PTSD: a quick guide to your treatment
Under the code "F43.1" of the ICD-10, we found Post Traumatic Stress Disorder or PTSD.
Is about a disorder that arises as a late response to a stressful eventuality or to a situation (brief or lasting) of an extremely threatening or catastrophic nature, which would cause by itself a great generalized malaise in almost all the population (for example, natural or man-made disasters such as armed combats, serious accidents or witness of the violent death of someone besides being victim of torture, terrorism, of a violation or of some other extremely significant crime).
Next we will give a quick review of the basic information on the diagnosis and treatment of PTSD .
- Related article: "Posttraumatic Stress Disorder: causes and symptoms"
Risk factors for this disorder
The risk factors that have been considered can trigger a PTSD are:
- Age at which the Trauma occurs
- Intelligence quotient
- Personal history of psychiatric history
- Report of abuse in childhood or other adverse events
- Family history of psychiatric illness
- Severity of Trauma
- Posttraumatic stress
- Post-trauma social support
In turn, the most frequent traumatic events are:
- Threat, sexual harassment by telephone
- Witness violent acts
- Physical attack
- War combat
Initial treatment of PTSD
In subjects with PTSD, the evidence shown by controlled and randomized clinical trials supports the initiation of treatment with psychotherapeutic strategies in addition to the use of secondary inhibitors of serotonin reuptake (SSRI) as the first line of intervention.
In relation to psychotherapy, cognitive behavioral therapy has shown evidence of being effective for the decrease of the symptoms presented and the prevention of symptomatic recurrences of crisis.
It is known that therapeutic strategies for symptoms that occur between 1 and 3 months after the triggering event are different from those that can be used in those whose symptoms occur or remit after 3 months of exposure to the traumatic event. It is considered that during the first three months after the traumatic event recovery is almost the general rule.
- Related article: "The 7 types of anxiety (causes and symptoms)"
General guidelines in the management of the disorder
These are other general guidelines that are followed in the initial treatment of this disorder:
- Elaborate a management plan considering the characteristics of the subject, the type of traumatic event, the previous antecedents, the severity of the damage.
- From the beginning the plan must Detail the selected treatment as well as the time and expected results . If the management plan is incorporated sequentially, this will allow an evaluation of the effects of the treatment.
- The health professional can much more easily identify any changes during the therapeutic process, such as worsening, improvement or appearance of another symptom.
- It is recommended to start treatment with paroxetine or sertraline under the following scheme: Paroxetine: 20 to 40 mg. maximum 60 mg. Sertraline: Start with 50-100 mg. and increase 50 mg. every 5 days up to a maximum of 200 mg.
- The use of neuroleptics as monotherapy for PTSD is not recommended. Atypical neuroleptics such as olanzapine or risperidone should be used for the management of associated psychotic symptoms.
- In patients who persist with serious nightmares despite the use of SSRIs it is suggested to add topiramate from 50 to 150 mg.
- It is recommended to add prazocin to treatment with SSRIs in patients who persist with nightmares associated with PTSD and who have not responded to treatment with topiramate.
Psychological treatment in adults
Cognitive behavioral therapy is the strategy that has proven to be most effective to reduce the symptomatology and prevent recurrence. Programs where cognitive behavioral therapy is incorporated are classified into three groups:
- Focused on trauma (individual treatment)
- Focused on stress management (individual treatment)
- Group therapy
Brief psychological interventions (5 sessions) can be effective if the treatment starts in the first months after the traumatic event . In turn, the treatment must be regular and continuous (at least once a week) and must be given by the same therapist.
All subjects presenting symptoms related to PTSD should be included in a therapeutic program with cognitive behavioral technique, focused on trauma.It is important to consider the time since the event occurred and the onset of PTSD symptoms to define the therapeutic plan
In the case of chronic PTSD , cognitive behavioral psychotherapy focused on trauma, should be given 8 to 12 sessions, at least once a week, always given by the same therapist.
- Related article: "Cognitive Behavioral Therapy: what is it and on what principles is it based?"
In children and adolescents: diagnosis and treatment
One of the important factors in the development of PTSD in children is related to the response of parents to the trauma of children. It must also be borne in mind that the presence of negative factors in the family nucleus leads to worsening of the trauma, and that the abuse of psychotropic substances or alcohol by the parents, presence of crime, divorce and / or separation of the parents or the physical loss of one of the parents at an early age, are some of the most common factors found in children with PTSD.
In preschool children the presentation of symptoms related to PTSD is not specific, given their limitations in cognitive abilities and verbal expression.
It is necessary look for symptoms of generalized anxiety disorder appropriate to your level of development , such as separation anxiety, anxiety before strangers, fears of monsters or animals, avoidance of situations that have or are not related to trauma, sleep disorders and concern with certain words or symbols that may or may not have an apparent connection to the trauma.
In children aged 6 to 11 years, the characteristic clinical picture of PTSD is:
- Representation of trauma in the game, drawings or verbalizations
- Distorted sense of time in what corresponds to the traumatic episode.
- Sleep disorders: dreams about trauma that can be generalized to nightmares about monsters, rescues, threats to him or others.
- They may believe that there are different signs or omens that will help them or serve as a warning against possible traumas or disasters.
- In these children it makes no sense to speak of a bleak future, because due to their level of development, they have not yet acquired the perspective of the future.
Other indications for intervention in minor patients
Cognitive-behavioral psychotherapy focused on trauma, it is advisable to use it in children with severe symptoms of PTSD, during the first month after the traumatic event. This psychotherapy must be adapted to the age of the boy or girl , circumstances and level of development.
It is important to consider give information to the parents or responsible for the child when they are treated in an emergency department for a traumatic event. Explain briefly the symptoms that the child may present, such as changes in the state of sleep, nightmares, difficulty concentrating and irritability, suggest carrying a medical assessment when these symptoms persist for more than a month.
Cognitive behavioral therapy focused on trauma is the therapeutic strategy that should be offered to all children who have severe symptoms of PTSD during the first month.
- In children younger than 7 years, it is not recommended to give pharmacological therapy with SSRIs.
- In children older than 7 years pharmacological treatment should not be considered routine , the condition and severity of the symptoms as well as the comorbidity should be assessed.
- In the case of chronic PTSD, cognitive behavioral psychotherapy focused on trauma, should be given 8 to 12 sessions, at least once a week, always given by the same therapist.