Makindo Medical Notes

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🧠 Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition that can occur after exposure to traumatic events. The lifetime risk is estimated at ~8% in men and ~20% in women.

📖 About

• PTSD involves persistent distress and re-experiencing symptoms following a traumatic event.
• Symptoms must last ≥1 month for diagnosis (acute stress disorder <1 month).
• Most present within the first month, though delayed onset (up to 6 months) can occur.
• Defined in ICD-10 and DSM-5 diagnostic criteria.

🧬 Aetiology & Pathophysiology

• Neuroendocrine findings: some individuals with PTSD show low cortisol levels and abnormal hypothalamic-pituitary-adrenal (HPA) axis regulation.
• Structural brain changes: reduced hippocampal volume on neuroimaging is linked to chronic PTSD.
• Neurobiological hyper-reactivity in the amygdala underpins intrusive memories and hyperarousal.

⚠️ At-Risk Groups

• Victims of violent crime: physical/sexual assault, abuse, bombings, riots.
• Service personnel: military, police, journalists, prison staff, fire, ambulance, and other emergency workers.
• Refugees, survivors of war, torture, terrorism, or state-sanctioned violence.
• Accident and disaster survivors (natural or man-made).
• Women following traumatic childbirth.
• Patients diagnosed with life-threatening illnesses (e.g., cancer, cardiac arrest).

🩺 Clinical Presentation

• Re-experiencing: vivid flashbacks, nightmares, intrusive images/sensory memories.
• Avoidance: deliberate efforts to avoid trauma-related reminders or thoughts.
• Hyperarousal: hypervigilance, exaggerated startle response, sleep disturbance, irritability.
• Negative cognition/mood changes: guilt, shame, emotional numbness, detachment from others, loss of interest.
• Co-morbid features: depression, anxiety, substance misuse (alcohol, nicotine, stimulants).

🔍 Investigations

• Diagnosis is clinical, based on structured history and symptom clusters.
• Screening tools: PCL-5 (PTSD Checklist), Impact of Event Scale (IES-R).
• No specific blood or imaging tests are routinely indicated.

💊 Management

• Initial GP Assessment: Assess symptom severity, suicidality, and functional impact.
• Supportive Care: Reassurance, empathetic listening, and addressing immediate needs.
• Psychological Therapy (first-line):
  • Trauma-focused CBT – addresses avoidance, desensitises trauma, builds coping strategies.
  • Eye Movement Desensitisation and Reprocessing (EMDR) – recommended by NICE for PTSD.
• Medication:
  • SSRIs (sertraline, paroxetine) or SNRIs (venlafaxine) are first-line pharmacological options.
  • Short-term anxiolytics may be used cautiously but are not long-term solutions.
• Specialist Referral: For severe, persistent, or complex PTSD (e.g., co-morbid depression, substance misuse, suicidality).

📌 Key Points

• Not every trauma leads to PTSD – resilience and social support are protective.
• Early intervention in acute stress disorder may prevent progression to PTSD.
• Always assess risk of suicide and substance misuse in PTSD patients.