PTSD: Trauma and Stress-Related Disorders

• Trauma and stress-related disorders are mental health conditions triggered by traumatic or highly stressful life events like combat, sexual assault, accidents, natural disasters, terrorist attacks, or childhood abuse.

PTSD (Post-Traumatic Stress Disorder)

• Individuals with PTSD experience maladaptive emotional and behavioral responses, including anxiety, fear, dissociation, avoidance, and hypervigilance.
• Diagnosis requires exhibiting symptoms from four categories for at least one month, according to DSM-5 criteria.

PTSD Symptoms

• Intrusive symptoms: Recurrent, involuntary, and distressing memories of the trauma.
• Flashbacks: Feelings as if the trauma is happening again, sometimes with nightmares.
• Avoidance: Efforts to avoid thoughts, memories, or conversations about the event, including places, people, or situations associated with the trauma.
• Negative alterations in cognition and mood: Persistent negative beliefs about oneself, others, or the world; distorted blame of self and others; inability to experience positive emotions; and loss of interest in activities.
• Hyperarousal symptoms: Irritability, anger outbursts, hypervigilance, and exaggerated startle response.

Risk Factors for PTSD

• Pre-trauma: Pre-existing mental health conditions like depression or anxiety, or a genetic predisposition to anxiety disorders.
• Childhood adversity: Experiences like abuse or neglect during childhood.
• Peritrauma factors: Factors during the trauma, such as the severity and duration of the event.
• Post-trauma factors: Lack of social support, repeated exposure to trauma reminders, and maladaptive coping strategies like substance use or avoidance.

Treatment and Medication Management for PTSD

• SSRIs (e.g., Zoloft, Paxil, Prozac) are often the first-line treatment.
• Prazosin or Minipress can be used for nightmares or flashbacks.
• Mood stabilizers or atypical antipsychotics may be used for agitation.
• Benzodiazepines can be used short-term for panic attacks

Minipress/Prazosin

• A blood pressure medication affecting the alpha-1 adrenergic blocker.
• Acts as an alpha-1 adrenergic blocker, relaxing blood vessels and reducing blood pressure.
• Off-label use to manage PTSD-related nightmares, helping with sleep.
• Reduces the body's hyperarousal response to adrenaline.
• Dosage starts at 0.5, with an effective dose between 1 to 15.
• Common side effects include dizziness, drowsiness, orthostatic hypotension, nausea, vomiting, and headache; uncommon side effects include blurred vision, urinary incontinence, and impotence.
• Use with caution in patients with renal impairment, on dialysis, or with kidney issues.

Psychological Treatment for PTSD

• Cognitive Behavioral Therapy (CBT): Helps reframe negative thoughts related to the trauma.
• EMDR (Eye Movement Desensitization and Reprocessing): Uses guided eye movements to process traumatic events.
• Prolonged Exposure Therapy: Reduces negative thoughts and avoidance behaviors.

Acute Stress Disorder

• Similar to PTSD but occurs within three days to one month after the trauma.
• If symptoms persist past one month, it may develop into PTSD.
• Symptoms include dissociative symptoms, intrusive thoughts, flashbacks, nightmares, avoidance of trauma-related stimuli, and hyperarousal.

Adjustment Disorder

• A maladaptive emotional or behavioral response to a stressful life event
• Occurs within three months of the stressor.
• Stressors are less severe than those in PTSD; examples include divorce or job loss.
• Symptoms include depression, anxiety, and anger; in children, conduct problems or sleep issues may be seen.
• Treatment involves CBT, supportive therapy and counseling, and possibly short-term use of antidepressants like SSRIs and anti-anxiety medications.

Dissociative Disorders

• Involve disruptions in memory, identity, emotions, perception of reality, and behavior.
• Commonly linked to severe childhood trauma and abuse.

Dissociative Amnesia

• Inability to recall important personal information, usually following a trauma.
• Localized amnesia: Inability to recall events during a particular time period.
• Selective amnesia: Partial memory loss with bits and pieces of the event remembered.
• Generalized amnesia: Complete memory loss.

Dissociative Fugue

• Sudden travel or wandering away from home with identity confusion.
• Treatment: Trauma-focused therapy and cognitive techniques to improve memory recall.

Dissociative Identity Disorder (Multiple Personality Disorder)

• Presence of two or more distinct personality states or alters.
• Each identity has different memories, behaviors, and speech patterns; alters may have foreign accents or immature voices.
• Often related to severe, repeated childhood abuse.
• Symptoms include memory gaps or time loss, sudden changes in mood, behavior, and identity, and an increase in self-injurious behaviors and suicidal tendencies.
• Treatment: Long-term psychotherapy, with the goal of integrating all identities into one using CBT or DBT therapy.

Depersonalization vs. Derealization

• Depersonalization: Feeling detached from oneself.
• Derealization: Feeling detached from reality or the external world.