POST TRAUMATIC STRESS

DISORDER
MERIN SOLOMON
MSc NURSING
VIJAYA COLLEGE OF NURSING
DEFINITION
PTSD are defined as individual who have been
exposed to a traumatic event in which one person
experienced witnessed or was confronted with
actual or threatened death or serious injury or the
threat to the physical integrity of self or other.
-DSM-IV,
Traumatic events that can lead to PTSD
Include
War
Natural disaster
Car or phone crashes
Terrorist attack
Childhood neglect
Kidnapping
Assault
Rape
Physical abuse
Sexual abuse
Sudden death of a loved one
RISK FACTORS FOR PTSD INCLUDE:
Women are at greater risk than males
Previous traumatic experiences, especially in early
life
Family history of PTSD or depression
History of physical or sexual abuse
History of substance abuse
History of depression, anxiety, or another mental
illness
 High level of stress in everyday life
 Lack of support after the trauma
Lack of coping skills
SIGNS AND SYMPTOMS
1.Symptoms of PTSD: Re-experiencing the
traumatic event
Intrusive, upsetting memories of the event
Flashbacks
 Nightmares
 Feelings of intense distress when reminded of the
trauma
Intense physical reactions to reminders of the event
(e.g. pounding heart, rapid breathing, nausea, muscle
tension, sweating)
2.Symptoms of PTSD: Avoidance and numbing
 Avoiding activities, places, thoughts, or feelings
that remind the trauma
Inability to remember important aspects of the
trauma
Loss of interest in activities and life in general
Feeling detached from others and emotionally
numb
Sense of a limited future (you don’t expect to
live a normal life span, get married, have a
career)
3.Symptoms of PTSD: Increased anxiety and
emotional arousal
 Difficulty falling or staying asleep
 Irritability or outbursts of anger
Difficulty concentrating
Hyper vigilance (on constant “red alert”)
 Feeling jumpy and easily startled
Other common symptoms
 Anger and irritability Guilt, shame, or self-blame
Substance abuse
Feelings of mistrust
Feelings of mistrust
Depression and hopelessness
Suicidal thoughts and feelings
Feeling alienated and alone
Physical aches and pains
Symptoms of PTSD in children and adolescents
 Fear of being separated from parent
 Losing previously-acquired skills (such as toilet
training)
 Sleep problems and nightmares without
recognizable content
 Compulsive play in which themes or aspects of
the trauma are repeated
 New phobias and anxieties that seem unrelated to
the trauma (such as a fear of monsters)
 Acting out the trauma through play, stories, or
drawings
 Aches and pains with no apparent cause
 Irritability and aggression
A Mnemonic for Screening Patients for
Post-traumatic Stress Disorder
DREAMS
Detachment
Re-experiencing the event
Event had emotional effects
Avoidance
Month in duration
Sympathetic hyperactivity or hyper vigilance
DSM IV TR Diagnostic Criteria
A. The person has been exposed to a traumatic event
in which both of the following were present:
 1. the person experienced, witnessed, or was
confronted with event or events involved actual
threatened death or serious injury.
 2. the person's response involved intense fear,
helplessness, or horror.
B. The traumatic event is persistently re experienced in one
(or more) of the following ways:
1. Recollections of the event, including images, thoughts, or
perceptions.
2. Dreams of the event.
3. Acting or feeling as the traumatic event were recurring.
(includes a sense of reliving the experience, illusions,
hallucinations, and dissociative flashback episodes)
4. Intense psychological distress at exposure to internal or
external cues that symbolize or resemble an aspect of the
traumatic event
5. Physiological reactivity on exposure to internal or external
cues that symbolize or resemble an aspect of the traumatic
event
C. Persistent avoidance of stimuli associated with the
trauma and numbing of general responsiveness (not
present before the trauma), as indicated by three (or
more) of the following:
 Efforts to avoid thoughts, feelings, or conversations
associated with the trauma
 Efforts to avoid activities, places, or people that arouse
 Inability to recall an important aspect of the trauma
 Markedly diminished interest or participation in significant
activities
 Feeling of detachment
 Restricted range of affect (e.g., unable to have loving
feelings)
 Sense of a foreshortened future (e.g., does not expect to
have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present
before the trauma), as indicated by two (or more) of
the following:
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Difficulty concentrating
Hyper vigilance
Exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B,
C, and D) is more than 1 month.
F. Impairment in social, occupational, or other
important areas of functioning
TREATMENT
Pharmacological treatment
1. Antidepressants
SSRIs – Sertraline, Fluoxetine
TCAs- Imipremine
2. Antianxiety drugs
Lorazepam
Psychosocial treatment
i)TRAUMA-FOCUSEDCOGNITIVE
BEHAVIORAL THERAPY
It involves carefully and gradually “exposing”
yourself to thoughts, feelings, and situations that
remind you of the trauma. Teaching the patient
specific techniques within a limited number of
sessions (with “homework exercises” between
sessions). Identifying upsetting thoughts about
the traumatic event
ii)Exposure therapy
It involves gradually facing the thoughts and
memories of the traumatic event or situations
(places where the event occurred) that make one
anxious. This can be done by using imaging
techniques or by actually returning to the place
where one had an accident. Exposure should be
gradual and done with the help of an experienced
clinician.
iii) Cognitive restructuring therapy
Cognitive restructuring involves identifying
irrational (but understandable) patterns of thought,
feeling and behaviour that emerge after a traumatic
event. Cognitive restructuring aims at replacing
dysfunctional thoughts with more realistic & helpful
ones.
e.g. “I’ll never be normal again..I am gonna die”
“I’ll get better..It will just take time”
Or “I feel scared..But I am safe”
iv)Eye movement desensitization and
reprocessing (EMDR)
The patient is asked to concentrate on an image
connected to the traumatic event and the related
negative emotions, sensations and thoughts, At that
time usually the therapist’s fingers moving from side
to side in front of your eyes. After each set of eye
movements (about 20 seconds), the patient is
encouraged to let go of the memories and discuss
the images and emotions he experienced during the
eye movements.
Cont...
This process is repeated, this time with a focus on
any difficult, persisting memories.
Once you feel less distressed about the image, you
should be asked to concentrate on it while having a
positive thought relating to it while having a
positive thought relating to it.
It is hoped that through EMDR you can have more
positive emotions, thoughts and behavior in the
future.
Cont...
v) Family therapy
It can help your loved ones understand what
you’re going through. It can also help everyone in
the family communicate better and work through
relationship problems caused by PTSD symptoms.
Cont...
vi) Group Psychotherapy
They often feel more confident and able to
trust. Telling one’s story (the “trauma narrative”)
and directly facing the grief, anxiety and guilt
related todirectly facing the grief, anxiety and guilt
related to trauma enables many survivors to go on
with their lives rather than getting stuck in
unspoken despair and helplessness.
POSITIVE WAYS OF COPING WITH
PTSD
Learn about trauma and PTSD
Join a PTSD support group
Practice relaxation techniques
Confide in a person you trust
Spend time with positive people
 Avoid alcohol and drugs
SELF-HELP TREATMENT FOR (PTSD)
PTSD self-help tip 1: Reach out to others for
support
PTSD self-help tip 1: Reach out to others for
support
PTSD self-help tip 2: Avoid alcohol and drugs
PTSD self-help tip 3: Challenge your sense of
helplessness
NURSING DIAGNOSIS
1. Post trauma syndrome related to distressing event
considered to be outside the range of usual
experience.
Accept client; establish trust
Stay with client during flashbacks
Encourage verbalization about the trauma when
ready
Discuss coping strategies
 Assist client to try to comprehend the trauma and
how it will be assimilated into his or her personal
Cont....
Dysfunctional grieving related to loss off self as
perceived prior to the trauma or other
actual/perceived losses incurred during/following
the event.
Acknowledge feelings of guilt or self-blame
Assess client's stage in grief process
Assess impact of trauma on ability to resume
ADLs
Assess for self-destructive ideas or behaviour
Assess for maladaptive coping (e.g., substance
abuse)
THANK
YOU