PTSD- NURSING

1. POST TRAUMATIC
STRESS DISORDER

2. INTRODUCTION
 Disorder driven by pathogenic memories
of past danger.
 Symptoms must last for more than one
month.

3.  PTSD can occur in persons who witnessed
an extraordinarily terrifying and
potentially deadly event. After traumatic
event the person re experiences all or
some of it through dreams or waking
recollections and responds defensively to
these flashbacks.

4. EPONYMS OF PTSD
 CIVIL WAR: IRRITABLE HEART
 WORLD WAR I : SHELL SHOCK/ EFFORT
SYNDROME
 WORLD WAR II : COMBAT STRESS
SYNDROME
 VIETNAM WAR: CONCEPT OF PTSD
 PTSD ENTERED IN DSM III IN 1980

5. DEFINITION
 PTSD is described as the development of
characteristic symptoms following
exposure to an extreme traumatic stress
or involving a personal threat to physical
integrity or to the physical integrity of
others.

6. EPIDEMIOLOGY
 Life time prevalence is about 8% in
general population
 10-12% among women
 5-6% among men
 Higher in women, single, divorced ,
widowed , socially withdrawn or low socio
economic class
 Sexual assault
 Sudden unexpected death of a loved one
and road traffic accidents

7. ETIOLOGY
 PSYCHOSOCIAL THEORY:
Green, Wilson and Lindy have proposed
an etiological model of PTSD that has
become widely accepted. This explains
why certain persons exposed to massive
trauma develops PTSD and others do not.
The variables include,

8. THE TRAUMATIC EXPERIENCE
 The specific characteristics related to
trauma
 Severity and duration of the stressor
 Degree of anticipatory preparation prior to
the onset
 Numbers of affected by life threat
 Location where in trauma was experienced

9. THE INDIVIDUAL
 FACTORS RELATED TO INDIVIDUALS
RESPONSE TO TRAUMA
 Degree of ego strength
 Effectiveness of coping resources
 Presence of preexisting psychopathology
 Behavior tendencies
 Current stage of psychosocial development
 Demographic factors

10. THE RECOVERY ENVIRONMENT
 The quality of the environment where the
individual attempt to work.
 Availability of social support
 Supportiveness of family and friends
 Attitude of society regarding the
experience

11. OTHER CAUSES
 Co-morbid psychiatric disorders
 Certain personality traits
 Traumatic painful experiences
 Witnessing abuse inflicted on others
 Witnessing kidnapping, robbery
 Automobile accidents
 Inadequate system
 Serious injury or death of loved one

12. TYPES OF PTSD
 ACUTE PTSD: subsides after a duration of
few weeks to 3 months.
 CHRONIC PTSD: if the symptoms persist
beyond 3 months
 DELAYED PTSD: it may progress to months,
years and decades after the event;
endures personality changes.

13. CLINICAL FEATURES
 Re- experiencing of the traumatic event
 A sustained and high levels of anxiety
 Intrusive recollections or nightmares of the
event
 Some are unable to remember some
aspects of the trauma
 Features of depression
 Restlessness
 Insomnia
 Aggressiveness

14.  Memory loss about an aspect of traumatic
event
 Hyper arousal: state of nervousness
 Avoidance: individual strives to avoid
contact with everything and everyone
 Hyper vigilance: close attention to and
anticipation of approaching danger

15. DIAGNOSTIC CRITERIA
 ICD 10
 Significant evidence of trauma
 Onset with in 6 months of traumatic event
 Repetitive, intrusive recollection of the
event in memories
 Daytime imagery or dreams
 Conspicuous emotional detachment
 Numbness of feelings
 Avoidance of stimuli that might arouse
recollection of the trauma

16. MANAGEMENT
 Co-morbid depression – treat PTSD first
 Substance dependence should be
addressed first before treating PTSD
 Support, encouragement to discuss the
event and education about a variety of
coping mechanisms
 Sedatives and hypnotics can be helpful

17. PHARMACOTHERAPY
 ANTIDEPRESSANTS
 SSRI
 TCA
 MAOIS

18.  ANTICONVULSANTS
 BENZODIAZEPINES

19. EXPOSURE TREATMENT
 IMAGINAL EXPOSURE
 IN-VIVO EXPOSURE: going to the site of
traumatic event./ driving again after a
road traffic accidents
 Exposure is repeated until the patient no
longer responds with high levels of distress.
 Helps in decreasing dysfunctional beliefs
about danger.

20. EYE MOVEMENT DESENSITIZATION
REPROCESSING