1. PTSD (Post Traumatic Stress Disorder) Dr Justine Croft Former Consultant Psychiatrist in Medical Psychotherapy Sat 16 th January 2016

2. What do you think of when you hear

3. What is PTSD? A collection of symptoms of mental distress that develop and persist in response to a severely traumatic event. Anyone who experiences a traumatic event is likely to have some symptoms of PTSD during the next few weeks as their mind processes what they’ve been through = A NORMAL HEALTHY RESPONSE to an ABNORMAL OCCURENCE

4. WHAT IS PTSD? For some people the symptoms gradually get worse rather than better Or persist for longer than 6 weeks Or are more severe from the outset, and persist

5. PTSD symptoms As well as feeling upset, guilty, grief stricken by events there are key symptoms associated with PTSD: 1) Flashbacks (during the day) and nightmares (at night) 2) Avoidance & emotional numbing 3) Being hypervigilant (permanently “on guard”)

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7. Flashbacks The person experiences the traumatic event as if it were happening in the here and now The person reacts as though it were happening now – E.g. freezing, panic attack, shouting out, diving for cover – visceral automatic bodily response Can be triggered by smells, similar sounds, similar sights Can occur as nightmares

8. Avoidance & Numbing The person may go to extremes to avoid any situation (or person, or type of person) which may remind them of the traumatic event May go to extremes to avoid thinking about it eg overworking, taking up new hobby, taking up risky activities May try to numb themselves emotionally – drink, drugs Or may become emotionally “numb” – difficult to experience any emotions

9. Hypervigilance Constantly on edge, scanning environment for threats, Enhanced startle reflex Irritable, jumpy, angry Can’t relax

10. What is a traumatic event? Generally one where we are in danger or our own life is threatened, (or you think at the time that is) or we see someone else dying or being seriously injured – particularly facial injuries or traumatic loss of part of the body And the experience is overwhelming, frightening and typically out of our own control, so that we feel helpless

11. Examples of traumatic events Serious vehicle accidents Personal attack – mugging, assault, rape Terrorist attack Military combat, being a prisoner of war Natural disasters Being tortured Being taken hostage Being diagnosed with a life threatening illness Being a patient in ITU Traumatic childbirth – having or witnessing

12. Factors more likely to be associated with PTSD WHEN THE TRAUMATIC EVENTS: are sudden and unexpected go on for a long time when you are trapped and can’t get away are man-made cause many deaths cause mutilation and loss of arms or legs involve children Feel helpless or feel you “should” be able to do something

13. Why does PTSD develop? Originally we had more primitive brains that were essentially survival driven – cavemen needed to detect threat and immediately respond …. Fight or flight?

14. CAVEMAN RESPONSE

15. As our brains developed we became more sophisticated – thinking, experiencing, imagining, creating Part of the brain called the hippocampus processes memories and emotions

16. FACED WITH THREAT

17. Why does PTSD develop? FOLLOWING THE TRAUMA: The heightened senses mean we remember the trauma in great detail – so we can learn from it (evolutionary advantage) Flashbacks help the brain process what’s happened as we go over it, and we may learn from it Exhausting constantly reliving it so avoidance and numbing help us function Being “on guard” means we can respond quicker to another crisis eg aftershocks following an earthquake and gives energy to deal with the after effects

18. Why does PTSD develop

19. Myths about PTSD Everyone who suffers a life threatening trauma will get PTSD Only happens to mentally weak people I should be over the trauma after a certain amount of time I should be able to cope with this myself – getting help means I’m crazy If I coped well initially it can’t be PTSD

20. Treating PTSD Debriefing immediately after a traumatic incident – surprisingly hasn’t been shown to be helpful Cognitive behavioural therapy (trauma focussed) usually 8 – 12 sessions EMDR – eye movement desensitisation and reprocessing Antidepressant medication Support group therapy Mindfulness Yoga

21. What might you see in a colleague or friend suffering PTSD? Changes in behaviour – being late for work, taking sick leave, poor performance, poor concentration leading to minor mistakes, avoidance of particular situations Mood changes – irritability, depression, anger, anxiety, withdrawal, lack of interest Reluctance to talk, reluctance to express any emotion

22. What can you do? Encourage them to talk about the event – helps process it Encourage them to do things to help relax and bring down hyperarousal If symptoms have persisted beyond 6 weeks encourage them to seek help

23. What can you do to reduce the risk after a traumatic event? Important to acknowledge this event has been traumatic – even if you’ve previously coped ok with similar events Talk about the event to someone you trust – as often as you need to Pay particular attention to eating and sleeping well Watch out for increased drinking, analgesic use – can creep up

24. What can you do to reduce the risk after a traumatic event? Exercise and deliberately do things to aid relaxation See family and friends Get back into your normal routine Go back to work – but don’t overwork – be kind to yourself Write a journal about the event

26. Thank you!