This document discusses post-traumatic stress disorder (PTSD) and acute stress disorder (ASD). It defines PTSD as developing after exposure to a traumatic event that threatens safety or control. Symptoms include intrusive memories, avoidance behaviors, increased arousal, and persist for over a month. Effective treatment includes building trust, exposure therapy, and teaching coping skills to move from victim to survivor status. Medications may help reduce symptoms like anxiety, sleep issues, and mood changes.

1. Presented by:
Eric F. Pazziuagan, RN, MAN

2. Disorders
that can develop after
exposure to a clearly
identifiable traumatic event
that threatens the
self, others, resources, and/or
sense of control or hope.
The event overwhelms the
individual’s coping strategies.

3.  Community
violence, war, terrorist
attack, being a hostage or
POW, torture, disasters, bombings, f
atalities in fires or
accidents, catastrophic illness, gross
injury to self or others, childhood
sexual abuse, chronic abuse as a
child or adult, rape, assault, and
sudden or major personal losses.

4. 7.8
to 8% of American adults
Women are twice likely to have
PTSD

5.  Individual’s
pre-existing
characteristics and conditions
 Usual coping style and defense
mechanisms
 Personal and social resources
 Previous exposure to trauma
 Meaning of the event to the
individual

7.  ASD:
dissociative symptoms during or
immediately after the distressing event:
amnesia, depersonalization, derealization
, decreased awareness of
surroundings, numbing, detachment, or
lack of emotional response,
 PTSD: not made because of initial
reactions at the time of the trauma but is
based on characteristic symptoms that
occur 1 month after the trauma.

8.  PTSD
may be unrecognized for years (even 10-20
years).
 Persistent attempt to avoid situations,
activities, and sometimes even people who
might evoke memories of the trauma.
 Denial, repression, and suppression are common
in both disorders.
 Constricted or blunted affect, or a limitation in
the range of feelings might occur.
 Might feel detached or estranged from family
and friends.
 Inability to trust might lead to withdrawal.
 Interest to activities is often lost.
 Perceptions of the future might change.

9.  Might
be in the form of intrusive, unwanted
memories, upsetting dreams or nightmares,
illusions, or suddenly the feeling as if the
event were recurring (flashbacks).
 PTSD: hallucination related to the event.
 Might have obvious connections to the
trauma or might not resemble the original
situation at all.
 Latter case, patients might try to avoid all
activities and people in an effort to prevent
reexperiencing the flashback.

10.  Increased
arousal, anxiety, restlessness, irritab
ility, disturbances in sleep, and
impairment in memory or
concentration.
 PTSD: occasional outbursts of anger
or rage and survivor guilt- guilt
about surviving or the actions to
survive.

11.  Psychological
and physiologic symptoms
that develop during exposure to situations
resembling the original trauma
(e.g., anxiety, panic attacks, GI
disorders, headache)
 Problems with grief, depression, suicidal
ideations and attempts, impulsive selfdestructive behaviors, anxiety-related
disorders, and substance abuse.
 Might appear
avoidant, schizoid, schizophrenic, paranoi
d or even manic (which complicate
treatment).

12.  Preexisting
psychiatric disorders, including
personality disorders can increase the risk.
 History of previous traumas leads to an
increased risk for PTSD after later traumas.
 Events in later life might trigger previously
unrecognized PTSD.
 Some difficulties:
arrests, unemployment, homelessness, abusi
veness, divorce and paranoia toward
authority figures or others whom the patient
sees as directly or indirectly responsible for
not helping with the original traumatic
situation.

13.  Common:
mistrust, isolation, abandonment
fears, workaholism, focusing on the need of
others, feelings of inadequacy, anger toward
God, unresolved grief, and fear of losing
control of emotions.
 Family members, friends, and co-workers
might develop problems as well, as
“secondary victims.”

15. Effective approach: prevent or minimize
symptoms.
 Application of critical incidence stress
management (CISM) principles to disaster
situations:

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Precrisis preparation
Large-scale demobilization procedures
Individual acute crisis counseling
Brief small group discussions (defusings)
Longer small group discussions (critical incident stress
debriefings or CISDs)
Family crisis intervention techniques
Follow-up procedures and/or referral for
psychological assessment or treatment

16. Goals of treatment:
 Progressive, intensive review of the traumatic
experiences (exposure therapy)
 Integration of the feelings and memories, often
from the least to the most painful.
 Moving from a victim status to a survivor
status, from “I can’t go on because of this” to “I
have learned from it and can go on with life.”
 Potential for growth and development of
improved coping skills, appreciation of value of
life, and enhanced relationships.


18.  First
priority: development of trust; might be
difficult.
 Other priorities: safety and security (risk of
suicide and aggression).
 Patients need to hear that they are not crazy
but are having typical reactions to a serious
trauma (teach about dynamics of ASD and
PTSD).
 Be prepared to hear horror stories about
hideous injuries, unpredicted behaviors, and
gross destruction.

19.  Gently
clarify connections between original
trauma and current feelings and problems.
 Patients need to evaluate their past behaviors
according to the original context of the
situation, not by current values and
standards.
 Specific techniques: exposure therapy
(imaginal or in vivo), systematic
desensitization, CBT, eye movement
desensitization and reprocessing.
 Safe verbalization of feelings, particularly
anger, that have been ignored or repressed.

Writing a journal, expressive therapt (art,music
or poetry).

20.  Empathy
and reassurance that they will be
safe and need to be taught relaxation
techniques, so they are not overwhelmed of
the anxiety.
 Take time to focus on emergent problems
and potential solutions.
 Encourage adaptive coping skills and use of
relaxation strategies.
 Discourage dysfunctional activities.
 Develop interpersonal skills and reestablish
relationships that provide and support and
assistance.
 Couple or family education and counselling.

22.  Benzodiazepines
(e.g., clonazepam) to
reduce levels of conditioned fear and anxiety
symptoms; might help with sleep
disturbances and nightmares; risk of
dependence.
 Clonidine and propranolol: diminish
peripheral autonomic response associated
with fear, anxiety, and nightmares.
 Valproic acid or carbamazepine: mood
swings, explosive outbursts and intense
feelings of being out of control; dcreases
hyperarousal, startle response, and
nightmares.

23.  SSRI
(paroxetine, escitalopram, and
sentraline): reverse continued
emergency responses and decreased
repetitive behaviors, disturbing
images, and somatic states.
 TCAs: depression, anhedonia, sleep
disturbances.
 Antipsychotics: if with psychotic
thinking; hyperarousal and sleep
disturbances; respiradone or
quetiapine to c=decrease flashbacks
and nightmares.

24.  Social
activities can help rebuild social
skills that have been damaged by
suspiciousness and withdrawal.
 Recreational and exercise programs can
help reduce tension and promote
relaxation.
 Groups: self-esteem, decision
making, assertiveness, anger
management, stress
management, relaxation techniques.
 Group meetings for victims.

26.  Be
nonjudgmental and honest; offer
empathy and support; acknowledge any
unfairness or injustices related to the
trauma.
 Assure patients that their feelings and
behaviors are typical reactions to serious
trauma.
 Help patients recognize the connections
between the trauma experience and their
current feelings, behaviors, and problems.
 Help patients evaluate past behaviors in the
context of the trauma, not in the context of
current values and standards.

27.  Encourage
safe verbalization of feelings,
especially anger.
 Encourage adaptive coping strategies,
exercise, relaxation techniques, and sleeppromoting strategies.
 Facilitate progressive review (imaginal or in
vivo) of the trauma and consequences.
 Encourage patients to establish or reestablish
relationships.