Best med for ptsd
Post-traumatic stress disorder (PTSD) - Diagnosis and treatment
To diagnose post-traumatic stress disorder, your doctor will likely:
- Perform a physical exam to check for medical problems that may be causing your symptoms
- Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
- Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:
- You directly experienced the traumatic event
- You witnessed, in person, the traumatic event occurring to others
- You learned someone close to you experienced or was threatened by the traumatic event
- You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)
You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.
Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. Combining these treatments can help improve your symptoms by:
- Teaching you skills to address your symptoms
- Helping you think better about yourself, others and the world
- Learning ways to cope if any symptoms arise again
- Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs
You don't have to try to handle the burden of PTSD on your own.
Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:
- Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative beliefs about yourself and the risk of traumatic things happening again. For PTSD, cognitive therapy often is used along with exposure therapy.
- Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach uses virtual reality programs that allow you to re-enter the setting in which you experienced trauma.
- Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.
Your therapist can help you develop stress management skills to help you better handle stressful situations and cope with stress in your life.
All these approaches can help you gain control of lasting fear after a traumatic event. You and your mental health professional can discuss what type of therapy or combination of therapies may best meet your needs.
You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.
Several types of medications can help improve symptoms of PTSD:
- Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
- Anti-anxiety medications. These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
- Prazosin. While several studies indicated that prazosin (Minipress) may reduce or suppress nightmares in some people with PTSD, a more recent study showed no benefit over placebo. But participants in the recent study differed from others in ways that potentially could impact the results. Individuals who are considering prazosin should speak with a doctor to determine whether or not their particular situation might merit a trial of this drug.
You and your doctor can work together to figure out the best medication, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.
Tell your doctor about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.
- Cognitive behavioral therapy
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Coping and support
If stress and other problems caused by a traumatic event affect your life, see your doctor or mental health professional. You can also take these actions as you continue with treatment for post-traumatic stress disorder:
- Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan and routinely communicating with your mental health professional will help move you forward.
- Learn about PTSD. This knowledge can help you understand what you're feeling, and then you can develop coping strategies to help you respond effectively.
- Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Try to reduce or avoid caffeine and nicotine, which can worsen anxiety.
- Don't self-medicate. Turning to alcohol or drugs to numb your feelings isn't healthy, even though it may be a tempting way to cope. It can lead to more problems down the road, interfere with effective treatments and prevent real healing.
- Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
- Stay connected. Spend time with supportive and caring people — family, friends, faith leaders or others. You don't have to talk about what happened if you don't want to. Just sharing time with loved ones can offer healing and comfort.
- Consider a support group. Ask your mental health professional for help finding a support group, or contact veterans' organizations or your community's social services system. Or look for local support groups in an online directory.
When someone you love has PTSD
The person you love may seem like a different person than you knew before the trauma — angry and irritable, for example, or withdrawn and depressed. PTSD can significantly strain the emotional and mental health of loved ones and friends.
Hearing about the trauma that led to your loved one's PTSD may be painful for you and even cause you to relive difficult events. You may find yourself avoiding his or her attempts to talk about the trauma or feeling hopeless that your loved one will get better. At the same time, you may feel guilty that you can't fix your loved one or hurry up the process of healing.
Remember that you can't change someone. However, you can:
- Learn about PTSD. This can help you understand what your loved one is going through.
- Recognize that avoidance and withdrawal are part of the disorder. If your loved one resists your help, allow space and let your loved one know that you're available when he or she is ready to accept your help.
- Offer to attend medical appointments. If your loved one is willing, attending appointments can help you understand and assist with treatment.
- Be willing to listen. Let your loved one know you're willing to listen, but you understand if he or she doesn't want to talk. Try not to force your loved one to talk about the trauma until he or she is ready.
- Encourage participation. Plan opportunities for activities with family and friends. Celebrate good events.
- Make your own health a priority. Take care of yourself by eating healthy, being physically active and getting enough rest. Take time alone or with friends, doing activities that help you recharge.
- Seek help if you need it. If you have difficulty coping, talk with your doctor. He or she may refer you to a therapist who can help you work through your stress.
- Stay safe. Plan a safe place for yourself and your children if your loved one becomes violent or abusive.
Preparing for your appointment
If you think you may have post-traumatic stress disorder, make an appointment with your doctor or a mental health professional. Here's some information to help you prepare for your appointment, and what to expect.
Take a trusted family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you.
What you can do
Before your appointment, make a list of:
- Any symptoms you've been experiencing, and for how long.
- Key personal information, especially events or experiences — even in your distant past — that have made you feel intense fear, helplessness or horror. It will help your doctor to know if there are memories you can't directly access without feeling an overwhelming need to push them out of your mind.
- Things you have stopped doing or are avoiding because of your stress.
- Your medical information, including other physical or mental health conditions with which you've been diagnosed. Also include any medications or supplements you're taking, and the dosages.
- Questions to ask so that you can make the most of your appointment.
Some basic questions to ask your doctor or mental health professional may include:
- What do you believe is causing my symptoms?
- Are there any other possible causes?
- How will you determine my diagnosis?
- Is my condition likely temporary or long term?
- What treatments do you recommend for this disorder?
- I have other health problems. How best can I manage these together with PTSD?
- How soon do you expect my symptoms to improve?
- Does PTSD increase my risk of other mental health problems?
- Do you recommend any changes at home, work or school to encourage recovery?
- Would it help my recovery to tell my teachers or co-workers about my diagnosis?
- Are there any printed materials on PTSD that I can have? What websites do you recommend?
Don't hesitate to ask any other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:
- What symptoms are concerning to you or your loved ones?
- When did you or your loved ones first notice your symptoms?
- Have you ever experienced or witnessed a traumatic event?
- Do you have disturbing thoughts, memories or nightmares of the trauma you experienced?
- Do you avoid certain people, places or situations that remind you of the traumatic experience?
- Have you been having any problems at school, work or in your personal relationships?
- Have you ever thought about harming yourself or others?
- Do you drink alcohol or use recreational drugs? How often?
- Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most helpful?
By Mayo Clinic Staff
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15 Best Medications for PTSD
You were created with natural coping mechanisms to deal with the stress and trauma that life will bring. However, as a human being, you were not meant to experience some of the trauma that occurs.
Your way of coping with trauma and stressful events needs to be healthy or your physical, mental, and emotional well-being are impacted.
When you experience PTSD, you often need medication to help heal.
What to Expect When Prescribed PTSD Medication
You will need to meet with your therapist and psychiatrist regularly for them to monitor your progress. You will discuss how you are taking the medications, resolving or worsening symptoms, and any side effects that you are experiencing.
It is important, to be honest with your treatment providers to get the best outcome from your treatment.
Taking psychotropic medications to treat PTSD will not cure the condition. However, taking the medication can turn down the volume of the symptoms to allow you to go on living your life.
You may be able to emotionally heal faster through therapy if you are taking medications to assist with the physical symptoms. Medications make the symptoms less bothersome, however, you must still address the root of the issue through therapy.Types of Medication
Medical professionals typically use a Selective Serotonin Reuptake Inhibitor (SSRI) or Serotonin Norepinephrine Reuptake Inhibitor (SNRI) first for the treatment of PTSD. Both of these types of medications decrease anxiety and depression.
They also assist with decreasing nightmares, improving sleeping patterns, and decreasing the occurrence of panic attacks. SSRI and SNRI medications do not create new chemicals in the brain. They balance the existing chemicals and hormones that are in your brain.
If you do not respond to the SSRI or SNRI medications, treatment providers will prescribe a mood stabilizer medication. This is most helpful when the main symptoms that you experience are anger, agitation, and irritability.
Another type of medication that could assist with PTSD treatment is fast-acting anti-anxiety medications. This provides short-term relief of symptoms by calming the central nervous system.
Some side effects of this type of medication include fatigue and dizziness. This class of medications also increases the risk of addiction to the medication.
Alpha Blockers are also used as a medication to treat symptoms of PTSD. These medications are typically used to lower blood pressure, and also have been proven to address symptoms of PTSD.
What Treatments Are Available for PTSD?
Treatment for PTSD includes a combination of therapy and the use of medication. Working with a competent therapist that specializes in working with people suffering from PTSD is necessary. To treat the symptoms of PTSD, it is necessary to identify the root cause and appropriately address this trauma.
Since PTSD causes physical and emotional symptoms that drastically impact your ability to carry on your normal life, using medications may be necessary. It is important to work with a provider that is well-versed in both.
At Modern Recovery Services, we understand the importance of using both therapy and medication to address the symptoms to get through the healing process to achieve wholeness.
Medications Use to Treat PTSDSSRI and SNRI (Antidepressants)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Venlafaxine (Effexor)
- Nefazodone (Serzone)
- Imipramine (Tofranil) – A tricyclic antidepressant
- Phenelzine (Nardil) – An MAOI medication
- Topomax (Topiramate) – A mood stabilizer
- Lamictal (Lamotrigine) – A mood stabilizer
- Xanax – A fast-acting anti-anxiety medication
- Klonopin (Clonazepam) – A fast-acting anti-anxiety medication
- Valium (Diazepam) – A fasting-acting anti-anxiety medication
- Ativan (Lorazepam) – A fast-acting anti-anxiety medication; also used to treat sleep disorder
- Minipress (Prazosis) – An Alpha Blocker
- Doxazosin – An Alpha Blocker
Types of Therapy Used to Treat PTSD
Cognitive Behavioral Therapy (CBT) -This is a therapy approach that focuses on the relationships between thoughts, feelings, and behaviors. This focuses on the change in patterns that led to the difficulty in your life.
Cognitive Processing Therapy (CPT) – This is a variation of CBT that focuses on helping to teach you how to modify and challenge unhelpful beliefs about experiencing trauma.
Cognitive Therapy (CT) – This therapy is also derived from the CBT method. This helps you to modify the negative memory of the trauma. The goal is to stop the behavior that is disrupting your life.
Prolonged Exposure – This is a type of CBT therapy that teaches you to gradually approach trauma-related memories, feelings, and situations. By facing what has been avoided, you learn that the trauma-related memories and cues are not dangerous and do not need to be avoided.
What is PTSD?
Post Traumatic Stress Disorder (PTSD) is a mental health condition triggered by a traumatic event or series of events. PTSD is a condition that results from someone experiencing or witnessing a traumatic event.
Many people have experienced trauma or witnessed something traumatic. People are sometimes able to cope with the trauma immediately. However, there are situations where people are unable to appropriately cope with trauma.
PTSD is most likely a combination of a stressful or traumatic event with several other factors. These factors include a possible history of mental health-related issues, your personality or temperament, and the way your brain physically regulates chemicals and hormones.
If you are diagnosed with PTSD, you have a different number of neurotransmitters in your brain than people without PTSD. The physical makeup of your brain is different or altered from PTSD.
Types of Trauma that Cause PTSD
When you are involved in or witness an event that involves death, the threat of death, or injury, you are more at risk of developing PTSD.
There are several types of trauma that a person may be involved with or witness that make you more likely to develop PTSD.
- Combat Exposure – Active members of the military or veterans.
- Childhood Abuse – If you experienced sexual, emotional, or physical abuse as a child.
- Sexual Abuse or Sexual Violence – If you have been the victim of sexual abuse or sexual assault.
- Physical Assault – If you have been the victim of a physical assault against you or watched someone else be physically assaulted.
- Accident – If you were involved in an automobile accident or an accident in which you or someone else was injured.
You are more at risk for developing PTSD if:
- You have experienced intense or long-lasting trauma.
- You are exposed to trauma at a young age in childhood.
- You have pre-existing mental health disorders or are predisposed based on heredity.
- You work in a profession that experiences trauma regularly. This includes first responders, police officers, medical professionals, or ambulance drivers/EMTs.
- You lack a support system.
What are the Symptoms of PTSD?
There are four types of symptoms that are experienced if you are suffering from PTSD.Intrusive Memories
If you suffer from PTSD, you can have sudden memories of the traumatic event without any warning. It is also common to suffer from dreams or nightmares related to experiencing the traumatic event. You can also experience physical or emotional responses when you have an intrusive memory.Avoidance
Suffering from PTSD can cause you to avoid certain people, places, or things that may remind you of the traumatic event. You can find yourself isolating yourself from activities that you once enjoyed because you are trying to avoid triggering any further symptoms.Negative Changes in Thinking and Mood
PTSD can cause you to have negative thoughts about yourself and this affects your self-image. PTSD can cause you to have negative thoughts about other people, including family and those that you love.
PTSD can cause you to have hopelessness about the present and future. If you have thoughts of harming yourself, do not delay and call 988 immediately to reach the National Suicide and Crisis Lifeline. If you are a veteran, select option 1. Your call will be answered 24/7.
PTSD causes memory loss. It can be very frustrating and scary when you no longer can recall simple facts or memories of your life.
PTSD frequently causes you to have issues within your relationships. You may notice that you no longer feel the same emotions and feel detached from those that you love. This impacts both you and all of your family and friends.
PTSD can cause you to feel numb or unable to respond to emotionally charged situations. You may struggle to respond to any form of stress appropriately.Changes in Physical and Emotional Reactions
When you are suffering from PTSD, you can become startled or frightened easily. You may feel like you are always on edge or on guard waiting for something bad to happen. This causes your emotions to be out of alignment.
You may experience significant difficulty sleeping. PTSD can cause you to suffer from insomnia. You may struggle to fall asleep or stay asleep.
Nightmares also play a role in your ability to sleep on a regular schedule. When you are unable to have a normal sleeping pattern, your body is not able to recuperate. This can cause more physical ailments to occur due to all of your bodily systems not receiving the appropriate amount of rest.
PTSD can cause your emotions to be dysregulated. You may experience significant irritability. This may cause you to be angry or sad when you should be happy.
The most frustrating part is that you know you do not want to have the opposite emotional response, however, your emotions and physical reactions are not responding correctly.
When To Seek Help for PTSD
When you have experienced a traumatic event, it is a natural human response to go through emotional turmoil and even experience some physical symptoms. However, this should not last long term.
If you are still experiencing emotional or physical symptoms one month after experiencing a traumatic event, it is time to seek out professional help.
Do not delay in seeking professional help. It is important to recognize and develop a plan to address PTSD.
The quicker you can recognize you are suffering from PTSD, the better the outcome will be. If you can begin addressing the root of the issue soon after developing PTSD, the recovery may not be as intense or long-lasting.
It is important to us at Modern Recovery Services to work with you to identify the root cause of PTSD and develop a treatment plan to help with thinking differently. We realize that your life can be hectic.
Our services will meet you where you are and provide convenient options to make your life easier. We provide you with the ability to reach a therapist or case manager at any time of the day or night through the use of calling, texting, or live chats by using our app.
We want to partner with you while you work through the healing process of PTSD.
When you delay seeking help for PTSD and the related symptoms, there is a higher risk that you will find other ways to cope with the discomfort and torment that you are feeling. You may find yourself engaging in high-risk behavior or finding other ways of escaping.
Many people turn to addictions to drugs or alcohol as a means of coping with PTSD. We can help if you find yourself having a co-occurring treatment need for mental health and substance abuse services.
Contact us today to develop a treatment plan that will address both your mental health and substance abuse treatment needs.
We Can Help
Contact us today to schedule a time to meet with one of our professional counselors and case managers to assess your treatment needs today. We are ready to help you create a treatment plan to best meet all of your needs.
- US Department of Veteran Affairs. Medications for PTSD. 2022. Available at ptsd.va.gov.
- National Library of Medicine. Mood Stabilizers. April, 28. 2020. Available at ncbi.nlm.nih.gov.
- The Mayo Clinic. Alpha Blockers. 2022. Available at mayoclinic.org.
- The Mayo Clinic. Post-traumatic stress disorder. 2022. Available at mayoclinic.org.
- National Suicide Prevention Lifeline. Available at 988lifeline.org.
- US Department of Veteran Affairs.Veteran Suicide Prevention. October 12, 2022. Available at va.gov.
- American Psychological Association. PTSD Treatments. June 2020. Available at apa.org.
Medicines for the prevention of post-traumatic stress disorder (PTSD)
Why is this review important?
Post-traumatic stress disorder (PTSD) is a severe and disabling condition that can develop in people who have been exposed to traumatic events. Such events can have long-term negative consequences for the lives of those who experience them, as well as for the lives of loved ones.
Research has shown that people with PTSD experience some changes in how the brain works. Thus, some researchers have proposed the use of drugs to treat these changes shortly after the traumatic event, as a way to prevent the development of PTSD. However, most people who survive a traumatic event do not develop PTSD. Therefore, drugs that may be given shortly after exposure to a traumatic event should be carefully evaluated for their effectiveness, including balancing the risk of side effects with the risk of developing PTSD. nine0005
Who will be interested?
- People who have been exposed to traumatic events and their families, friends and loved ones
- Professionals working in mental health
- Professionals working in traumatology and emergency medicine veterans of the armed forces
What questions did this review seek to answer? nine0004
Are some drugs more effective than other drugs or placebos (pacifiers) in people who have experienced a traumatic event, whether they have psychological symptoms or not, in:
- reducing the severity of PTSD symptoms?
- reducing the number of people who stop taking medicines because of side effects?
- reducing the likelihood of developing PTSD?
What studies were included? nine0004
We searched scientific databases for studies in which participants were randomly assigned to receive medication to prevent or reduce the severity of PTSD and its symptoms. We included studies published up to November 2020. We selected studies of adults who had experienced a traumatic event and were treated, whether or not the participants had psychological symptoms. nine0005
We included 13 studies with a total of 2023 participants. One study alone had 1244 participants. Studies have been conducted in a variety of settings and have included people who have been exposed to a wide range of traumatic events. Some studies have been conducted in emergency departments and have included people whose injury was caused by intentional or unintentional harm. Other studies have looked at life-threatening illnesses as the source of injury, including major surgery or hospitalizations in intensive care units. The medications most commonly taken by study participants included: hydrocortisone (which suppresses the body's immune response), propranolol (used to treat heart problems and anxiety, among other conditions), and gabapentin (a medication primarily used to treat seizures and nerve pain) . nine0005
What does the evidence say?
We found four trials comparing hydrocortisone to placebo. These trials did not report on how participants felt three months after the traumatic event, a time point that is useful for assessing the development of PTSD symptoms.
We found very low-certainty evidence for propranolol versus placebo three months after the traumatic event. This evidence does not tell us whether propranolol is more effective than placebo in reducing PTSD symptoms and the likelihood of developing PTSD. We found no evidence for the likelihood of discontinuing medications due to side effects, quality of life, or functional impairment (a measure of how life is limited by symptoms). nine0005
We found very low-certainty evidence for gabapentin compared with placebo three months after the traumatic event. This evidence does not tell us whether gabapentin is more effective than placebo in reducing PTSD symptoms and the likelihood of developing PTSD. We found no evidence regarding the likelihood of drug discontinuation due to side effects, quality of life, or functional impairment.
We found studies on complementary medications where information on reduction in the severity of PTSD and the likelihood of drug discontinuation was either inconclusive or absent. nine0005
None of the included studies assessed functional impairment in participants.
What to do next?
The evidence we found does not support the use of any medication to prevent PTSD in people who have experienced a traumatic event, whether they have psychological symptoms or not. Better studies with more people are needed to draw conclusions about these treatments. nine0005
Translation: Morozova Svetlana Yurievna. Editing: Yudina Ekaterina Viktorovna. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia on the basis of the Russian Medical Academy of Continuing Professional Education (RMANPE). For questions related to this transfer, please contact: [email protected]
PTSD - post-traumatic stress disorder
Initially, the term "post-traumatic stress disorder" appeared as a diagnosis in the military. It happened during the Vietnam War. Then he firmly established himself in medical circles, and already at 1968 entered the ICD. But the disorder is actually very ancient - they learned to define it back in Ancient Rome.
PTSD - what is it?
Complex post-traumatic stress disorder is a mental disorder that occurs in a person after some kind of traumatic impact. It was not for nothing that the violation was first diagnosed in the military - it was the military operations that caused PTSD. After the disease became generally accepted, the reasons for its appearance became more "domestic". And the range of causes that cause it has become more extensive. But, as before, the largest part of patients with this disorder are those who did military service. nine0005
Post-traumatic stress disorder, in simple words, is a disorder that appears after trauma of a very different nature. For example, after violence, disaster, death of a loved one. Any threat to life can lead to PTSD. Often the diagnosis is misused and applied to people whose symptoms are completely different from those confirmed by psychiatric researchers. Therefore, in recent years, the term has somewhat depreciated. But it is important to understand that the cause has always been and remains strong stress. nine0005
According to the ICD, post-traumatic stress disorder always appears as an abandoned and prolonged reaction of the psyche to a stressful event. In this case, the event necessarily has the character of a threat or catastrophe. Here it is necessary to introduce the concept of distress, which is used as a counterweight to eustress - positive stress that does not bring the psyche out of balance. Distress, on the other hand, is always negative, destructive, and it is this that is applied to PTSD. It brings the nervous system out of a stable state, from which the whole organism suffers. The stronger the stress factor, the more likely it is that eustress will turn into distress. nine0005
It must always be remembered that PTSD, if not treated in time, can change the patient's personality and destroy his life, leaving an imprint on every area of it.
According to statistics, post-traumatic stress personality disorder is most common among women. Since the most common cause of violation is rape. In percentage terms, the data are as follows: PTSD affects 1.2% of women and 0.5% of men. But not always a stressful event can lead to PTSD. Firstly, not all people are susceptible to it, and secondly, in many cases it can be prevented. nine0005
Post-traumatic stress disorder in the ICD-10 is in the group "Neurotic, stress-related and somatoform disorders". Due to the unstable psyche, the disorder is most often diagnosed in the elderly and in children. Resistance to stress in these groups is much lower, and in older people it is also accompanied by a gradual loss of mental adaptation. Plus, the rigidity of mental processes increases.
PTSD needs to be examined comprehensively, so the observation is usually carried out by more than one specialized specialist. Among the areas of medicine that deal with the treatment of patients with post-traumatic stress disorder are psychiatry, psychotherapy and clinical psychology. Often the disorder is accompanied by depression, but it is also not uncommon for the patient to seek a way out of it with the help of chemical addictions. The disorder has relatively recently been recognized by the psychiatric community as a diagnosis in its own right. Therefore, the methods of treatment are still at the research stage. Experts often choose experimental methods, but it is still unclear whether they have high efficiency. nine0005
PTSD (Post-Traumatic Stress Disorder) is a disorder that provokes instantaneous reactions of the psyche under the influence of a negative event. In patients without PTSD, a self-preservation reaction occurs during stressful moments, but a person with a disorder feels in danger even at a time when nothing threatens his life. And there is no natural fight-or-flight response to a threat. There is no guarantee that the disorder will not occur, even if the person is mentally stable. After all, it is not known what event can bring a person out of balance and how he will react to this or that stress. nine0005
Like any mental disorder, post-traumatic disorder syndrome should be detected in a timely manner, and treatment should be carried out under the strict supervision of a specialist. In this, close people who recognize PTSD by the first signs can play a key role. We cannot close our eyes to the changed state of a person and his inappropriate behavior. The statistics in this disease are disappointing - 8 people out of 100 at least once experienced the condition of this disorder.
Mentally stable people are more at risk of developing this disease under the influence of traumatic circumstances, from calm to go into a state of post-traumatic stress disorder. At the same time, it can also be due to a genetic predisposition and manifest itself during minor shocks. Interestingly, people diagnosed with this condition rarely experience a single stressful shock. Most often, the violation is manifested due to several shocks. They can occur with a significant temporary break or go one after another. The presence of a diagnosis significantly reduces the patient's quality of life, and the disorder itself can take on a more advanced form and become complex - it is more complicated and requires a more thorough approach to treatment. nine0005
Why PTSD occurs
The causes of the disease are various and very extensive. Not always the disorder can be acquired, heredity also often plays a decisive role in the appearance of signs of PTSD.
The main causes of post-traumatic stress disorder are:
- Military events, military service, participation in hostilities.
- Act of terrorism.
- Cultural and ethnic conflicts. nine0103 Assault causing bodily harm, threat of death.
- Death of loved ones, protracted illnesses that threaten death.
- Psychological or physical abuse.
- Political prerequisites are revolutions, genocide, forced migration, repressions.
- Man-made or natural disasters.
- Epidemics and pandemics.
The number of people with PTSD has increased significantly over the past two years. Because post-traumatic stress disorder usually occurs in a stressful situation, and general panic only exacerbates the situation. This is demonstrated by the situation in the world, which is faced with a coronavirus infection. This suggests that the list of reasons is very dynamic and can expand in connection with the changing situation in society. nine0005
In general, the factors that provoke PTSD are past events that led to psychological trauma. They are called acquired. But they can also be congenital - when post-traumatic stress disorder occurs due to heredity. It has been proven that there is a strong connection between a woman and a child. If the first suffered physical abuse during pregnancy, then it is likely that the baby will be predisposed to a mental disorder.
Pathogenesis of PTSD
When a traumatic event occurs, there is an instant rush of adrenaline. As a result, a neurological response appears in the brain. For a long time it persists, and provokes various mental reactions in the future in response to similar situations. Each time similar events occur, the activity of the hypothalamus decreases due to the high level of adrenaline. This is what causes the violation.
The pathogenesis of PTSD is also associated with low production of cortisol, increased excretion of corticotropin in the urine. The dexamethasone suppression test in people with PTSD is significantly higher than in those who suffer from clinical depression. nine0005
All of these factors indicate an abnormality in the axis of the hypothalamic-pituitary-adrenal axis (HPA). The HRA axis turns on in response to constantly arising fear. Therefore, there is also a connection between the frontal cortex and the limbic system. The axis triggers a hormonal surge, but in turn triggers the LC-noradrenergic system, which is associated with reinforcing bad memories. The subcortical basal nucleus (amygdala) is responsible for emerging threats and natural responses to them.
People with the syndrome have low levels of serotonin, which causes non-standard behavioral symptoms. The patient develops irritability, thoughts of suicide, unreasonable aggression. The secretion of the hormone dopamine is also involved. Its decrease causes apathy, inhibition in actions, and an increased level of dopamine provokes arousal - psychosis, unreasonable anxiety appears.
Symptoms of PTSD
Usually, signs of post-traumatic stress disorder appear within three months after the traumatic event. But there are also patients in whom symptoms do not appear earlier than after 6 months. It is possible at the same time a regular manifestation of a mental state, which allows us to talk about the chronic nature of PTSD. nine0005
Symptoms of post-traumatic stress disorder:
- One or more cases of avoiding a traumatic situation.
- One or more recollections of the traumatic situation.
- Two or more cases of violation of an adequate perception of reality, a sharp change in mood.
- Two or more cases of sudden excitability and increased activity.
Characterizing post-traumatic stress disorders, one cannot fail to mention the changing behavior of a person, which leaves an imprint on interaction with people, personal life and career. nine0005
- It seems to the patient that he is in a state of nervous breakdown or is about to break loose.
- There are uncontrollable outbursts of anger, sleep disturbance.
- A person enters an anxious state very quickly, instantly goes from a calm state to a frightened one.
The symptoms of this group have a permanent property. If the rest can appear from time to time, then excitability and activity will accompany the patient's behavior throughout the entire period marked by the presence of PTSD. nine0005
Characterization of post-traumatic stress disorder necessarily includes the presence of symptoms in the patient. It is important to monitor the patient - these symptoms should be observed for at least a month. Their severity also plays a role - they must have a negative impact on a person's life, his interaction with society.
How PTSD is classified
The disease can pass into different stages, have a different nature of the course and be characterized by different degrees of severity. All these parameters, as well as signs of post-traumatic stress disorder, allow us to classify the disease. nine0005
If we give a general classification of the violation, then experts define it as an anxiety disorder, the accompanying signs of which are unpleasant experiences, behavior unusual for a calm person. Physiological reactions often also occur when contact with a traumatic situation occurs. All of these functions are observed within a month - this is the main distinguishing aspect in comparison with short-term stress.
The disease is divided into 3 forms: nine0005
- Sharp. Occurs after 30 days, it is preceded by a strong shock.
- Chronic. The appearance of this form is associated with heredity. Some traumatic event provoked PTSD, but the person had preconditions for this.
- Delayed. When much more than a month passes after the event. Sometimes the event can be repeated, but does not have consequences in the form of PTSD. But the origin of the corresponding biochemical processes provokes the development of the disease. nine0104
Post-traumatic stress disorder is also divided into several stages:
- A traumatic situation affects the psyche.
- A person begins to constantly think about it, rethink how it could have been prevented, feels guilty for what happened.
- The subject begins to avoid the place, people and things associated with the situation.
- There are symptoms of arousal, which become permanent.
- Symptoms persist for 30 days or more. nine0104
- The symptoms of post-traumatic stress disorder leave an imprint on the patient's habitual life, he has problems in communication and organization of activities.
According to the ICD-10 classification, there are 4 types of PTSD:
- Dysphoric type. The patient is characterized by constant irritability, aggressive behavior, dissatisfaction with the behavior of other people. Such people feel resentment, they can even take revenge, inflict physical damage on others. At the same time, regret about such behavior is not ruled out, but often satisfaction with destructive actions. People with this type of disease try to avoid outside help, refuse to see a doctor. nine0104
- Anxious type. He has frequent unmotivated anxiety attacks. It is realized not only mentally, but also manifests itself bodily. Describing post-traumatic stress disorder, specialists note frequent changes in the patient's mood and sleep disturbance in this type. A person strives for communication, as this helps him relieve anxiety.
- somatoform type. Accompanied by massive painful sensations in the body. Most people complain of pain in the heart area, a little less of changes in the gastrointestinal tract, some complain of headaches. These symptoms usually appear six months after the event. This type refers to the delayed form of the disease. The patient is constantly fixed on these sensations, which makes him go to the doctor. nine0104
- Asthenic type. Characteristics of post-traumatic stress disorders in this case include apathy, lethargy, indifference to everything that happens. This state is depressing. Drowsiness appears, the person does not want to get out of bed. At the same time, dreams do not take the form of nightmares, they may not even appear. This type is most supportive of medical intervention - he willingly responds to the help of loved ones and agrees to appear to a specialist without unnecessary persuasion.
Post-traumatic stress disorder may take up to a month to appear, or it may take much longer. Diagnosis can be complicated by different behavior between types, but one thing unites patients - the indispensable presence in life of a situation that disrupts the usual course of life.
Once diagnosed, PTSD can also be classified as a treatable disorder or a disorder whose symptoms can be completely eliminated. PTSD usually causes disturbances in social, professional and other areas of activity. nine0005
Stages of PTSD
There are several stages of the onset of this disease:
- Traumatic stress. Occurs during a critical incident and immediately after it for 2 days.
- Acute stress disorder. It appears within two days, can last up to 4 weeks.
- Post-traumatic stress disorder. Must have been more than 4 weeks.
- Post-traumatic personality disorder. It can run throughout life. nine0104
The last stage is considered incurable, so it is important to recognize the disease in the early stages. Symptoms at all stages are similar, but at each stage the conditions become more and more intrusive, getting rid of them becomes more and more difficult.
The signs themselves depend on the type - at each stage, an asthenic, somatoform, dysphoric or anxious type can manifest itself. Passing through all the stages, PTSD manifests itself brighter, but the main signs remain the same.
Complications of PTSD
In post-traumatic stress disorder, the consequences can be devastating to a person’s psyche, his physical health, but can also affect other people. This disease greatly increases the risk of problems such as:
- Drug use, alcoholism.
- Constant depression, which is accompanied by medication and the inability to lead a normal life.
- Eating disorder, deterioration of the brain, central nervous system and heart. nine0104
When to see a doctor
If a frightening situation has occurred in a person’s life that entails a traumatic experience, then this is already a reason to turn to the text. The patient may notice non-standard behavior behind him or heed the advice of loved ones who have noted changes in his condition.
The presence of symptoms also plays an important role - constantly occurring destructive deviations, disturbing dreams, aggression, or vice versa, an apathetic state. If they appear after a traumatic situation and do not let a person go for 30 days, then you should make an appointment with a psychiatrist or psychotherapist. nine0005
Only a specialist is able to establish the correct diagnosis and prescribe treatment. It is better to exclude an independent solution to the problem in this disease.
Diagnosis of disorder
Screening is usually used to diagnose PTSD. First of all, this is the PTSD scale, generally accepted in the ranks of researchers of mental disorders. It was developed by the Mississippi Group of Scientists. It is a questionnaire of 35 questions (for the military) or 39(a variation of the test for those suspected of having non-war related PTSD). Answers are ranked on a Likert scale. After the analysis, the final coefficient is derived. The questionnaire form contains inverted values - this prevents the possibility of setting a potential patient. It is also excluded that they are filled in random order.
Diagnostic criteria for post-traumatic stress disorder are established by a psychologist, psychiatrist or psychotherapist - they depend on the stage of the disease, the type and severity of the course. nine0005
Before proceeding with the diagnosis, the doctor gets acquainted with the anamnesis and talks with the patient. Often, friends and relatives of the patient are involved and interviewed for diagnosis. A doctor, based on third-party reviews, can create an unbiased and most complete picture of the condition of a potential patient.
Criteria for diagnosing post-traumatic stress disorder always involve the use by a doctor of tests, questionnaires, scales - everything that will help to fully assess the patient's condition. All these tools are used in a conversation not only with the patient himself, but also with his relatives. nine0005
The main method of diagnosing the disease is SCID (structured clinical diagnostic interview). It includes blocks of questions that are interconnected and help to smoothly move from one block to another. This technique is convenient in that it can be adjusted depending on specific tasks.
Other methods for diagnosing post-traumatic stress disorder include the Beck questionnaire (used to identify a depressive state), the Keane scale (used to assess the severity of combat experience), the Derogatis scale (assesses the severity of psychopathologies), the scale for assessing the severity of a traumatic event. A significant disadvantage of the listed scales is that they were developed by world scientists and their adaptation into Russian may cause certain difficulties, which will distort the results. At the moment, this problem is a priority in the community of Russian psychiatrists. nine0005
Post-traumatic stress disorder, its diagnosis and treatment should be under the strict supervision of a competent specialist.
In general, the diagnosis can be divided into several stages:
- Conducting a survey.
- Projective method of personality research. At this stage, generally accepted tests in psychology are used - Rorschach, Luscher, apperceptive.
- Use of standardized personality questionnaires. nine0104
- The use of questionnaires that diagnose the severity of pathopsychological symptoms in accordance with ICD-10.
Treatment of disorder
Depending on the nature of the disease, concomitant factors and the degree of neglect of the patient, the psychotherapist prescribes appropriate treatment. Sometimes medical intervention is required. Treatment for PTSD (post-traumatic stress disorder) often involves a holistic approach.
In the early stages, cognitive behavioral therapy is used. The specialist corrects the behavior model by replacing negative emotions with positive ones. With this approach, the patient can learn to identify depressing thoughts and use various techniques to get rid of them. The goal of therapy is to identify the symptoms of PTSD, monitor stress, behavioral changes, emotional outbursts and understand the nature of their origin. Correction of post-traumatic stress disorder with the help of cognitive therapy is often crowned with success. nine0005
Medication is an under-researched method of dealing with PTSD. It is believed that many drugs have a placebo effect - the patient drinks them and through self-hypnosis believes in getting rid of the disease. But the likelihood of relapse is high when prescribing such medications. Today, experts usually prescribe three drugs - paroxetine, venlafaxine and fluoxetine, which have successfully proven their effectiveness.
When authentic, PTSD is best treated with antibiotics. Serotonin-norepinephrine and serotonin reuptake inhibitors are prescribed. Tricyclic antidepressants such as sertraline and venlafaxine have been shown to be effective in some cases. These are second-line drugs for PTSD. nine0005
Benzodiazepines are also prescribed as medications. But their effectiveness has not yet been proven and their use is associated with a certain risk. Therefore, many doctors try to refuse these drugs, but some still prescribe them for severe insomnia.
Treatment of PTSD in the early stages of symptoms may include the use of glucocorticoids. The purpose of their appointment is to neutralize neurodegeneration, however, long-term use of them can, on the contrary, enhance it. nine0005
Children can also be affected. This is where play therapy helps. Studies have shown that it helps the child connect internal experiences with the outside world.
Psychotherapy for post-traumatic stress disorder, based on repetitive games, involves abstract thinking, helps children experience negative emotions.
As an additional recommendation, the specialist may advise physical activity. It must be moderate. Exercise and sports distract from bad thoughts, can improve self-esteem and control the physiological manifestations of a mental disorder. The main thing is not to overdo it so that the desire to get in shape does not become an obsession. nine0005
Therapy for complex post-traumatic stress disorder always includes an individual visit to a psychotherapist - a specialist identifies the causes of the disease, helps to recognize the signs of the condition, and accepts that the patient has a mental disorder.
For the treatment of PTSD, it is better to choose clinics that specialize in the treatment of mental disorders. Doctors with many years of experience work in such institutions, who have been practicing and conducting effective treatment for many years. nine0005
Some patients try to cope with the disease on their own. They try to contact other people, seek solace in conversations, recreational activities, hit on religion, practice breathing exercises. But the use of all these methods as a therapy for post-traumatic stress disorder cannot become the basis for its treatment and get rid of it forever.
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There is no effective prevention for PTSD. A person cannot always predict whether a traumatic event will occur in his life, and what consequences it will lead to. nine0005
Some of the research on disorder prevention has focused on learning resilience—the ability to bounce back from tragic events. Such a strategy can be useful for people at risk - military personnel, journalists, members of rapid response teams. But the clinical guidelines for post-traumatic stress disorder don't place much emphasis on the effectiveness of this approach. Such strategies include teaching people how to respond to stressful situations and self-management techniques such as sleep control and mindfulness. nine0005
The support of loved ones plays an important role in preventing violations.