1. PTSD – Post Traumatic Stress Disorder
Dr. Ismail Lunat

2. PTSD Based on Nice Guidelines (2005)
Can occur in any individual following stressful event or situation of an extremely threatening or catastrophic nature.
Under recognised.
Following terrorism, wars and extensive media coverage, there is increased acceptance. Also, the arrival of asylum seekers and refugees from war torn areas. 1

3. Post Traumatic Stress Disorder (PTSD)
No Wounds upon my body,
No scars that you can find,
Just hurt from wars fought long ago
implanted in my mind
No outward signs of injury,
No telltale signs of pain,
Only flashbacks and the nightmares
Time and Time again.
But all’s not lost for us old friend
There are those that understand
Just let them lead us through the darkness
Go with them hand in hand
  P,T.S.D. is a state of the mind, that leaves our minds in a state
Poem written by former soldier on

4. Diagnosis Typical symptoms: DSM IV Criteria:
Exposure to a traumatic event, or series of events as well as symptoms from each of the following clusters:
Intrusive recollections
Avoidant or numbing symptoms
Hyperarousal, anxiety symptoms
Symptoms persist for > 1 month & cause significant levels of distress or impairment in social functioning.

5. What is a traumatic stressor?
Experiences of soldiers, Sudden bereavement, traumatised images of death & destruction on TV, bullying and abuse.
Typical patients are frequent primary care users and have high rates of somatic symptoms. Not always presenting with classic PTSD symptoms, so screen

6. Management Debriefing after disasters should not be routine
Consider watchful waiting when symptoms are mild and <4wks. Arrange follow-up in 1 months time.
Trauma focused CBT if symptoms. If symptoms present >3months after trauma- consider trauma focused psychological treatment (CBT or EMDR)
Drugs (not routine 1st line) For use by mental health specialists
Drugs inc Paroxetine, mirtazepine, amitryptilline. Treatment for 12 months

7. Voluntary/charity organisations
Department of Defence Mental Health (London)
– Charity organisation set up by the Ex Services Mental Welfare Society (80 years service). They provide assessment and therapies inc CBT and EMDR (nice recommends)
– set up by fellow PTSD sufferers and provide contact and links
References:
1 Ollf, M. Coping with the aftermath of trauma, Editorial, BMJ  2005;330:
2 Nice Guidelines: