Under the CIE-10 code “F43.1” we find post-traumatic stress disorder or PTSD.
This is a disorder that occurs as a late response to a stressful eventuality or to a situation (brief or lasting) of an extremely threatening or catastrophic nature, which in itself would cause great generalized unrest in almost the entire population (for example, natural or man-made disasters such as armed combat, serious accidents or witness the violent death of a person in addition to being the victim of torture, terrorism, rape or any other extremely serious crime).
Then we will do a quick review of the basic information about the diagnosis and treatment of PTSD.
Risk factors for this disorder
The risk factors that have been taken into account can trigger PTSD are:
- Age at which trauma occurs
- Personal history of psychiatric history
- Report child abuse or other adverse events
- Family history of psychiatric illness
- Severity of trauma
- post-traumatic stress
- Post-traumatic social support
In turn, the most common traumatic events are:
- Threat, sexual harassment by telephone
- Witness of violent acts
- physical attack
- warrior fight
Initial treatment for PTSD
In subjects with PTSD, evidence from randomized controlled clinical trials supports initiation of treatment with psychotherapeutic strategies in addition to use of secondary serotonin reuptake inhibitors (SSRIs) as the first line of intervention.
Regarding psychotherapy, cognitive behavioral therapy has been shown to be effective by reducing the symptoms presented and prevention of symptomatic recurrence of the seizure.
Treatment strategies for symptoms appearing 1 to 3 months after the initiating event are known to be different from those that can be used in symptoms present or resolved after 3 months of exposure to the event. Recovery in the first three months after the traumatic event is considered almost the general rule.
General guidelines in managing the disorder
Here are other general guidelines that are followed in the initial treatment of this disorder:
- Develop a management plan taking into account the characteristics of the subject, the type of traumatic event, the history, the severity of the damage.
- From the start, the plan must detail the selected treatment as well as the time and expected results. If the management plan is incorporated sequentially, this will allow an assessment of the effects of the treatment.
- The healthcare professional can more easily identify any changes during the treatment process, such as worsening, improvement or the appearance of another symptom.
- It is recommended to start treatment with paroxetine or sertraline according to the following scheme: Paroxetine: 20 to 40 mg. maximum 60 mg. Sertraline: Start with 50-100 mg. and increase 50 mg. every 5 days up to a maximum of 200 mg.
- The use of neuroleptics as monotherapy for PTSD is not recommended. Atypical neuroleptics such as olanzapine or risperidone should be used for the management of associated psychotic symptoms.
- In patients who persist with severe nightmares despite the use of SSRIs, it is suggested to add topiramate 50 to 150 mg.
- It is recommended that prazocin be added to SSRI therapy in patients who persist with nightmares associated with PTSD and who have not responded to topiramate therapy.
Psychological treatment in adults
Cognitive behavioral therapy is the most effective strategy to reduce symptoms and prevent recurrence. The programs in which cognitive behavioral therapy is integrated are classified into three groups:
- Trauma-focused (individual treatment)
- Focused on the use of stress (individual treatment)
- Group therapy
Brief psychological interventions (5 sessions) can be effective if treatment is started in the first months after the traumatic event. In turn, the treatment should be regular and continuous (at least once a week) and should be administered by the therapist himself.
All subjects exhibiting symptoms related to PTSD should be integrated into a therapeutic program with the cognitive-behavioral technique, focused on the trauma. It is important to consider the time since the event and the onset of symptoms of PTSD in defining the treatment plan.
For chronic PTSDTrauma-focused cognitive behavioral psychotherapy should be delivered 8 to 12 sessions, at least once a week, always taught by the same therapist.
In children and adolescents: diagnosis and treatment
One of the important factors in the development of PTSD in children is related to the parental reaction to the trauma of the children. It should also be borne in mind that the presence of negative factors in the family leads to an aggravation of the trauma, and that the abuse of psychotropic substances or alcohol by the parents, the presence of a crime, divorce and / or parental separation, or the physical loss of one parent at an early age, are some of the most common factors in children with PTSD.
In preschool children the presentation of symptoms related to PTSD is not specific, given their limitations in cognitive and verbal expression skills.
cal look for symptoms of generalized anxiety disorder appropriate to their level of development, Such as separation anxiety, anxiety towards strangers, fear of monsters or animals, avoiding situations that may or may not be related to trauma, sleep disturbance, and worry about certain words or symbols that may or may not have an apparent connection to the trauma.
In children aged 6 to 11 years, the characteristic clinical picture of PTSD is:
- Representation of trauma in play, drawings or verbalizations
- Distorted sense of time in what corresponds to the traumatic episode.
- Sleep disorders: dreams of trauma that can generalize into nightmares on monsters, rescues, threats against him or others.
- They may believe that there are different signs or omens that will help or serve as a warning when faced with trauma or disaster.
- In these children, it does not make sense to talk about a bleak future, because due to their level of development, they have not yet acquired the prospect of the future.
Other indications for intervention in underage patients
Trauma-focused cognitive behavioral psychotherapy is recommended for children with severe symptoms of PTSD in the first month after the traumatic event. This psychotherapy must be adapted to the age of the child, Circumstances and level of development.
It is important to consider give information to the child’s parents or guardians when these are treated in an emergency department by a traumatic event. Briefly explain the symptoms that the child may have, such as changes in sleep state, nightmares, difficulty concentrating and irritability, suggest having a medical examination when these symptoms persist for more than one month.
Trauma-focused cognitive behavioral therapy is the treatment strategy that should be offered to all children who present with severe symptoms of PTSD during the first month.
- At the children under 7 years of age, pharmacological treatment with SSRIs is not recommended.
- In children over 7 years old pharmacological treatment should not be considered routineThe condition and severity of symptoms in addition to comorbidity should be assessed.
- In the case of chronic PTSD, trauma-based cognitive behavioral psychotherapy should be given 8 to 12 sessions, at least once a week, always taught by the same therapist.