Post-traumatic stress disorder (PTSD)

PTSD is a disorder that wasn't properly recognized as a real psychiatric problem up until the Vietnam war. PTSD is one of those disorders that benefits from early treatment with shorter duration and less severe symptoms. 

• PTSD
  • Life-threatening stressor leading to a disorder
  • Severity depends on the stressor and its proximity to the patient 
  • Furthermore, certain people are more vulnerable to PTSD
  • Stressor types
    • 
    • Actual death of someone 
    • Threatened death 
    • Combat 
    • Survivors of sexual abuse 
    • Survivors of physical abuse and neglect 
  • Proximity 
    • Experienced by the patient 
    • Witnessed by the patient 
    • Told to the patient (especially when family members are exposed)
    • Post-trauma presence - paramedics, firefighters, police officers...
    •  
  • Disorder symptoms 
    • Intrusion
      • Memories, flashbacks
    • Mood changes
      • [Almost always] Depressed mood 
    • Dissociation 
      • Depersonalization 
    • Avoidance 
      • Avoiding the location, people or conversations 
    • Arousal  
      • Hypervigilance 
      • Looking for danger 
  • Diagnosis - designed to lower the number of false negatives
    • Shorter than 1 month = Acute stress disorder 
      • Treatment at this stage very effective
    • Longer than 1 month = PTSD 
      • Treatment more difficult 
  • Treatment 
    • Psychotherapy is the best - group therapy 
      • Can be problematic to some people who have developed avoidance 
    • Medical therapy 
      • Chronic 
        • SSRIs
      • Acute - for panic attacks 
        • Benzodiazepines 
• Adjustment disorder
  • 
  • Life-changing (non-life threatening) stressor leading to a disorder
  • Mood changes can be present but no mood disorder is present 
  • There is no psychosis, suicidal ideation, homicidal ideation
  • Diagnosis 
    • Onset within 3 months of the stressor 
    • Duration <6 months
  • Treatment 
    • Medical - none 
    • Therapy may be helpful  
• Reactive attachment disorder
  • 
  • Little pairing with others
  • Stressor 
    • Abuse or neglect in infancy 
    • Can be caused by parents or institutional care 
  • Learn to be lonely
    • Mood disorders 
    • Substance addictions 
    • Learning disabilities 
  • Diagnosis 
    • Made <5 years
    • Autism must be ruled out 
  •  Treatment 
    • Very difficult 
    • Targeted at the caregiver 
      • Give them resources 
    • Replace caregivers 
• Disinhibited social engagement disorder
  • 
  • Too much pairing with others 
  • Stressor 
    • Abuse or neglect in infancy 
    • Can be caused by parents or institutional care 
  • No difference between strangers and friends
  • Diagnosis 
    • Made <5 years
    • Autism must be ruled out 
  •  Treatment 
    • Very difficult 
    • Targeted at the caregiver 
      • Give them resources 
    • Replace caregivers