Posttraumatic stress disorder (PTSD)

In general

• w>m (4:1)
• the reaction is subjective
• External stressor -> long-lasting stress reaction (acute stress disorder becomes PTSD)

What are possible stressors?

• Actual death, treathened death, combat, raped, abused, neglect
• Exposure: it can affect yourself or someone else (e.g. you can get PTSD if your child died) → Experienced, witnessed, learned, repeated aftermath (responders)

Clinical picture

• Intrusion: intrusive thoughts: flashbacks, intrusive thoughts (recollection of psychotraumatic events)
• Negative effect on mood and cognition: distorted memories, negative thoughts or expectations, constant negative emotions
• Dissociation
• avoidance: e.g. not talking about it, not going to the place
• arousal: irritability (not anxiety, angry outbursts), hypervigilance, sleep disturbance

Diagnosis

• is made clinical with the emphasis on ruling people in

Classification

• Acute stress disorder: > 3 D but < 1 month
• PTSD > 1 month
• Adjustment disorder

Therapy

• Psychotherapy (e.g. psychodynamic analysis, group therapy): the goal is here really to re-experience the trauma in a controlled manner and work through it
• Eye movement desensitization and reprocessing (bilobal activation? desensitization?)
• Pharmacotherapy
  • Prazosin: helps tremendously with insomnia and nightmares
  • SSRI, SNRI (usually reserved for people, who have either very severe symptoms or don´t want to do psychotherapy
  • if panic disorders occur: benzos

Complications

• they can self-medicate (substance abuse) and develop mood disorders
• can evolve into F62.0 enduring personality change
• Suicide