Trauma- and stress-related disorders are a group of psychiatric disorders that arise following a life-threatening or traumatic event. They include acute stress disorder, adjustment disorder, and post-traumatic stress disorder, with the last one PTSD being the most challenging of these three disorders. So we will spend a little bit more time on this topic during this lecture.
• The component that is common in all these disorders is having been exposed to trauma- or a traumatic event that was life threatening. Trauma can come in different forms and in all faces
• Child and early physical and emotional abuse
• Domestic abuse and violence/
• War-related terrors
• And major natural and man-made catastrophes
• And this year we have experienced a collective upheaval that has led to traumatic events experienced by millions around the world.
The primary symptoms for PTSD include Re-experiencing the trauma. For example, distressing, vivid memories of the trauma that come as sudden flashes of the scene, accompanied by feelings of fear reminiscent of the original experience.
Avoidance of things that remind one of the trauma. For example, avoiding thoughts of the trauma, or avoiding activities or situations that remind one of the trauma, amnesia for parts of the trauma, feelings of detachment from others, feelings of numbness to emotions.
Increased tenseness and heightened awareness. For example, hyper-vigilance (always being exceptionally watchful of potential danger) and exaggerated startle response (jumping or reacting strongly when surprised or frightened)
CRH is increased and its associated with the cardinals features of PTSD (hyperarousal, startle responses, conditioned fear response. CRH is also very important for the stress response. That is why CRH has been targeted as a topic for research looking for therapeutics–
Catecholamines have been thought to also be related. NE is associated with enhanced arousal and with sympathetic nervous system activity. But also the flood of NE that happens during acute trauma may be responsible for encoding the emotional response associated with stress.
Serotonin is also involved — research has shown that 5hT2 recepto (modulate anxiogenic effects – turn up the effect of anxiety and fear) on the other hand 5-HT1 mediate anxiolytic effects. There is interest in developing medications that target these specific receptors to try to deal with PTSD.
5-HT is also involved in symptoms such as impulsivity, hostility, aggression, and suicidality.
PTSD is also associated with fewer GABA receptors (GABA is inhibitory neurotransmeter that helps to calm down multiple systems.
ON TH EOTHER HAND Glutamate is increased (It’s a stimulatory transmitter- and can contribute to neurotoxic effects of stress and trauma)
Also, lower NPY (which is an anxilytic) in those who develop PTSD
Endogenous opiates (which are also anxiolytics) are also lower- so during trauma that may not kick in to help, which how this system would behave normally- but may be in some individuals it does not work efficiently
The base rate can increase depending on location of events and proximity to these events, and in this year of the COVID pandemic data are already coming out indicating a third of patients hospitalized with COVID-related symptoms meet the diagnostic criteria for PTSD.
This was a study conducting last Spring as the pandemic was spreading. So with the severity and the spread since then this rate and the total number of affected individuals would be larger and the effects may not only be limited to hospitalized patients but to their loved ones and to health workers
Although treatment to dates are only modestly effective, there has been a lot of exciting research to advance treatment and will likely make a big difference in the future.
One of the available treatments is cognitive behavioral therapy:
This treatment focuses on the traumatic event and how thoughts related to it have affected the patient’s life.
Activities may include identifying details about what happened.
As an example, a patient may have been blaming themselves for something related to the event. Treatment here helps the patient take into account all the things that were beyond their control, so they can move forward, understanding and accepting that, deep down, it wasn’t their fault, despite things they did or didn’t do.
8-12 sessions can have significant effects in addressing the PTSD
Education and Stress Inoculation Training can be helpful
It is a type of CBT where the focus is more on changing how you deal with the stress from the event.
A patient might learn breathing techniques and other ways to stop negative thoughts by relaxing your mind and body. It takes about 3 months of exercises.
محاضرة للدكتور مصطفى العبسي بروفيسور في كلية الطب جامعة منسوتاعن الصدمات النفسيه وثارها