PTSD – Post Traumatic Stress Disorder Dr. Ismail Lunat
PTSD Based on Nice Guidelines (2005) Can occur in any individual following stressful event or situation of an extremely threatening or catastrophic nature. Under recognised. Following terrorism, wars and extensive media coverage, there is increased acceptance. Also, the arrival of asylum seekers and refugees from war torn areas. 1
Post Traumatic Stress Disorder (PTSD) No Wounds upon my body, No scars that you can find, Just hurt from wars fought long ago implanted in my mind No outward signs of injury, No telltale signs of pain, Only flashbacks and the nightmares Time and Time again. But all’s not lost for us old friend There are those that understand Just let them lead us through the darkness Go with them hand in hand P,T.S.D. is a state of the mind, that leaves our minds in a state Poem written by former soldier on www.ptsd.org.uk
Diagnosis Typical symptoms: DSM IV Criteria: Exposure to a traumatic event, or series of events as well as symptoms from each of the following clusters: Intrusive recollections Avoidant or numbing symptoms Hyperarousal, anxiety symptoms Symptoms persist for > 1 month & cause significant levels of distress or impairment in social functioning.
What is a traumatic stressor? Experiences of soldiers, Sudden bereavement, traumatised images of death & destruction on TV, bullying and abuse. Typical patients are frequent primary care users and have high rates of somatic symptoms. Not always presenting with classic PTSD symptoms, so screen
Management Debriefing after disasters should not be routine Consider watchful waiting when symptoms are mild and <4wks. Arrange follow-up in 1 months time. Trauma focused CBT if symptoms. If symptoms present >3months after trauma- consider trauma focused psychological treatment (CBT or EMDR) Drugs (not routine 1st line) For use by mental health specialists Drugs inc Paroxetine, mirtazepine, amitryptilline. Treatment for 12 months
Voluntary/charity organisations Department of Defence Mental Health (London) www.combatstress.com – Charity organisation set up by the Ex Services Mental Welfare Society (80 years service). They provide assessment and therapies inc CBT and EMDR (nice recommends) www.ptsd.org.uk – set up by fellow PTSD sufferers and provide contact and links References: 1 Ollf, M. Coping with the aftermath of trauma, Editorial, BMJ 2005;330:1038-1039 2 Nice Guidelines: www.nice.org.uk