1. PTSD Besher Mousa Basha Medical student Al-Ma’arefa Colleges

2. Presentation outline The definition of PTSD. Causes of PTSD. Risk factor. Symptoms of PTSD. The management.

3. Introduction -Post traumatic stress disorder, or PTSD, is a commen disorder in which a person experiences disabling anxiety after trumatic event. -People with PTSD cannot stop thinking about the traumatic event and, in many cases, relive the event repeatedly

4. PTSD can lead to other problems, such as depression and alcoholism or smoking. It can also get in the way of work, daily activities and relationships.

5. Case study Sara 17 years old, student, single. came to psychiatric clinic Suffering from severe trauma exposed, She has been raped by armed men who broke into her home and killed her parents in front of her eyes during the war in Syria. she has been having these episodes for the past 4 months and it comes when she sees his parent's room or walk near the place where the event happened which made here go out of her home and avoid any other reminder of the incident. she has been having nightmares and flashbacks of the incident lately which made here depressed and anxious. These symptoms affected his life style in a lack of appetite, disturbance of sleep,Loss of social relationships and does not going to school. she does not use any medication now and does not suffer any other psychiatric illness. No one from her family has psychiatric illness.

6. What is the PTSD Post-traumatic stress disorder (PTSD) is a debilitating mental disorder that follows experiencing or witnessing an extremely traumatic, tragic, or terrifying event.

8. Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety as, War. Rape or sexual abuse. Kidnapping or torture. A car accident or plane crash. A natural disaster such as a flood, earthquake or hurricane. More extreme and prolonged the threat = The greater the risk of developing PTSD

9. Risk Factor 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

10. Recent brain imaging studies place emphasis on two brain structures: the amygdala and hippocampus. The amygdala is involved with how we learn about fear. and there is some evidence that this structure is hyperactive in people with PTSD The hippocampus plays an important role in the formation of memory, and there is some evidence that in people with PTSD there is a loss of volume in this structure, perhaps accounting for some of the memory deficits and other symptoms in PTSD.

12. Symptoms & Diagnosis Criterion Traumatic event Re- experiencing the traumatic event Avoidance and numbing Increased anxiety and emotional arousal Duration of symptoms last more than 1 month

13. Trauma survivors must have been exposed to actual or threatened: -Death -Serious injury -sexual violence The exposure can be: direct witnessed indirect, by hearing of a relative or close friend who has experienced the event—indirectly experienced death must be accidental or violent Traumatic event

14. NightmaresFlashbacks Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating) Feelings of intense distress when reminded of the trauma Re-experiencing the traumatic event

15. Avoiding activities, places, thoughts, or feelings that remind you of 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 Avoidance and numbing

16. Difficulty falling or staying asleepIrritability or outbursts of anger Difficulty concentrating Hyper vigilance (on constant “red alert”) Increased anxiety and emotional arousal

17. Other common symptoms of post-traumatic stress disorder PTSD Onset of the PTSD is usually after a latency period ( usually 1 month )

18. Differential Diagnosis 1- Anxiety disorder. 2- Head injury sequence ( if the traumatic event has include injury to the head, e.g. road accident ) 3- substance abuse ( intoxication or withdrawal ) 4- adjustment disorder ( usual life stress )

19. Psychological ( Major approach ) Support – reassurance – explanation – education. Exposure therapy. This therapy helps people face and control their fear. It exposes them to the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings. Cognitive restructuring. This therapy helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.

20. Eye movement desensitization and reprocessing (EMDR) : is another type of therapy for PTSD. Like other kinds of counseling, it can help change how you react to memories of your trauma. Pharmacological approach : Symptomatic treatment : Anxiolytics such as alprazolam. Antidepressants such as selective serotonin reuptake inhibitors (sertraline) or tricyclic antidepressants.

21. Prognosis : Good If : 1- the person is cooperative with treatment and has healthy premorbid function. 2- the trauma was not severe or prolonged. 3- early intervention and social support exist.

22. Refrences Basic psychiatry, Prof. mohammed alsughayir www.psychcentral.com www.ptsd.va.gov www.helpguide.org https://www.youtube.com/watch?v=ZGWSSUNXn4A