidents, heroin addicts, other childhood
risks

History:

·        
50% U.S. women and 60% men w/ trauma
experience (Koenen)

o  
10% women and 5% men developed PTSD

·        
Research to find cause/risk

o  
no attention on genetics – new diagnosis

·        
called shell shock, gross stress reaction,
etc.

o  
1980 – DSM-III = diagnosis

o  
Early cause – trauma-related and
environmental risk factors (Koenen)

o  
Until 1990s – only in certain
subpopulations and rare (Koenen)

§  Studies
proved commonness

·        
Research complicated b/c of comorbidity = two
chronic diseases simultaneously

·        
PTSD – polygenetic disorder

o  
No gene

o  
Many genes contribute to PTSD risk

·        
Family studies (if genetic) – PTSD in
family members lead to higher prevalence of PTSD in individual (Koenen)

·        
Twin studies – Vietnam era twin registry

o  
Genetic influences on symptoms

o  
Similar in non-veteran twins

·        
Association studies – explain differences
in risk

o  
Select genes for phenotype

§  Identified
two are more versions of alleles

o  
Correlate variation in alleles

o  
5 studies – dopaminergic system
(neurotransmitter in fear conditioning)

·        
Candidate gene studies – PTSD have higher
occurrence for other mental disorders

o  
Genetics for PTSD can only be expressed by
exposure

·        
Etiology of PTSD – genetic variants inc.
our understanding of PTSD developmental systems

o  
Better knowledge will help in development
of predictive tests following a traumatic event

·        
Gene expression studies – how genes
respond to environment

·        
Gene expression signatures differentiate
between those with PTSD and those without

o  
Test which trauma survivors are at higher
risk for PTSD after traumatic event

·        
Genetic studies – targets for therapeutic
drugs given after traumatic event

o  
Hallmark symptom – reexperiencing trauma

·        
Memory consolidation – amygdala and stress
hormones

o  
Drug interventions to prevent PTSD

·        
Genetic studies – why some respond to
drugs and some don’t

o  
Pharmacogenetics

o  
Genes influence response to pharmological
agents used to prevent PTSD

Treatment:

·        
PTSD lifetime prevalence in population =
7-8%

o  
Common illness

o  
Higher in combat veterans and vulnerable
populations

·        
PTSD complications amplify effects

o  
Substance abuse, depression, interpersonal
conflicts, etc.

o  
Amplifies effects on individual, family,
and society

·        
PTSD described in literature

o  
Homer – Odyssey

o  
Stephen Crane – The Red Badge of Courage

§  acute
stress disorder

o  
Kurt Vonnegut – Slaughterhouse Five

o  
nonclinical view of acute and long-term
effects of trauma

·        
Different names earlier:

o  
Soldiers heart – Civil War

o  
Traumatic war neurosis and shell shock –
WWI

o  
Battle fatigue or combat stress disorder

o  
All implied psychological or
constitutional (physical/mental) weakness

·        
DSM-III (1980)

o  
Described as PTSD

o  
Nature and degree of trauma as causative
agent

o  
Later versions refined stressor criterion
and symptoms

·        
Considered as chronic condition that could
be managed rather than treated

o  
Trial proven psychotherapies and
treatments lead to remission

·        
Veterans Health Administration and
Department of Defense – cognitive processing therapy (CPT) and prolonged
exposure (PE) most common

·        
Medications proven less effective in
treatment

o  
Do have role in psychotherapy support

·        
CPT and PE – main approach in military and
vet population

·        
Vets and active duty military reluctant to
participate

o  
stigma with mental health treatment,
multiple weekly appointments

o  
many reluctant to engage to psychological
treatment unlike treatment for life-threatening diseases

o  
not willing to attend mental health
clinics

o  
prefer treatment within primary care

·        
lack of definitive treatments for PTSD

o  
Collaborative Care Management (CoCM) –
little effect

§  Combined
with mental health profession (STEP-UP trial) – more effective

·        
CPT and PE:  

o  
Relief from symptoms that can cause
distress but not to the level of diagnosis

o  
Sustained symptom remission for many

§  May
not be for those whose symptoms don’t remit

o  
Need for replication and enhancements

o  
Help in developing a patient acceptable
treatment

o  
Help reduce long-term psychological
consequences of trauma

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Works Cited

Anderson, Jane M. “Post-Traumatic Stress Disorder Recognized
in Victims of Many   

Traumas.” Journal
of Controversial Medical Claims, vol. 14, no. 2, May
2007, pp. 1–11.,

doi:10.17744/mehc.39.4.01.

Blankenship,
David M. “Five Efficacious Treatments for Posttraumatic Stress Disorder: An

Empirical Review.” Journal of Mental Health Counseling, vol. 39, no. 4, 2017, pp. 275–

288., doi:10.17744/mehc.39.4.01.

Koenen,
Karestan C. “Genetics of PTSD: A Neglected Area?” Psychiatric Times,
1 Aug. 2005,

p. 32. Academic OneFile, http://link.galegroup.com/apps/doc/A135855600/AONE?

u=j101912026&sid=AONE&xid=8d099df8.
Accessed 25 Jan. 2018.

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