PTSD: a quick guide to treatment

Post Traumatic Stress Disorder requires different interventions depending on the age of the patient.

Under the ICD-10 code "F43.1", we find Post Traumatic Stress Disorder or PTSD.

It is a disorder a disorder that arises as a delayed response to a stressful event or situation or to a situation (brief or long-lasting) of a highly threatening or catastrophic nature, which in itself would cause great generalized distress in almost the entire population (for example, natural or man-made disasters such as armed combat, serious accidents or witnessing the violent death of someone as well as being a victim of torture, terrorism, rape or some other highly significant crime).

The following is a quick review of the basic information about the basic information on PTSD diagnosis and treatment.

Risk factors for this disorder

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

• Age in which the Trauma is presented
• Schooling
• Intellectual quotient
• Ethnicity
• Personal history of psychiatric history
• Report of childhood abuse or other adverse events
• Family history of psychiatric illness
• Severity of trauma
• Post-traumatic stress
• Post-traumatic social support

In turn, the most frequent traumatic events are:

• Threat, sexual harassment via telephone
• Rape
• Witnessing violent acts
• Physical attack
• Accidents
• Combat in war

Initial treatment of PTSD

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

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

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.

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 history, the severity of the damage.

• From the beginning, the plan should detail the selected treatment as well as the time and the expected results.. If the management plan is incorporated sequentially, this will allow for an evaluation of the effects of the treatment.

• The health professional can more easily identify any changes during the therapeutic process, such as worsening, improvement or appearance of another symptom.

• It is recommended to initiate 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, topiramate despite the use of SSRIs, the addition of Topiramate 50 to 150 mg is suggested.

• The addition of prazocin to SSRI treatment is recommended 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 in reducing to reduce symptomatology and prevent recurrence. Programs incorporating cognitive behavioral therapy are classified into three groups:

• Trauma-focused (individual treatment).
• Focused on stress management (individual treatment).
• Group therapy

Brief psychological interventions (5 sessions) can be effective. if treatment begins within the first few months after the traumatic event .. In turn, treatment should be regular and continuous (at least once a week) and should be given by the same therapist.

All subjects presenting symptoms related to PTSD should be incorporated into a therapeutic program with the cognitive behavioral technique, focused on the 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 PTSDIn the case of chronic PTSD, trauma-focused cognitive behavioral psychotherapy should be given from 8 to 12 sessions, at least once a week, always given by the same therapist.

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 the parents to the child's trauma. It should also be noted that the presence of negative factors in the nuclear family leads to worsening of the trauma, and that the abuse of psychotropic substances or alcohol by parents, presence of criminality, divorce and / or separation of 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 PTSD-related symptoms is not specific, given their limited cognitive and verbal expression skills.

It is necessary to look for symptoms of generalized anxiety disorder. look for symptoms of generalized anxiety disorder appropriate to their developmental level.PTSD symptoms include separation anxiety, anxiety about strangers, fears of monsters or animals, avoidance of situations that may or may not be related to the trauma, sleep disorders and preoccupation with certain words or symbols that may or may not have an apparent connection with the trauma.

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

• Representation of the trauma in play, drawings or verbalizations.

• Distorted sense of time as it corresponds to the traumatic episode.

• Sleep disturbances: Dreams about the trauma that may generalize to nightmares about monsters, rescues, threats, etc. about monsters, rescues, threats to himself 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 does not make sense to talk about 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 children with severe PTSD symptoms during the first month after the traumatic event. This psychotherapy should be adapted to the child's age, circumstances and developmental level.circumstances and developmental level.

It is important to consider giving information to the child's parents or caregivers 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, and suggest to take the child for medical evaluation when these symptoms persist for more than one month.

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

• In children under 7 years of age, pharmacological therapy with SSRIs is not recommended.

• In children older than 7 years pharmacological treatment should not be considered routinely.The condition and severity of symptoms as well as 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.