Overview

• Severe psychological disturbance following a traumatic life event.
  • Occurs within 6 months of a traumatic event.
  • Symptoms lasting at least 1 month (acute stress disorder is <1 month).

Making Diagnosis

Clinical Features

• Hypervigilance → constantly on guard for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating.

• Avoidance → avoiding people, situations or circumstances resembling or associated with the event.

• Intrusive re-experiencing of event → distressing involuntary memories, flashbacks, nightmares.

• Emotional numbing → lack of ability to experience feelings, feeling detached.

  <aside> 💡 HARE → hypervigilance, avoidance, re-experiencing of event, emotional numbing.

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Investigations

Management Plan

• Mild Symptoms lasting <4 Weeks → watchful waiting. Arrange follow-up within 1 month.
• Psychoeducation, Sleep Hygeine etc.
• More Severe Cases:
  • Trauma-Focused CBT (1st line psychotherapy) → offered to all patients with PTSD symptoms lasting >1 month.
    • Traumatic event can shatter previous belief systems. These thoughts can be examined and tested, to support the patient to work through the memories. 8-12 regular sessions, can be computerised or face-to-face.
  • Eye Movement Desensitisation and Reprocessing (EMDR) → adults with a diagnosis of PTSD who have presented >3 months after non-combat related trauma.
    • Original trauma is deliberately re-experienced in as much detail as possible. Whilst the patient does this, they fix their eyes on the therapist’s finger as it quickly passes from side to side in front of them. This aids memory processing.
• Pharmacological Treatment (if CBT or EMDR unsuccessful) → SSRI or venlafaxine (SNRI).

Complications →