Post-Traumatic Stress Disorder (PTSD)

Basics

Description

  • A condition of persistent mental and emotional stress occurring as a result of injury or severe psychological shock
  • Patients present with recent exposure to events known to possibly precipitate posttraumatic stress disorder (PTSD)
  • Individuals already suffering from PTSD:
    • Victims of violence
    • Sexual abuse
    • Medically induced trauma
  • These patients may have acute exacerbations in response to interventions in the ED
  • Unrecognized previous PTSD from medically induced trauma or past victimization can often complicate presentation and treatment in the ED

Epidemiology

  • Life-time risk for PTSD in the U.S. is 8.7%
  • 12-mo prevalence in the U.S. is 3.5%
  • Risk factors:
    • Survivors of rape (highest rate)
    • Veterans:
      • Warfare
      • Captivity
    • EMS personnel
    • Medical personnel
    • Domestic violence
    • Political or ethnically motivated internment or risk of genocide

Etiology

  • Genetic vulnerabilities include individuals with variations in serotonin transporter proteins
  • Individuals with anxiety sensitivity are more prone to develop PTSD in the presence of traumatic events
  • Current thinking that when individual coping mechanism are overwhelmed, PTSD develops first with symptoms of hyperarousal and sympathetic overdrive and then when overwhelmed by hyperarousal dissociation occurs via activation of the vagal/parasympathetic nervous system
  • Hyperarousal of amygdala often leads to decreased activation in prefrontal cortex on neuroimaging studies that could explain the loss of coherent sense of narrative in many traumas

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