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Post-Traumatic Stress Disorder

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder
Prevalence 3.6-8.0% of U.S. adults
May occur at any age; triggered by trauma
Women more likely affected
Minority groups have much higher rates of PTSD than do non-Hispanic white persons
30% of the men and women who have spent time in the war zones

Pathophysiology
Reduced hippocampal volume among those exposed to combat trauma, sexual assault, or MVA's

Increased regional cerebral blood flow to limbic and paralimbic areas esp. right amygdala, decreased blood flow to Broca's area in the left temporal lobe

Sympathetic nervous system activation
Autonomic hyperresponsiveness to both neutral and trauma-related stimuli
Elevated urinary catecholamine levels
Downregulation of beta- and alpha-2 adrenergic receptors
Increased reactivity to the alpha-2 antagonist, yohimbine
Hypothalamic-Pituitary-Adrenocortical mobilization

Lower urinary cortisol levels

Elevated lymphocyte glucocorticoid receptor levels

Dexamethasone supersuppression
Other theories of causation
Acoustic startle-response
Shorter latency and increased amplitude of the acoustic-startle-eyeblink reflex
Significant loss of the normal inhibitory modulation of the startle reflex
Resistance to habituation of the startle response
Fear conditioning
Appraisal

DSM-IV-TR
The person experienced or witnessed an event that involved death or serious injury, or the threat of death or serious injury; response to the event involved intense fear, horror, or a sense of helplessness

Relived experiences of the event, such as having distressing images and memories, upsetting dreams, flashbacks, or physical reactions
DSM-IV-TR Cont'd
Persistent avoidance of situations or things that remind the person of the traumatic event or feeling of emotional numbness

Feeling as if constantly on guard or alert for signs of danger, which may cause difficulty sleeping or concentrating

Symptoms last longer than one month
Acute:...