PTSD: A Quick Guide to Your Treatment

Under the code “F43.1” of the ICD-10, we find 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 long-lasting) of an extremely threatening or catastrophic nature, which would in itself cause great discomfort widespread in almost the entire population (for example, natural or man-made disasters such as armed combat, accidents serious or witnessing the violent death of someone in addition to being a victim of torture, terrorism, rape or some other crime highly significant).

Next we will give a quick review of the basic information about the diagnosis and treatment of PTSD.

• Related article: "Post Traumatic Stress Disorder: causes and symptoms"

Risk factors for this disorder

The risk factors that have been considered can trigger PTSD are:

• Age at which Trauma occurs
• Scholarship
• Intelligence quotient
• Ethnicity
• Personal history of psychiatric history
• Report of childhood abuse or other adverse events
• Family history of psychiatric illness
• Trauma severity
• Posttraumatic stress
• Post-trauma social support

In turn, the most frequent traumatic events are:

• Threat, sexual harassment over the phone
• Violation
• Witness violent acts
• Physical attack
• Accidents
• Warfare

Initial treatment of PTSD

In subjects with PTSD, the evidence shown by clinical trials that have been controlled and randomized, supports starting treatment with psychotherapeutic strategies in addition to use of secondary serotonin reuptake inhibitors (SSRIs) as the first line of intervention.

In relation to psychotherapy, cognitive behavioral therapy has shown evidence of being effective for the reduction of the symptoms presented and the prevention of symptomatic crisis recurrences.

Therapeutic strategies for symptoms occurring between 1 and 3 months after the triggering event are known to differ from those that can be used in those whose symptoms appear or remit after 3 months of exposure to the traumatic event. Recovery is considered to be almost the general rule for the first three months after the traumatic event.

• 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:

• Prepare a management plan considering the characteristics of the subject, the type of traumatic event, the previous history, 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 assessment 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 the appearance of some other 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 severe nightmares Despite the use of SSRIs, it is suggested to add 50 to 150 mg topiramate.

• Adding prazocin to SSRI treatment is recommended in patients who persist with nightmares associated with PTSD and that 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 symptoms and prevent recurrence. The 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 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 with symptoms related to PTSD should be included in a therapeutic program with the 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 treatment plan

In the case of chronic PTSD, trauma-focused cognitive behavioral psychotherapy, should be given from 8 to 12 sessions, at least once a week, always taught 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 children's trauma. In addition, it must be taken into account that the presence of negative factors in the family nucleus leads to the worsening of the trauma, and that the abuse of psychotropic substances or alcohol by parents, presence of criminality, divorce and / or separation from Parents or the physical loss of a parent 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 its limitations in cognitive abilities and verbal expression.

It is precise look for generalized anxiety disorder symptoms appropriate to their developmental level, such as separation anxiety, anxiety before strangers, fear of monsters or animals, avoidance of situations that are related or not with trauma, sleep disturbances, and preoccupation with certain words or symbols that may or may not have an apparent connection to the trauma.

In children 6 to 11 years old, the characteristic clinical picture of PTSD is:

• Representation of trauma in play, pictures or verbalizations

• Sense of time distorted in what corresponds to the traumatic episode.

• Sleep disorders: dreams about trauma that can generalize to nightmares about monsters, rescues, threats towards him or others.

• They may believe that there are different signs or omens that will help or alert them to possible trauma or disaster.

• In these children it does not make sense to speak of a bleak future, since due to their level of development, they have not yet acquired the perspective of the future.

Other indications for intervention in younger patients

Trauma-focused cognitive behavioral psychotherapy is recommended for use in children with severe PTSD symptoms, during the first month after the traumatic event. This psychotherapy must be adapted to the age of the child, circumstances and level of development.

It is important to consider give information to the parents or guardians of the child when they are treated in an emergency department for a traumatic event. Briefly explain the symptoms that the child may present, such as changes in sleep state, nightmares, Difficulty concentrating and irritability, suggest taking a medical evaluation when these symptoms persist for more of one month.

Trauma-focused cognitive behavioral therapy is the therapeutic strategy that should be offered to all children who present with severe PTSD symptoms during the first month.

• In children under 7 years it is not recommended to give drug therapy with SSRI.

• In children older than 7 years drug treatment should not be considered routine, the condition and severity of symptoms should be assessed in addition to comorbidity.

• In the case of chronic PTSD, trauma-focused cognitive behavioral psychotherapy should be given from 8 to 12 sessions, at least once a week, always taught by the same therapist.