PTSD

• Management:

  • Referral to specialist mental health team
  • Psychological therapy e.g. trauma-focused CBT
  • EDMR
  • Medication can be started in primary care before specialist assessment - SSRI or venlafaxine first line - possible adjunctive antipsychotic
  • Psychoeducation, sleep hygiene and relaxation
• EDMR:

  • Eye movement desensitisation and reprocessing
  • Processing traumatic memories while performing specific eye movements
  • Improperly stored traumatic memories are reprocessed and stored again in a more normal way so they no longer cause as much distress
• Overview:

  • May develop following exposure to an extremely threatening/horrific event or series of events
  • Thought to result from impaired memory consolidation or experiences too traumatic to be processed normally
  • Leads to a chronic hyperarousal of fear circuits
  • Females more likely than males to develop PTSD after the traumatic event
• Characteristic features of PTSD include (remember using the mnemonic HARD):

  • Hyperarousal: persistently heightened perception of current threat (may include enhanced startle reaction)
  • Avoidance of situations/activities reminiscent of the events, or of thoughts/memories of the events
  • Re-experiencing the traumatic events (vivid intrusive memories, flashbacks, or nightmares).
  • Distress: strong/overwhelming fear and physical sensations when re-experiencing
• Other symptoms:

  • Negative emotions - fear, anger, guilt or worthlessness
  • Negative beliefs e.g. the world is dangerous
  • Difficulty with sleep
  • Depersonalisation
  • Derealisation
  • Emotional numbing
• The Trauma Screening Questionnaire (TSQ) can be used as a screening tool, prompting a referral for further assessment.

  Diagnosis is based on criteria from either:

  • Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
  • International Classification of Diseases (ICD-11)