Symptoms post-traumatic stress disorder

Spiro, A., Schnurr, P. and Aldwin, C., Combat related post traumatic stress disorder symptoms in older men. Psychology and Aging 9(1), 17-26, 1994. 

Ohtani, T., Iwanami, A., Kasa, K., Yamasue, H., Kato, T., Sasaki, T., Kato, N. (2004). Post-traumatic stress disorder symptoms in victims of Tokyo subway attack a 5-year follow-up study. Psychiatry Clin. Neurosci. 58(6) 624-9. 

Post-traumatic stress disorder Symptoms must last at least one month if more that six months after event should specify delayed onset, must be outside range of usual experience individuals frequently report that they relive the situation... 

A prospective, randomized, placebo-controlled trial of paroxetine in adults with chronic post-traumatic stress disorder (PTSD) was recently conducted (Marshall etal., 2007). The subjects were New Yorkers, predominantly female (67%) and Hispanic (65.4%). Seventy subjects entered the study and after a one week placebo lead-in, 52 subjects were randomized to placebo or paroxetine for ten weeks. The subjects were treated with a flexible dosage design (mean dosage, 40.4 mg/day). Dropout rates were 32% for paroxetine and 51.9% for placebo. There were no differences in rates of adverse effects between treatment arms. Paroxetine was superior to placebo in ameliorating the primary symptoms of PTSD (56% vs. 22.2%). 

In June of 2005, DHEC mailed a follow-up questionnaire to 280 people who were interviewed. Of the 94 respondents 23 percent had been hospitalized, 83 percent still were experiencing symptoms they felt related to the chlorine spill, 52 percent were taking medication for problems they felt were related to chlorine exposure, 51 percent were under a doctor s care for problems they felt were related to chlorine exposure, and 48 percent screened positive for post-traumatic stress disorder. 

The mood disorders were once called affective disorders and are grouped into two main categories unipolar and bipolar. The unipolar depressive disorders include major depressive disorder and dysthymic disorder the bipolar disorders include bipolar 1, bipolar II, bipolar not otherwise specified, and cyclothymic disorder. Other mood disorders are substance-induced mood disorders and mood disorders due to a general medical condition. In addition, mood disturbance commonly occurs as a symptom in other psychiatric disorders including dementia, post-traumatic stress disorder, substance abuse disorders, and schizophrenia. 

Although we are focusing on the primary sleep disorders, sleep disturbance quite often occurs as a symptom of another illness. Depression, anxiety, and substance abuse can impair the quality of sleep, though in the setting of chronic insomnia, other psychiatric disorders account for less than 50% of cases. Nightmares are a frequent complication of post-traumatic stress disorder (PTSD), and pain, endocrine conditions, and a host of medical illnesses can produce sleep problems. Thus, when discussing insomnia or hypersomnia, we are well advised to remember that these can be either a symptom of a psychiatric syndrome, a medical illness, or a sleep disorder. 

TABLE 43.2 Potential Neurobiological Abnormalities Associated With Post-traumatic Stress Disorder and Related Symptoms... 

Neurobiological System Clinical Symptom Effect in Post-traumatic Stress Disorder... 

Some of the growth in antidepressant use may be related to the broad application of these agents for conditions other than major depression. For example, antidepressants have received FDA approvals for the treatment of panic disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). In addition, antidepressants are commonly used to treat pain disorders such as neuropathic pain and the pain associated with fibromyalgia. Some antidepressants are used for treating premenstrual dysphoric disorder (PMDD), mitigating the vasomotor symptoms of menopause, and treating stress urinary incontinence. Thus, antidepressants have a broad... 

Fluoxetine Highly selective blockade of serotonin transporter (SERT) little effect on norepinephrine transporter (NET) Acute increase of serotonergic synaptic activity slower changes in several signaling pathways and neurotrophic activity Major depression, anxiety disorders panic disorder obsessive-compulsive disorder post-traumatic stress disorder perimenopausal vasomotor symptoms eating disorder (bulimia) Half-lives from 15-75 h oral activity Toxicity Well tolerated but cause sexual dysfunction Interactions Some CYP inhibition (fluoxetine 2D6, 3A4 fluvoxamine 1A2 paroxetine 2D6)... 

POST-TRAUMATIC STRESS DISORDER A mental dis order that can occur in those who have experienced a life threatening-situation. PTSD is characterized by nightmares and flashbacks, among other symptoms. 

Horowitz MJ, Wilner N, Kaltreider N, Alvarez W (1980) Signs and symptoms of post-traumatic stress disorder. Arch Gen Psychiatry 37 85-92... 

A four-year-old girl took fluoxetine for symptoms of post-traumatic stress disorder after a severe burn injury and 2 days after the addition of linezolid developed agitation, mydriasis, and abnormal movements in her limbs (106). Linezolid was withdrawn, and the symptoms resolved after 2 days. 

Hamner MB, Faldowski RA, Ulmer HG, Frueh BC, Huber MG, Arana GW. Adjunctive risperidone treatment in post-traumatic stress disorder a preliminary controlled trial of effects on comorbid psychotic symptoms. Int Clin Psychopharmacol 2003 18 1-8. 

As her story unfolded, it became clear that she was experiencing symptoms of a serious, delayed-onset post-traumatic stress disorder. In prior treatments, her therapists had never explored her circumstances beyond observing her feelings of panic, depersonalization, and confusion. They were quick to medicate her and seal over her distress. 

Although DSM-IV includes twelve types of anxiety disorders, the list of disorders in this chapter is somewhat more brief. Patients suffering from post-traumatic stress disorder (PTSD) and a related disorder, acute stress disorder often do present with a host of anxiety symptoms however, anxiety is but one aspect of PTSD. This syndrome also often includes symptoms of depression, transient psychosis, and dissociation. Thus, we have chosen not to address it here, but in a separate chapter (see chapter 10). Additionally, although obsessive-compulsive disorder (OCD) is considered to be an anxiety disorder, its pathophysiology and treatment varies enough from the anxiety disorders to warrant a separate chapter (see chapter 8). 

Although DSM-IV includes post-traumatic stress disorder as an anxiety disorder, in some respects this may be a misnomer. Clearly, anxiety symptoms predominate in PTSD, but it is very common for PTSD patients to exhibit major depression, transient psychosis, and substance abuse as well. The symptoms of PTSD can be organized into six categories, as follows ... 

Besides the paucity of historic data, another difficnlty associated with mental health studies of disaster victims is the lack of standardization of criteria used for case definitions of mental health disorders following mass trauma, such as post-traumatic stress disorder (PTSD) (6,7). Diagnostic criteria for PTSD, as noted in the fourth edition of the diagnostic and statistical manual (DSM-IV), should go beyond specified combinations of symptoms to include requirements for symptom duration and the patient s ability to function (6,7). Specifically, for a PTSD diagnosis, the patient must have symptoms for more than 1 month, and the symptoms must cause clinically significant distress or impair the patient s ability to function (6,7). In addition, the symptoms must occur after the traumatic event and could not have existed before the event. Unfortunately, many studies have used questionnaires that fail to distinguish new symptoms following traumatic events from previous prevalent symptoms such as sleeplessness that many people have at various times (6). The consequence is that many studies tend to inflate the prevalence of PTSD. 

There is also little evidence of central nervous system damage as indicated by objective evidence of neuropsychological deficits (David et al., 2002). Subjective symptoms of cognitive difficulties are, of course, very common, but just as in the literature of chronic fatigue syndrome, these do not relate very well to objective indices of neuropsychological difficulties, but do relate to symptoms of post-traumatic stress disorder or depression (David et al., 2002 Lindem et al., 2003). In conclusion, it is unlikely that the tens of thousands of Gulf War veterans with unexplained health problems are suffering from the results of exposure to neurotoxic chemicals (Spencer et al., 2001). 

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