Teaching Point | PTSD

Date: /2017

Post-Traumatic Stress Disorder (PTSD)

 Definition: A mental disorder that develops secondary to experiencing or
observing a generally catastrophic experience/event, which is life-threatening
or otherwise traumatic.
 Most common traumatic events include:
o War exposure from the perspective of a civilian or a combatant
o Physical assault (physical abuse of a child, robbery)
o Sexual violence
 Characterized by the following clinical features:
o Re-experiencing of the event through intrusive thoughts, flashbacks,
memories and nightmares (which result in disturbed sleep)
o Hypervigilance/hyperarousal
o Emotional numbing
o Avoidance of stimuli associated with the traumatic event
o Causes significant distress/impaired functioning
 Timeline:
o Onset > 1 month after event with symptoms persisting > 1 month
o If onset of symptoms is between 3 days and 1 month after being exposed
to the traumatic event, then it is referred to as acute stress disorder.
o If symptoms begin ≥6 months after traumatic event exposure, it can be
called delayed-onset PTSD.
 Other Useful Info:
o In patients with PTSD, there is a high incidence of substance abuse and
depression.
 Hence, addictive drugs such as benzodiazepines should be avoided
in these patients (especially those with a history of substance use).
 All patients should be monitored for signs of abuse of the
prescribed drug.
o Most common neuroanatomical finding in PTSD is decreased
hippocampal volume.
 Therapy/Treatment:
o First-line treatments for PTSD include trauma-focused cognitive-
behavioral therapy (preferred) with or without pharmacotherapy with
either an:
 SSRI (e.g. Paroxetine [Paxil], Sertraline [Zoloft])
 SNRI (e.g. Venlafaxine [Effexor])
o Relaxation training and desensitization/exposure psychotherapies also
play a role in treatment.
o Prazosin [Minipress] is an α1-adrenergic receptor blocker that can be
used to reduce PTSD-related nightmares.
 It is often used concurrently with first-line pharmacotherapy (e.g.
SSRIs).
Teaching Point | PTSD
Date: /2017

DSM-5 Criteria for PTSD:

 Criterion A (one required): The person was exposed to: death, threatened
death, actual or threatened serious injury, or actual or threatened sexual
violence, in the following way(s):
o Direct exposure
o Witnessing the trauma
o Learning that a relative or close friend was exposed to a trauma
o Indirect exposure to aversive details of the trauma, usually in the course
of professional duties (e.g., first responders, medics)
 Criterion B (one required): The traumatic event is persistently re-experienced,
in the following way(s):
o Intrusive thoughts
o Nightmares
o Flashbacks
o Emotional distress after exposure to traumatic reminders
o Physical reactivity after exposure to traumatic reminders
 Criterion C (one required): Avoidance of trauma-related stimuli after the
trauma, in the following way(s):
o Trauma-related thoughts or feelings
o Trauma-related reminders
 Criterion D (two required): Negative thoughts or feelings that began or
worsened after the trauma, in the following way(s):
o Inability to recall key features of the trauma
o Overly negative thoughts and assumptions about oneself or the world
o Exaggerated blame of self or others for causing the trauma
o Negative affect
o Decreased interest in activities
o Feeling isolated
o Difficulty experiencing positive affect
 Criterion E (two required): Trauma-related arousal and reactivity that began or
worsened after the trauma, in the following way(s):
o Irritability or aggression
o Risky or destructive behavior
o Hypervigilance
o Heightened startle reaction
o Difficulty concentrating
o Difficulty sleeping
 Criterion F (required): Symptoms last for more than 1 month.
 Criterion G (required): Symptoms create distress or functional impairment (e.g.,
social, occupational).
Teaching Point | PTSD
Date: /2017

 Criterion H (required): Symptoms are not due to medication, substance use, or

other illness.