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50 to 90% of the population have been exposed to traumatic events during their life.
Most individuals do not develop PTSD.
For each exposure Proximity Similarity Helplessness Social Support 6-month stressors Hx of mental illness
Initial Interventions Stabilizing Supportive medical care Supportive psychiatric care Ensure availability of basic resources
Provide information verbally and in writing to the patient and support persons.
Avoidant symptoms
avoid thoughts, feelings, or conversations associated with the trauma
avoid activities, places, or people that arouse recollections of the trauma
inability to recall an important aspect of the trauma
feeling of detachment or estrangement from others
Hypervigilence Symptoms
difficulty falling asleep or staying asleep
irritability or outbursts of anger
difficulty concentrating
hypervigilence
exaggerated startle response
Grief Stages
Denial
Anger
Bargaining
Depression
Acceptance
During the first 48 to 72 hours after a traumatic event, some individuals may be very aroused, anxious, or angry while others may appear minimally affected or numb.
Ongoing Treatment
establish a therapeutic alliance
increase understanding of and coping with the psychosocial effects of the trauma
evaluate and manage physical health and functional impairments
coordinate care
SSRIs Ameliorate all three PTSD symptom clusters
Are effective treatments for comorbid disorders
May reduce clinical symptoms
Have relatively few side effects
Choosing Treatments
The patient’s age and gender
Presence of comorbid medical and psychiatric illnesses
Propensity for aggression or self-injurious behavior
Recency of the precipitating traumatic event
Severity and pattern of symptoms
Presence of distressing target symptoms
Development of problems in psychosocial functioning
Preexisting developmental or psychological issues
Debriefing
Psychological debriefing or single session techniques
are not recommended
may increase symptoms in some settings
appear to be ineffective in treating individuals with ASD and PTSD
Triage assessments in a group setting may identify those in need of intervention, but detailed discussion of distressing memories and events should be avoided in the group setting.
Supportive Interventions
Encourage acutely traumatized patients to rely on:
their inherent strengths
their existing support networks
their own judgments of the need for further intervention
Treatment Goals
Reducing the severity of symptoms
Preventing or treating related comorbid conditions
Improving adaptive functioning
Restoring a sense of safety and trust
Protecting against relapse
Restoring normal developmental progression
Integrating the trauma into a constructive schema of risk, safety, prevention, and protection
Treatment Plan
Observable, measurable goals and objectives
Interventions and their rationale
CBT Targets the distorted threat appraisal process in order to desensitize the patient to trauma related triggers
Stress inoculation training
Psychodynamic Psychotherapy
Focus on the meaning of the trauma in terms of prior psychological conflicts and development
Assure patients that they will decide how deeply to explore the difficult events/feelings
Normalize their distress
Psychoeducation the expected physiological and emotional responses strategies for decreasing secondary or continuous exposure to the trauma stress reduction techniques
the importance of remaining mentally active the need to concentrate on self-care tasks
Patients with serious mental illness have higher rates of abuse.
Depression, substance abuse, panic attacks and severe anxiety are associated with increased risk for suicide.
PTSD has demonstrated the strongest association with suicidal behaviors.
Family members of victims are not only secondary victims but also one of the major buffers.
Aggressive behavior in patients with PTSD results from the anticipatory bias caused by the trauma. Occurs in the context of reexperiencing symptoms. Techniques targeting symptoms may reduce aggression. Personality Disorders
Childhood trauma associated with development of PD
Features of PTSD and PDs overlap PTSD may be masked by PD symptoms
There are many causes for PTSD.
Early intervention may be key to preventing later developmental issues in children.
Strengths-based, supportive interventions are the best first-line treatments.
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