Stress Disorder : Post-Traumatic Stress Disorder (PTSD)

Hey friends welcome again I'm here to containing a new blog PTSD. Let's start it.

Introduction                                                                                                                              

What is Stress & Trauma?

Stress is basically a result of threatening and disturbing situations which cause the human being's body to suffer from disequilibrium or homeostasis. It is important for the person to gain back his homeostasis in order to rectify and rebuild his or her emotional and cognitive organization.

    In our daily lives, we may suffer from tow types of stress, namely stress (negative) and eustress (positive). Eustress is also called positive stress because it is experienced at time such as, when an individual is preparing for his examination or a presentation. This eustress is taken in a non-harmful manner because it dose not interfere with the person's cognitive functioning.

    Trauma on the other hand, is defined as an event that is caused due to human or nature, and leads to changes being faced by individual associated to food, shelter and safety.

There are three types of stress disorder

i) Post-traumatic stress disorder (PTSD)

ii) Dissociative and conversion disorder.

iii) Acute stress disorder

Here we'll talk about the most common stress disorder PTSD

Post-traumatic Stress Disorder                                                                                               

Post-traumatic stress disorder(PTSD) is a mental disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collision, child abuse, domestic violence or other threats on a person's life. Symptoms may include disturbing thoughts, felling or dreams related to the events, mental or physical distress to trauma-related cause alterations in the a person thinks and fells, and increase in the fight-or flight response.

    Most people who experience traumatic events do not develop PTSD. People who experience interpersonal violence such as rape, other sexual assault, being kidnapped, stalking, physical abuse by an intimate partner and incest or other forms of childhood sexual abuse are mostly likely to develop PTSD than those who experience non-assault based trauma, such as accidents and natural disasters.

    Prevention may be possible when counselling is targeted at those with early symptoms but is not effective when provided to all trauma-exposed individuals whether or not symptoms are present. The main treatment for people with PTSD are counselling (psychotherapy) and medication. In much of the rest of the world, rates during a given year between 0.5% and 1%. Higher rates may occur in regions of armed conflict, It is more common in women than men.

    Here I want to present an example of Covid-19 pandemic-

In the newspaper THE HINDU the writer writes- 

    "A nation wide lock-down may have prevented the covid-19 pandemic curve from peaking earlier but it certainly has shown adverse impact on psychological profile of people in the form of rise in Post-traumatic Stress Disorder, said a dip-test, pan India, web based Survey conducted via Google form during the last weeks of April 2020 when the nation had completed four weeks of lock-down. The survey was conducted by the Department of Community Medicine Vardhaman Medical College and Safdarjang Hospital. The survey indicated that 28.2% of population (That participated in the survey) suffered from PTSD during lock-down in India. (said Amita Khokhar under whose supervision the research was carried out by Suraj Prakash Singh.)"

In the another newspaper THE GAURDIAN writer Rhiannon Lucy Cosslet (she is a Gaurdian columnist and author) writes-

    "When the Covid-19 pandemic began people working in the trauma field knew the psychological tall would be colossal. In the spring of 2020, I began interviewing professionals about the mental health fallout of the pandemic, specifically its impact on front line medical staff. During the first wave, two in every five intensive care staff in England reported symptoms of Post-traumatic Stress Disorder.

    That work continued for almost year, during which time a second wave hit and the initial traumas were exacerbated. But it wasn't only front line workers who were experiencing trauma symptoms: Covid has posed perhaps the biggest threat to mental health in England since the second world war. Now, at the till end of 2021, the pandemic is still not over. The NHS forecast that nationally, there will be 2,30,000 new cases of PTSD as a result of Covid-19."

 

Symtoms                                                                                                                                  

Symptoms of PTSD generally began within the first three months after the inciting traumatic event, but may not began until year later. In the typical case, the individual with PTSD persistently avoids either trauma-related thoughts and emotions or discussion of traumatic event and may even have amnesia of event.

Associated medical conditions-

Trauma survivors often develop depression, anxiety disorder and mood disorder in addition to PTSD. Substance use disorder, such as alcohol use disorder, commonly co-occur with PTSD. Recovery from Post-traumatic Stress Disorder or other anxiety disorder may be hindered or the condition worsened, when substance use disorder are co-morbid with PTSD.

    In children and adults, there is a strong (e.g. Mood swing, Anger, Outbursts, Temper, Tantrums) and post-traumatic stress disorder symptoms, independent of age, gender, or type of trauma. Moral injury the feeling of moral distress such as shame or guilt following a moral transgression is associated with PTSD but is distinguished from it.

Risk Factors                                                                                                                              

Persons considered at risk include combat military personnel, victims of natural disasters concentration camp survivors, and victims of violent crime, persons employed in occupations that expose them to violence (such as solders) or disasters (such as emergency service workers) are also at risk. Other occupations that are at high risk include police officers, firefighters, ambulance personnel, health care professionals, train drivers, drivers, journalists, and soilors, in addition to people who work at bank, post offices or in stores.

    PTSD has been associated with a range of traumatic events. The risk of developing PTSD after a traumatic events varies by trauma type and is highest following exposure to sexual violance(11.4%) particularly rape(19.0% ). Men are most likely to experience the kind of high-impact traumatic event that can lead to PTSD. Such as interpersonal violence and sexual assault.

Intimate Partner Violence-

An individual that has been exposed to domestic violence is predisposed to the development of PTSD. However, being exposed to a traumatic experience dose not automatically indicate that an individual will develop PTSD. There is a strong association between the development of PTSD in mothers that experienced domestic violence during the perinatal period of pregnancy.

War-related Trauma-

Military service is a risk factor for development of PTSD. Around 78% of people exposed to combat do not develop PTSD; in about 25% of military personnel who develop PTSD, its appearance in delayed.

    Refugees are also at an increased risk for PTSD due to their exposure to war, hardships, and traumatic events. The rates of PTSD within refugees populations range from 4% to 86%. While the stress of war affect everyone involved, displaced persons have been shown to be more so than other.

Unexpected death of a loved one-

Sudden, unexpected death of a loved one is the most common traumatic event type reported in cross-national studies. However, the majority of people who experience this type of event will not develop PTSD. An analysis from the WHO world mental health surveys found a 5.2% risk of developing PTSD after learning of the unexpected death of a loved one.

Pathophysiology                                                                                                                       

Neuroendocrinology- PTSD symptoms may result when a traumatic event causes an over-reactive adrenaline response, which creates deep neurological patterns in the brain, these patterns can persist long after the event that triggered the fear, making an individual hyper-responsive to future fearful situations. During traumatic experiences, the high levels of stress hormones secreted suppress hypothalamic activity that may be a major factor toward the development of PTSD. 

    PTSD causes biochemical changes in the brain and body, that differ from other psychiatric disorders such as major depression. Individuals diagnosed with PTSD, respond more strongly to a dexamethasone suppression. Individuals diagnosed with clinical depression.

    Most people with PTSD show a low secretion of cortisol and high secretion of catecholamine in urine, with a norepinephrine/cortisol ratio consequently higher to the normative fight-to flight response, in which both catecholamine and cortisol levels are elevated after exposer to stressor.

    Brain catecholamine levels are high, and corticotrophin-releasing factor(CRF) concentrations are high. Together, these findings suggest abnormality in the hypothalamic-pituitary-adrenal (HPA) axis. 

Neuroanatomy- A meta-analysis of structural MRI studies found an association with reduced total brain volume, intracranial volume and volumes of hippocampus, insula cortex and anterior cingulate. Much of this research stems from PTSD in those exposed to the Vietnam war. 

   People with PTSD have decreased brain activity in the cortex, areas linked to the experience and regulation of emotion.

    The amygdala is strongly involved in forming emotional memories, especially fear-related memories. During high stress, the hippocampus, which is associated with placing memories in the correct cortex of space and time and memory recall is suppressed. According to one theory this suppression may be the cause of flashbacks that can affect people with PTSD. When someone with PTSD undergoes stimuli similar to the traumatic event, the perceives the event as occurring again because the memory was never properly recorded in the persons memory.

    In a 2007 study Vietnam war combat veterans with PTSD showed 20% reduction in the volume of their hippocampus compared with veterans who did not have such symptoms. This finding was not replicated in chronic PTSD patients traumatized at an air show plane crash in  1988.

    A 2020 study found no evidence for conclusions from prior research that suggested low IQ is a risk factor for developing PTSD.

Diagnosis                                                                                                                                   

PTSD can be difficult to diagnose, because of:

• The subjective nature of most of the diagnostic criteria.
• The practical for over-reporting.
• The potential for under-reporting.,
• Symptoms overlap with other mental disorders such as obsessive compulsive disorder and generalized anxiety disorder.
• Associated with other mental disorders such as major depressive disorder and generalized anxiety disorders.
• Substance used disorder.

Prevention-                                                                                                                                

Modest benefits have been seen from early access to cognitive behavioral therapy. Critical incident stress management has been suggested as a means of preventing PTSD, but subsequent studies suggest the likelihood of its producing negative out comes. Some evidence supports the use of hydrocortisone for preventing in adults, although there is limited or no evidence supporting propranolol, escitalopram, temazepam or gabapentin.

Psychological Debriefing                                                                                                         

Trauma-exposed individuals often treatment called psychological debriefing in an effort to prevent PTSD, which consists of interviews that are meant to allow individuals to directly confront the event share their feelings with the counselor and to help structure their memories of the event.

        As of 2017 the American psychologist Association assessed psychological debriefing as No research support treatment is potentially harmful. 

Management-

Reviews of studies have found that combination the rapidly is no more effective than psychological therapy alone.

Counselling-                                                                                                                              

The approaches with the strongest evidence include behavioral and cognitive-behavioral therapies such as prolonged exposure therapy, cognitive processing therapy and Eye Movement Desensitization and Reprocessing (EMDR). There is some evidence for Brief Eclectic Psychotherapy (BEP), Narrative Exposure Therapy (NET), and Written Exposure Therapy.

Cognitive Behavioral Therapy-

CBT seeks to change the way a person feels and act by changing the patterns of thinking or behavior, or or both, responsible for negative emotions. Result from a 2018 systematic review found high strength of evidence that that supports CBT exposure therapy efficacious for a reduction in PTSD diagnosis.

Eye Movement Desensitization and Reprocessing-

EMDR is a form of psychotherapy developed and studied by Francine Schapiro. She had noticed that, when she was thinking about disturbing memories herself her eyes was were moving rapidly. When she brought eye movement under control while thinking, the through were less distressing. 

Medication-

While many medications do not enough evidence to support their use, four (sertraline, Fluoxetine, Paroxetine and Venlafaxine) have been shown to have a small to modest benefit over placebo. With many medications, residual PTSD symptoms following treatment is the rule rather than the exception.

Antidepressants-

Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) may have some benefit for PTSD symptoms, Tricyclic antidepressants and equally effective but are less will tolerated.

Benzodiazepines-

Benzodiazepines are not recommended for the treatment of PTSD due to lack of evidence of benefit and risk of worsening PTSD symptoms. some authors believe that the use of benzodiazepines is contraindicated for acute stress, as this group of drugs can cause dissociations.

                

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