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Dr Uwakwe-mangse Hanna (MBBS, MRCS)

INTRODUCTION

This week I have been reminiscing on the Chibok girls and wondering how traumatised they are, hoping that anyone with PTSD amongst them is identified and quickly treated.

Post-traumatic stress disorder (PTSD) by description is an anxiety disorder caused by very stressful, frightening or distressing events.

Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.

Even though cases of PTSD were first documented during the First World War when soldiers developed shell shock because of the harrowing conditions in the trenches, it wasn’t until in 1980 that it was first officially recognised as a mental health condition.

 

SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER (PTSD)

The symptoms of post-traumatic stress disorder (PTSD) can significantly affect the victim’s daily affairs.

In most cases, the symptoms few months after the traumatic events but in few cases it could take years for it to manifest.

Some people with PTSD experience long periods when their symptoms are less noticeable, followed by periods where they get worse. Other people have constant, severe symptoms.

 

Individuals with PTSD exhibits different forms of symptoms but generally, below are some of the common symptoms

 

Re-experiencing

Re-experiencing is the most typical symptom of PTSD. This is when a person involuntarily and vividly re-lives the traumatic event in the form of:

  • flashbacks
  • nightmares
  • repetitive and distressing images or sensations
  • physical sensations – such as pain, sweating, nausea or trembling

Some people have constant negative thoughts about their experience, repeatedly asking themselves questions that prevent them from coming to terms with the event.

For example, they may wonder why the event happened to them and if they could have done anything to stop it, which can lead to feelings of guilt or shame.

 

Avoidance and emotional numbing

Trying to avoid being reminded of the traumatic event is another key symptom of PTSD. This usually means avoiding certain people or places that remind you of the trauma, or avoiding talking to anyone about your experience.

Many people with PTSD try to push memories of the event out of their mind, often distracting themselves with work or hobbies.

Some people attempt to deal with their feelings by trying not to feel anything at all. This is known as emotional numbing. This can lead to the person becoming isolated and withdrawn, and they may also give up pursuing activities they used to enjoy.

 

Hyperarousal (feeling ‘on edge’)

This happens when people with PTSD are very very anxious and find it difficult to relax. They may be constantly aware of threats and easily startled. This state of mind is known as hyperarousal.

Hyperarousal often leads to:

  • irritability
  • angry outbursts
  • sleeping problems (insomnia)
  • difficulty concentrating

 

Other uncommon symptoms

Many people with PTSD also have a amount of other problems, including:

  • other mental health problems – such as depression, anxiety or phobias
  • self-harming or destructive behaviour – such as drug misuse or alcohol misuse
  • other physical symptoms – such as headaches, dizziness, chest pains and stomach aches

PTSD sometimes leads to work-related problems and the breakdown of relationships.

 

PTSD in children

PTSD is no respecter of age as it can affect can affect both children and adults. Children with PTSD can have similar symptoms to adults, such as having trouble sleeping and upsetting nightmares.

Like adults, children with PTSD may also lose interest in activities they used to enjoy and may have physical symptoms such as headaches and stomach aches.

However, there are some symptoms that are more specific to children with PTSD, such as:

  • bedwetting especially after being potty trained or after having good control of their bladder in the past.
  • being unusually anxious about being separated from a parent or other adult
  • re-enacting the traumatic event(s) through their play

 

CAUSES OF POST-TRAUMATIC STRESS DISORDER (PTSD)

PTDS can happen after many traumatic events. Below are some of the causes that can precipitate such:

  • serious road accidents
  • violent personal assaults, such as sexual assault, mugging or robbery
  • prolonged sexual abuse, violence or severe neglect
  • witnessing violent deaths
  • military combat
  • being held hostage- Chibok girls on my mind
  • terrorist attacks
  • natural disasters, such as severe floods, earthquakes or tsunamis
  • a diagnosis of a life-threatening condition
  • an unexpected severe injury or death of a close family member or friend

 

PTSD isn’t usually related to situations that are simply upsetting, such as divorce, job loss or failing exams.

PTSD develops in about 1 in 3 people who experience severe trauma. It still baffles many researchers why some develop PTDS for an event while others at the same event or worst do not.

However, certain factors appear to make some people more likely to develop PTSD.

 

Past diagnosis of depression or anxiety, or lack of support from family or friends, predisposes one to developing PTSD after a traumatic event.

There may also be a genetic factor involved in PTSD. A family history of mental health problem is thought to increase your chances of developing the condition.

 

OTHER POSSIBLE CAUSES

Although it’s not clear exactly why people develop PTSD, few possible reasons have been suggested. These are described below.

 

Survival mechanism

One suggestion is that the symptoms of PTSD are the result of an instinctive mechanism intended to help you survive further traumatic experiences.

For example, the flashbacks many people with PTSD experience may force you to think about the event in detail so you’re better prepared if it happens again. The feeling of being “on edge” (hyperarousal) may develop to help you react quickly in another crisis.

 

However, while these responses may be intended to help you survive, they’re very unhelpful in reality because you can’t process and move on from the traumatic experience.

 

Adrenaline levels

Studies have shown that people with PTSD have abnormal levels of stress hormones.

Normally, when in danger, the body produces stress hormones such as adrenaline to trigger a reaction in the body. This reaction, often known as the “fight or flight” reaction, helps to deaden the senses and dull pain.

 

People with PTSD have been found to continue to produce high amounts of fight or flight hormones even when there’s no danger. It’s thought this may be responsible for the numbed emotions and hyperarousal experienced by some people with PTSD.

 

Changes in the brain

In people with PTSD, parts of the brain involved in emotional processing appear different in brain scans.

 

Hippocampus is that part of the brain responsible for memory and emotions and in people with PTSD, this organ appears smaller in size. It’s thought that changes in this part of the brain may be related to fear and anxiety, memory problems and flashbacks.

The malfunctioning hippocampus may prevent flashbacks and nightmares from being properly processed, so the anxiety they generate doesn’t reduce over time.

Treatment of PTSD results in proper processing of the memories so, over time, the flashbacks and nightmares gradually disappear.

 

TREATING POST-TRAUMATIC STRESS DISORDER (PTSD)

The main treatments for post-traumatic stress disorder (PTSD) are psychotherapy and medication.

 

Traumatic events can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.

It’s possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it’s never too late to seek help.

 

ASSESSMENT

Before having treatment for PTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs.

You should be referred to a mental health specialist for further assessment and treatment if you’ve had symptoms of PTSD for more than four weeks or your symptoms are severe, but first you need to see your doctor for such a referral to be made

 

Some mental health specialists you may see if you have PTSD are psychologists, a community psychiatric nurse or a psychiatrist.

 

WATCHFUL WAITING

If you have mild symptoms of PTSD, or you’ve had symptoms for less than four weeks, an approach called watchful waiting may be recommended. This involves not doing anything in the interim and see how it goes.

In summary, it involves carefully monitoring your symptoms to see whether they improve or get worse. It’s sometimes recommended because 2 in every 3 people who develop problems after a traumatic experience get better within a few weeks without treatment.

 

If watchful waiting is recommended, you should have a follow-up appointment within one month.

 

PSYCHOTHERAPY

If you have PTSD that requires treatment, psychotherapy is usually recommended first. A combination of psychotherapy and medication may be recommended if you have severe or persistent PTSD.

This treatment is carried out by trained mental health professionals who listen to you and help you come up with effective strategies to resolve your problems.

 

The main types of psychotherapy used to treat people with PTSD are:

 

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.

 

For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail. They do this by helping you cope with any distress you feel, while identifying any unhelpful thoughts or misrepresentations you have about the experience.

You may also be encouraged to gradually restart any activities you’ve avoided since your experience, such as driving a car if you had an accident.

 

In the UK you’ll usually have 8-12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60-90 minutes.

 

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment which has been found to reduce the symptoms of PTSD.

It involves making side-to-side eye movements, usually by following the movement of your therapist’s finger, while recalling the traumatic incident. Other methods may include the therapist tapping their finger or playing a tone.

 

It’s not clear exactly how EMDR works but it may help you to change the negative way you think about a traumatic experience.

 

 

Group therapy

You may also be offered group therapy as some people find it helpful to speak about their experiences with other people who also have PTSD. Group therapy can be used to teach you ways to manage your symptoms and help you understand the condition.

 

Medication

Antidepressants such as paroxetine, sertraline, mirtazapine, amitriptyline or phenelzine are sometimes used to treat PTSD in adults.

Of these medications, paroxetine and sertraline are the only ones licensed specifically for the treatment of PTSD. However, mirtazapine, amitriptyline and phenelzine have also been found to be effective and may be recommended as well.

 

However, these medications will only be used if:

  • you choose not to have trauma-focused psychological treatment
  • psychological treatment wouldn’t be effective because there’s an ongoing threat of further trauma (such as domestic violence)
  • you’ve gained little or no benefit from a course of trauma-focused psychological treatment
  • you have an underlying medical condition, such as severe depression, that significantly affects your ability to benefit from psychological treatment

 

If medication for PTSD is effective, it will usually be continued for a minimum of 12 months before being gradually withdrawn over the course of four weeks or longer. If a medication isn’t effective at reducing your symptoms, your dosage may be increased.

Before prescribing a medication, your doctor should inform you about possible side effects you may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn.

 

For example, common side effects of paroxetine include feeling sick, blurred vision, constipation and diarrhoea.

 

Possible withdrawal symptoms associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability. Withdrawal symptoms are less likely if the medication is reduced slowly.

 

Treating Children and young people with PTSD

 

For children and young people with PTSD, trauma-focused CBT is usually recommended.

This normally involves a course of 8-12 sessions that have been adapted to suit the child’s age, circumstances and level of development. Where appropriate, treatment includes consulting with and involving the child’s family.

 

Treatment with medication isn’t usually recommended for children and young people with PTSD.

 

In conclusion, if you are reading this and you or a friend and or relatives have a PTSD, you now know where to seek help. Prevention they say is better than cure, but also knowing where and when to seek help matters most.

 

See you next week

 






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