Contents
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Introduction Introduction
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What makes a stressor traumatic? What makes a stressor traumatic?
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Clinical features Clinical features
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Classification Classification
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Diagnosis and differential diagnosis Diagnosis and differential diagnosis
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Diagnostic criteria in ICD-10 and DSM-IV Diagnostic criteria in ICD-10 and DSM-IV
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Differential diagnoses Differential diagnoses
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Ongoing research on symptom criteria Ongoing research on symptom criteria
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Assessment instruments Assessment instruments
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Epidemiology Epidemiology
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How common are traumatic events in the population? How common are traumatic events in the population?
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What types of trauma are associated with high PTSD rates? What types of trauma are associated with high PTSD rates?
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What proportion of people develop PTSD in response to a traumatic stressor? What proportion of people develop PTSD in response to a traumatic stressor?
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How prevalent is PTSD in the population? How prevalent is PTSD in the population?
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Partial PTSD Partial PTSD
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Comorbidity of PTSD with other disorders and symptoms Comorbidity of PTSD with other disorders and symptoms
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Summary of main findings from epidemiological studies Summary of main findings from epidemiological studies
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Aetiology Aetiology
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Psychological processes Psychological processes
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(a) Fear conditioning (a) Fear conditioning
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(b) Personal meanings of the traumatic event and its aftermath (b) Personal meanings of the traumatic event and its aftermath
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(c) Nature of trauma memories (c) Nature of trauma memories
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(d) Behaviours that maintain PTSD symptoms (d) Behaviours that maintain PTSD symptoms
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Biological processes Biological processes
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(a) Chronic stress reaction (a) Chronic stress reaction
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(b) Hypothalamic-pituitary-adrenal axis abnormalities (b) Hypothalamic-pituitary-adrenal axis abnormalities
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(c) Hypothalamic-pituitary-thyroid axis (c) Hypothalamic-pituitary-thyroid axis
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(d) Neuroendocrinological abnormalities (d) Neuroendocrinological abnormalities
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(e) Neuroimaging (e) Neuroimaging
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(f) Animal models of PTSD (f) Animal models of PTSD
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(g) Genetic factors (g) Genetic factors
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Course and prognosis Course and prognosis
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Time course of symptoms Time course of symptoms
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Factors that influence the risk of developing PTSD Factors that influence the risk of developing PTSD
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(a) Demographic and pre-trauma variables (a) Demographic and pre-trauma variables
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(b) Stressor variables (b) Stressor variables
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(c) Psychological responses during trauma (c) Psychological responses during trauma
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Factors affecting recovery from trauma Factors affecting recovery from trauma
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(a) Recovery environment (a) Recovery environment
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(b) Psychological processes (b) Psychological processes
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Treatment of PTSD Treatment of PTSD
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Psychological treatments Psychological treatments
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(a) Trauma-focused psychological treatments (a) Trauma-focused psychological treatments
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(i) Cognitive behavioural therapy (CBT) (i) Cognitive behavioural therapy (CBT)
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(ii) Eye-movement desensitization and reprocessing (EMDR) (ii) Eye-movement desensitization and reprocessing (EMDR)
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(iii) Other psychological treatments (iii) Other psychological treatments
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Pharmacological treatments Pharmacological treatments
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(a) Selective serotonin-reuptake inhibitors (SSRIs) (a) Selective serotonin-reuptake inhibitors (SSRIs)
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(b) Monoamine oxidase inhibitors (MAOIs) (b) Monoamine oxidase inhibitors (MAOIs)
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(c) Other antidepressants (c) Other antidepressants
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(d) Benzodiazepines (d) Benzodiazepines
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Advice on management Advice on management
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Diagnosing PTSD Diagnosing PTSD
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Is PTSD the main problem? Is PTSD the main problem?
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(a) Choice of treatment (a) Choice of treatment
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(i) Psychological treatment (i) Psychological treatment
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(ii) Pharmacological treatment (ii) Pharmacological treatment
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(b) Special problems in the management of PTSD patients (b) Special problems in the management of PTSD patients
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Further information Further information
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References References
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4.6.2 Post-traumatic stress disorder
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Published:February 2012
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Abstract
Clinicians have long noted that traumatic events can lead to severe psychological disturbance. At the end of the nineteenth and the beginning of the twentieth centuries, railway disasters, the World Wars, and the Holocaust prompted systematic descriptions of the symptoms associated with traumatic stress reactions. These include the spontaneous re-experiencing of aspects of the traumatic events, startle responses, irritability, impairment in concentration and memory, disturbed sleep, distressing dreams, depression, phobias, guilt, psychic numbing, and multiple somatic symptoms. A variety of labels were used to describe these reactions including ‘fright neurosis’, ‘combat/war neurosis’, ‘shell shock’, ‘survivor syndrome’, and ‘nuclearism’. This chapter covers clinical features of post-traumatic stress disorder, classification, diagnosis and differential diagnosis, epidemiology, prevalence, comorbidity of PTSD with other disorders, aetiology, course and prognosis, treatment, and finally advice on management.
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