Post-Traumatic Stress Disorder

Table of Contents

Introduction………………………………………………………………………………………..3
Risk Factors……………………………………………………………………………………….3
Pathophysiology…………………………………………………………………………………...4
Clinical manifestation……………………………………………………………………………..5
Diagnostic criteria…………………………………………………………………………………5
Laboratory and Diagnostic test……………………………………………………………………6
Evaluation & Treatment…………………………………………………………………………...6
Prognosis…………………………………………………………………………………………..6
Summary…………………………………………………………………………………………..7


There are hundreds of different kinds of psychiatric disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). One of them is called Post-traumatic stress disorder (PTSD). Based on the research, post-traumatic disorder usually occurs following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape (Harvard Women's Health Watch, 2005). The purpose of this paper is to discuss the risk factors, pathophysiology, clinical manifestation, diagnostic criteria and tests, treatment, prognosis and future research and approaches to treat this psychiatric illness of post-traumatic stress disorder.
Risk Factors
As to all other kinds of disorders, determining the risk factors is a major influential aspect of a person's life in exposing herself to such diseases and illnesses. The factors that put people at risk for post-traumatic disorder are having a history of physical, emotional and sexual abuse. In addition to that, people who have been abused as children or who have had other previous traumatic experiences at a time in their lives are more highly to develop the disorder (Harvard Women's Health Watch, 2005). Other risk factors that contribute to PTSD include motor vehicle crashes, disasters, torture, and comorbid substance abuse (Miller, 2000). The most common precipitating events for PTSD in women were rape and physical assault. For men, physical assault and other traumas were the most prevalent. However, both genders are at heightened risk for PTSD when it comes to motor vehicle accidents. These are the major risk factors people may face that predict the likelihood of post-traumatic stress disorder to occur. Furthermore, according to Harvard Women's Health Watch 2005, people do not necessary have to encounter the traumatic events directly in order for PTSD to develop.

Pathophysiology
Until now, there has not been a definite understanding of how post-traumatic stress disorder occurs in the brain. The exploration into its pathophysiology is fairly recent. However, there is research around it discussing about PTSD's pathophysiology and coming to a complete understanding. In a normal person without the disorder, a stress hormone, adrenaline, releases from the body and prepares it to flee or fight from any stressful, traumatic events. "In the brain, adrenaline and the brain chemical norepinephrine stimulate the amygdala, a deep brain structure that spurs the formation of vivid, emotional memories of the threat," (Harvard Women's Health Watch, 2005, p. 5). In contrast, a post-traumatic stress disorder person's system would seem to be oversensitive. Source says the amygdala may look to be over reactive in PTSD, but it posts a question upon if the amygdala is already over reactive in itself or it could naturally be over reactive responding to trauma (Harvard Women's Health Watch, 2005). With the help of imaging techniques and its imaging studies, it shows that the hippocampus and the anterior cingulated cortex found to be smaller in PTSD. The two areas of the brain which help maintain the amygdala in check seem to have trouble functioning properly in people with PSTD (Harvard Women's Health Watch, 2005). Another thought that involves the pathophysiology of PTSD is the role of basal catecholamines. However, the subject is controversial (Miller, 2000). There has been a hypothesis made that cerebrospinal fluid (CSF) corticotrophin-releasing hormone (CRH) concentrations increase in people with PTSD from a study comparing combat veterans and normal volunteers (Miller, 2000). As with any disorder of the brain, the complexities of PTSD are extensive and require a lot of integrating components. Therefore, the pathophysiology of PTSD is unclear.

Clinical Manifestation
Post-traumatic stress disorder falls into three general categories of symptoms: Intrusion, avoidance, and arousal. Intrusion is repeatedly re-living the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma, causing intense emotional and physical distress (Harvard Women's Health Watch, 2005).
Second category of PTSD symptoms, avoidance, involves the numbing of general responsiveness and the avoidance of stimuli associated with the trauma. Those include places, thoughts, activities, and many more (Harvard Women's Health Watch, 2005).
Finally, symptoms of arousal include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, and an easy startle response (Harvard Women's Health Watch, 2005). These symptoms are usually experienced after a trauma and are considered chronic PTSD if lasting more than three months.
Having diagnosed with PTSD can also manifest other disorders as symptoms such as depression, anxiety disorder.
Diagnostic Criteria
Four categories of criteria are needed to accurately diagnose PTSD (Table 1).
First, a traumatic event occurred in which the person witnessed or experienced actual or threatened death or serious injury and responded with intense fear, horror or helplessness. Second, on exposure to memory cues, the person has re-experiencing symptoms, such as intrusive recollections, nightmares, flashbacks or psychologic distress. Third, the patient avoids trauma-related stimuli and feels emotionally numb. Fourth, the person has increased arousal, manifested by hypervigilance, irritability or difficulty sleeping. The symptoms persist for at least one month and significantly disturb the patient's social or occupational functioning (American Psychiatric Association, 1994).
Laboratory and Diagnostic Tests
There are no tests that can be done to make the diagnosis of PTSD. The diagnosis is made based on a certain set of symptoms that persist after a history of extreme trauma. Doctor does psychiatric and physical examinations to rule out other illnesses. Table 1 is a list of criteria that clinicians use to diagnose PTSD. See Appedix A. A diagnostic screening questionnair screens people to find who is positive for PTSD, but this tool does not necessary diagnosed them with PTSD. Those who are positive for PTSD are referred for consultation with a structured interview (Miller, 2000). See Appendix B for questionnaires.
Evaluation and Treatment
"… treatment isn't a bout forgetting a trauma or feeling as if it never happened. The goal is to eliminate or reduce its ability to dirupt your life," (Harvard Women's Health Watch, 2005, p. 5). Research has demonstrated the effectiveness of cognitive-behavioral therapy, group therapy, and exposure therapy, in which the patient repeatedly relives the frightening experience under controlled conditions to help him or her work through the trauma. Medications have also been shown to help ease the symptoms of depression and anxiety and help promote sleep: SSRIs (Harvard Women's Health Watch, 2005). See Appendix C. Treating a disorder whose components are not fully understood is a little bit difficult.
Prognosis
The best outcome of PTSD depends on some factors. The factors include whether it was a simple trauma or a complicated one. A single traumatic event or a short period of a trauma happens later on in life minus the involvement of human violence is considered as simple trauma (Miller, 2000). On the other hand, complicated trauma is the opposite. It involves a series of events over a long duration and usually starts in childhood (Miller, 2000). One would think that receiving treatment early would help with the onset and progress with the disorder. However, it is unfortunate that it does not work that way. "An expert review of studies by the international nonprofit Cochrane Collaboration concluded that it may interfere with natural recovery from trauma and should be compulsory for any trauma victims, (Harvard Women's Health Watch, 2005).
Summary
Overall, if understanding the pathophysiology of post-traumatic stress disorder is unclear, then there is not really a potent treatment to PTSD. However, the future holds a lot of key ideas to potential treatments in PTSD. A relatively new therapy called Eye Movement Desensitization and Reprocessing (EMDR) has shown to be effective, but not all mental health practitioners know the method due to its recency (Miller, 2000). Another new brief treatment called Metacognitive therapy is say to process "the strengthening of a cognitive plan that can guide thinking and behaviour in future potential encounters with trauma…," (Wells & Sembi, 2004, p. 308). Future research also includes postmortem brain studies because it is significant in understanding psychiatric disorders to the neurobiology level (Soboslay, Martin, & Kleinman, 2004). Scientists are attempting to determine which treatments work best for which type of trauma.