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By Rosabel Zohfeld, MSN, APRN, FNP-C
Post-traumatic stress disorder (PTSD) is a severe, disabling, and often chronic condition. PTSD develops mostly following exposure to a traumatic event involving actual or threatened injury to the individual or others. While most individuals experience trauma to some degree during their lifetime, patients with Post-traumatic stress disorder have marked cognitive, affective, and behavioral responses to stimuli that lead to severe anxiety, flashback, and combative behavior. Individuals with PTSD may try coping by avoiding the triggers that may elicit their symptoms, leading to emotional numbing, detachment from others, and decreased interest in everyday life activities. According to The National Comorbidity Survey, 16% of those with PTSD have at least one coexisting psychiatric disorder. In comparison, 17% can have two psychiatric disorders, and 50% have three or more coexisting conditions such as depression, anxiety, substance abuse, and others. Alcohol and other substance abuse are more prevalent among people living with PTSD.
PTSD increases the occurrence of borderline personality disorder (BPD) and antisocial personality disorder (APD). Individuals with two or more comorbid conditions are more likely to attempt suicide. Somatic symptoms are much more likely in patients with PTSD than in those without the disorder.
PTSD is associated with a range of physical health conditions, including:
• Bone and joint, neurologic, cardiovascular, respiratory, and metabolic disease
• Cardiovascular and pulmonary risk factors, including obesity, dyslipidemia, tobacco use, hypertension, and type II diabetes in women.
• Angina, heart failure, asthma, bronchitis, liver disease and peripheral artery disease, myocardial infarction, autoimmune and endocrine disorders.
• Accelerated aging, traumatic brain injury (TBI), among others.
Individuals with one or more PTSD symptoms are more likely to experience:
• occupational problems,
• have lower social support
• higher rates of problems in intimate relationships, including marital difficulties, compared with people without the disorder
Is there any help for PTSD?
Psychotherapy improves the overall psychosocial functioning cognitive-behavioral therapy strategy for reducing PTSD symptom severity. Patients with possible PTSD should receive a comprehensive psychiatric assessment. A diagnosis of PTSD begins with patients six years of age and older who meet the DSM-5 criteria, which include: experiencing or witnessing a severe, traumatic event resulting in symptoms in each of four categories (intrusion, adverse alteration in mood and cognition, avoidance, and arousal); social or occupational impairment; and signs and impairment lasting at least one month after the trauma.
The therapeutic goals of pharmacologic therapy for those individuals with PTSD are to decrease intrusive thoughts and images, phobic avoidance, irritability and anger, pathological hyperarousal, hypervigilance, and depression. Drug therapies are generally more effective in reducing hyperarousal and mood (irritability, anger, depression) symptoms. They are less useful for re-experiencing, emotional numbing, and behavioral avoidance; individual responses generally outweigh treatment-specific differences.
Some of the drug classes used in the pharmacologic treatment of PTSD may include:
• Serotonin reuptake inhibitors (SRIs): Sertraline, Paroxetine, Escitalopram
• Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine, Citalopram
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): Duloxetine
• Second-generation antipsychotics (SGAs): aripiprazole, clozapine, risperidone
• Monotherapy: quetiapine and other SGAs reduce PTSD symptoms in military and non-military patients.
• Drug Augmentation: Use of SRIs + SSRIs
• Alpha-adrenergic receptor blockers — prazosin
• Benzodiazepines — alprazolam, clonazepam, Diazepam
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Other medications may include:
• Other antidepressants (trazodone) or atypical antidepressants ( mirtazapine)
• Beta-adrenergic receptor blockers – such as propranolol in the early prevention or subsequent treatment of PTSD
• Mood stabilizers – Anticonvulsant medications with mood-stabilizing properties such as Tiagabine, Topiramate, Divalproex.
• Ketamine, an N-methyl-D-aspartic acid antagonist used as an anesthetic and understudy in depression, reduced PTSD symptoms in a clinical trial
• Cannabis
• Nabilone: A test of the synthetic cannabinoid in patients with difficult-to-treat PTSD Duration of Treatment
Effective oral medication treatment should be continued for at least 6-12 months to prevent relapse and recurrence.
When should I get help?
If you are having trouble coping because of your PTSD symptoms, you should do one or both of the following:
• Seek medical attention to start treatment with medicine
• See a therapist who is trained in CBT to start therapy
If you are thinking of hurting yourself, or if you feel that life isn't worth living, you should get help right away:
• If you see a therapist or doctor for your PTSD, call them immediately. If you do not see a therapist or health provider, call 911 or go to the emergency room.
Sources:
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