Post-Traumatic Stress Disorder

PTSD Overview - Trauma's Lingering Shadow

• Develops post-exposure to actual/threatened death, serious injury, or sexual violence (Criterion A).
• Trauma Exposure Types:
  • Direct experience
  • Witnessing in person
  • Learning of trauma to close ones (violent/accidental)
  • Repeated/extreme exposure to aversive details (e.g., first responders)
• Core DSM-5 Symptom Clusters:
  • B (Intrusion): Flashbacks, nightmares, distressing memories.
  • C (Avoidance): Of trauma-related thoughts, feelings, reminders.
  • D (Negative Cognitions/Mood): Amnesia, negative beliefs, detachment, anhedonia.
  • E (Arousal/Reactivity): Hypervigilance, exaggerated startle, irritability, sleep issues.

⭐ Symptoms must last for >1 month for a PTSD diagnosis, distinguishing it from Acute Stress Disorder. oka

Etiology & Risks - Seeds of Distress

• Trauma Exposure: Essential. Severity, duration, and nature of event(s) are critical.
  • Includes direct experience, witnessing, learning of trauma to loved ones, or repeated exposure to aversive details (e.g., first responders).
• Risk Factors: Multifactorial, influencing vulnerability and resilience.
  • Pre-Traumatic: Female gender, prior trauma, pre-existing psychiatric conditions, ↓socioeconomic status, genetic predisposition, early life adversity.
  • Peri-Traumatic: Severity of trauma (dose-response relationship), perceived life threat, physical injury, interpersonal violence (especially if perpetrated by caregiver), dissociation during trauma.
  • Post-Traumatic: Lack of social support, ongoing life stressors, maladaptive coping strategies, subsequent traumatic events.
• Neurobiology: Complex interplay of brain circuits and stress systems.

  ⭐ Key neurobiological changes involve an overactive amygdala (fear response), underactive medial prefrontal cortex (mPFC) (emotional regulation), and altered hippocampal function (memory).

  • Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation (e.g., altered cortisol levels).
  • Neurotransmitter imbalances (e.g., ↑Norepinephrine, ↓Serotonin, altered GABA & glutamate).

Diagnosis & DDx - Pinpointing PTSD

• DSM-5 Criteria: Exposure to trauma; Symptoms from 4 clusters (Intrusion, Avoidance, Negative Cognitions/Mood, Arousal/Reactivity); Duration >1 month; Significant distress/impairment.
• Key Assessment Tools:
  • Clinician-Administered PTSD Scale (CAPS-5) - Gold standard
  • PTSD Checklist for DSM-5 (PCL-5) - Self-report
• Differential Diagnosis:
  • Acute Stress Disorder (ASD)
  • Adjustment Disorder (stressor severity differs)
  • Anxiety Disorders (GAD, Panic)
  • Depressive Disorders (MDD)
  • OCD (nature of intrusions differs)
  • Malingering/Factitious

⭐ Acute Stress Disorder (ASD) symptoms last from 3 days to 1 month post-trauma; if symptoms persist beyond 1 month or develop later, it's PTSD.

Treatment Modalities - Paths to Recovery

• Primary Goals: Symptom reduction, functional improvement, enhanced quality of life.

• Combined Approach: Psychotherapy and pharmacotherapy often yield best outcomes.

• Psychotherapy (First-line & Cornerstone):

  • Trauma-Focused CBT (TF-CBT): Gold standard. Targets maladaptive thoughts & behaviors.
  • Eye Movement Desensitization & Reprocessing (EMDR): Uses bilateral stimulation (e.g., eye movements) while processing trauma.
  • Prolonged Exposure (PE): Gradual, systematic confrontation with trauma memories/cues.
  • Cognitive Processing Therapy (CPT): Identifies & challenges unhelpful trauma-related beliefs.

• Pharmacotherapy:

  • SSRIs (First-line):
    • Sertraline (50-200 mg/day).
    • Paroxetine (20-60 mg/day).
  • SNRIs (e.g., Venlafaxine): Second-line option.
  • Prazosin: Effective for nightmares and sleep disturbances.
  • ⚠️ Benzodiazepines: Generally avoided due to risks of dependence and symptom worsening.

⭐ First-line pharmacological treatments for PTSD are SSRIs (Sertraline, Paroxetine); Prazosin is used for nightmares.

High‑Yield Points - ⚡ Biggest Takeaways

• PTSD follows traumatic event exposure; symptoms must last >1 month.
• Core features: Intrusion (flashbacks, nightmares), Avoidance of reminders, Negative alterations in cognitions/mood, and Altered arousal/reactivity.
• Differentiate from Acute Stress Disorder (symptoms 3 days to 1 month).
• SSRIs (Sertraline, Paroxetine) are first-line drugs; CBT/EMDR are key psychotherapies.
• Prazosin specifically targets and reduces nightmares.
• Frequently comorbid with depression, anxiety disorders, and substance abuse.