PTSD

In a lifetime approximately 70% of all people experience a significant trauma and over 1 in 3 experience 4 or more traumatic events. It is understandable then that with the psychologic and emotional challenges trauma brings to an individual about 2% of the population suffer from PTSD at any one time, while the overall lifetime prevalence is just under 10%. These lifetime rates increase to over 20% when risk factors involving occupation, such as those involving military service, fire fighting, Para medic are considered. However additional risk factors include, interpersonal violence exposure, childhood trauma, previous history of mental health disorders, poor education levels, multiple traumatic event exposure, situations involving events that are inescapable, unpredictable and uncontrollable, severity of trauma and events which involve fear of death. Additionally co-morbidity involving substance abuse, anxiety states and depression are commonly reported at approximately 50%.

Features of PTSD can be considered within four general  symptomatic groupings. These are related to

1)arousal, including sleep disturbance, hyper-vigilance, aggression.

2) avoidance, including avoiding anything that provokes memories of the traumatic situation.

3)negative emotions and cognition, including feelings of emotional constriction, alienation, distorted sense of attribution about blame.

4) trauma re-experiencing, including nightmares, recurrent intrusive thoughts.

 

There is a genetic predisposition to the development of PTSD in FKBP5 gene polymorphism. The pathology of PTSD involves several aspects of brain function including fear associations (involving the amygdala) threat detection (involving the anterior cingulate gyrus and insular) , executive function (involving the fronto-parietal regions), and contextual  and memory processing (involving the prefrontal cortex and hippocampus).

 

Treatment for PTSD can include a number of modalities. Overall Cognitive Behavior Therapy is the most effective treatment, however depending on the clinical situation treatment emphasis on psychotherapy, Exposure Therapy, emotional regulation training, desensitisation, EMDR, Mindfulness Meditation, relaxation therapies are helpful.

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