Posttraumatic Stress Disorder (Ptsd)

Basics

Description

  • PTSD is a psychiatric condition which may develop following a significant injury, life-threatening event, or traumatic experience
  • Traumatic events which may precipitate PTSD include:
    • Physical violence
    • Combat exposure
    • Sexual assault
    • Natural disasters
    • Immigration or refugee experiences
    • Medically-related trauma, eg, intensive-care unit admissions or firing of implantable cardioverter-defibrillator
    • Traumatic experiences related to occupation including 1st responders and health care professionals
  • Patients may experience acute exacerbations prompting presentation to the ED
  • Interventions performed in the ED may lead to acute exacerbations of PTSD symptoms

Epidemiology

  • Lifetime prevalence ranges from 3–9%
  • 12-mo prevalence in the US is 1–4%
  • Risk factors:
    • Repeated exposure to traumatic experiences
    • Female sex
    • Unemployment
    • Lower household income
    • Lower level of education
    • Limited psychosocial supports

Etiology

  • Underlying pathophysiology not clear
  • Risk of developing PTSD following traumatic experience likely related to underlying genetic predispositions, sociodemographic factors, and nature of trauma
  • Certain individuals may be more prone to develop PTSD in the presence of traumatic events (see risk factors above)
  • Neurobiologic factors may contribute including activity and regulation of glucocorticoid, norepinephrine, and other neurotransmitter levels as well as activity of sympathetic and parasympathetic nervous systems
  • 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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