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Abstract
Sometimes,
as a result of experiencing or witnessing a distressful/traumatic event, there
are changes in the brain leading to an anxiety disorder called as Post
Traumatic Stress Disorder (PTSD). In the present article, symptoms of PTSD have
been described which may be categorized into four different categories viz.
flashbacks, avoiding behaviour, unusual alertness and negative feelings. Person
with PTSD has mental problems like depression, phobias and anxiety. Person when
feels that distressful event is occurring again or recalls in the memory, there
may be increased heart beats, high blood pressure etc. Here, screening for PTSD
has also been described. On MRI of brain, patient has difference in the size of
hippocampus compared to normal person. There are changes in the levels of
certain hormones involved in stress conditions also. Mostly doctors recommend
counselling, psychotherapy, medicines or combination of these.
Keywords:
Post traumatic stress disorder;
Traumatic events; Flashbacks; Depression; Anxiety; Hippocampus
Introduction
If
a person experiences or witnesses a traumatic event which is shocking, life
threatening, humiliating, distressful and feels helpless, these conditions may
happen in situations like crimes, fire, accident, death of a very loved person,
sexual or physical abuse in some form, rape, terrorist attack, ragging in the
college/ hostel etc. It causes changes in the brain leading to disturbance in
thinking and emotional process leading to an anxiety disorder called as
posttraumatic stress disorder (PTSD).
As
per an estimate, nearly 45 million people worldwide are suffering from PTSD.
This number may be even more since many people do not go to a doctor since they
do not realize about the seriousness of the situation or due to shame or societal
fear. It has also been predicted that women are more prone to PTSD than men
since men are generally more able to tolerate [1,2]. Generally, person gets
shocked and suffers from stress disorder within short span of the distressful
event, however, in some cases, symptoms develop at a later stage. It has been
found that with time, person instead of feeling better, he/ she feels worse and
becomes more anxious and fearful. In the present article, symptoms of the
disease have been discussed. Besides, clinical screening for diagnosis and
various treatment therapies and medicines available are discussed including
present trend of research for PTSD.
Symptoms
of PTSD
Generally,
symptoms are visible within three months of a distressful event, sometimes, it
takes longer. The symptoms of PTSD may be categorized into following four
categories, and one may develop either of these or jointly more than one
category.
Flashbacks/Intrusion
i.
The person has upsetting memories of the distressful event and generally sees
the event in nightmares feeling that the same event is occurring with him/her.
ii.
Person always feels as the traumatic (distressful) event will occur with
him/her again.
iii.
Person feels unusual body reactions like increased heart beats, high blood
pressure when he/ she feels that distressful event is occurring again or
recalls in the memory.
Avoiding behaviour
i.
Person avoids to go the place, or to meet the person(s), which reminds him/ her
of that distressful event. ii. Person avoids to discuss the event with anyone.
Unusual alertness
i.
Person behaves abnormally, for example, on ringing the telephone, he/ she
starts jumping or running towards the telephone.
ii.
Person develops the tendency to cause harm to himself/ herself or sometimes
even develops suicidal behaviour.
iii.
Person remains irritated all the time, unable to sleep properly, not able to
concentrate on any work.
Negative feelings
i.
Person feels unsafe everywhere.
ii.
Person develops persistent negativity and blames to himself/ herself for the
distressful event.
iii.
Person feels isolated/ detached from everyone.
iv.
Person feels reduced interest in life.
v.
Person has mental problems like depression, phobias and anxiety.
Although,
it is usual to feel anxiety immediately after the traumatic event but normally
there is healing with time. If healing did not occur with time and increased
with time, then these may be symptoms of PTSD.
American
Psychological Association (APA) has also formulated the guidelines for
detecting symptoms of PTSD. According to these guidelines, person has been
exposed to death or threatened death, serious injury or sexual violence whether
directly, through witnessing it, by it happening to a loved one, or during
professional duties. Besides, APA has also described more or less the same
symptoms as stated above [3,4]. It is advisable that if a person got witnessed
or suffered a distressful/ traumatic event and finds the persistent symptoms as
stated above for a longer time, he/she must visit expert doctor for checkup.
Physical
Symptoms
Besides,
person suffering from PTSD may also have following physical symptoms:
a)
observed that if behaviour changes persist for a longer time, person has
problems at work and in the When person is not able to sleep properly, he/ she
may feel much tiredness and other problems like body ache.
b)
Sometimes, person gets frequent infections. It is due to weakened immune
system.
c)
Besides, person may feel chest pain, stomach cramps/ pain, headache, dizziness
etc.
It
has also been marital relationship. Person starts drinking more alcohol or
taking drugs. Under the circumstances, it is advisable to get check up by an
expert doctor.
In case of children who suffer sexual abuse, may have
following visible symptoms:
a)
They generally have low self-confidence.
b)
They try to hurt themselves.
c)
Mostly appear sad, anxious, feared and prefer to stay in isolation.
d)
Sometimes become habitual for alcohol and/or drugs.
e)
They mostly behave aggressively.
f)
Sometimes, depending upon the age, show unusual sexual behaviour.
g)
Sometimes, depending upon the age, feel guilt and think, why he/ she did not
resist during the traumatic event; and afterwards have the feeling of taking
revenge.
h)
Sometimes, children exhibit reflection of the traumatic event in paintings,
plays, stories etc. They feel nightmares of traumatic event and get disturbed.
Due to fear, they hesitate to go to school or are not able to behave properly
with the friends. Sometimes, even are not able to study properly.
If
even a few symptoms are visible in a child who has witnessed or suffered any
sex abuse or other stressful event, parents without much delay must carry the
child to an expert doctor.
Screening
for PTSD
Doctors
generally give a screening test in order to confirm whether he/ she is
suffering from PTSD. If symptoms of PTSD get faded or disappear after a few
weeks or a couple of months, it may be acute stress disorder and not PTSD. If
person suffers from PTSD, symptoms are much severe and mostly appear after few
months of the distressful event. In case of PTSD, patient is likely to recover
within a year or so [5-7]. However, in some cases, patient suffers for years
with visible symptoms.
It
has been observed that some people suffer from PTSD after experiencing or
witnessing a traumatic event while others don’t.
There
are number of factors which increase the chances of PTSD like:
a.
If person does not get social support from the family or friends.
b.
If person in the past had some mental problems.
c.
If in the past, person experienced sexual abuse.
d.
If person’s physical health is weak.
e.
If after the tragedy, person got other problems too like firing from the job or
loss of some beloved one.
On the other hand, there may be conditions which help in not
developing PTSD. These are:
a. If person has emotional support from the friends/ family
members.
b. If person is having the quality to face the odd
situations boldly.
c. If person has the quality to cope up even under much
traumatic conditions.
According to some reports, genetic factors also influence
the condition by increasing depression, anxiety etc.
On MRI of brain, it has been found that people with PTSD
have difference in the size of hippocampus compared to normal individual since
this part of the brain is involved in processing emotions and memories which
may affect the flashbacks.
It has also been reported that levels of hormones which are released
under adverse conditions/ stress, has also been found to be different in
persons with PTSD compared to normal person.
Treatment
Mostly doctors recommend counselling, psychotherapy,
medicines or combination of these.
It is recommended that if talks are done repeatedly about
the traumatic event and about the fear present in the patient in a safe
environment, it may help to control the adverse thoughts. This therapy is
called Exposure Therapy. However, in this therapy, there is always a risk that
instead of improvement, condition of the patient may be worse.
Besides, person is convinced to think the whole event in a
new way. Psychotherapy may help in controlling the stress and fear.
Medicines
No patient must take any medicine without consulting a doctor.
If above mentioned treatments, exposure therapy and/or psychotherapy do not
work, Doctors normally prescribe selective serotonin reuptake inhibitors
(SSRIs) like paroxetine. The SSRIs help in reducing depression, anxiety and
sleep problems, symptoms mostly present in PTSD. However, sometimes,
antidepressant medicines have adverse effects like patient may think to
suicide. Some doctors also prescribe benzodiazepines for anxiety, sleep
problems, irritation etc. It is pertinent to mention that generally it must be
preferred not to give any medicine (unless there is a severe problem) since
these medicines only subsidize visible symptoms and person may become habitual
of taking these antidepressants.
Other
Therapies
1. Specialist asks the patient to recall the traumatic event
after making a specific type side to side eye movement. This therapy helps in
reducing the stress level for patients of PTSD and also helps in developing
positive emotions, thoughts, behaviour etc. This therapy is called as eye
movement desensitization and reprocessing.
2. It has also been suggested that if cortisol hormone
therapy is given to the patient just after the distressful event, it may help
in reducing the risk of PTSD.
3. Some doctors prefer to prescribe a recreational drug
which affects the memories more positively by encouraging a feeling of safety.
All these therapies are not proven therapies and require
more research.
Sareen [8] discussed important advances in PTSD considering
much increase in the number of patients of PTSD after many highprofile
traumatic events like wars in Iraq and Afghanistan, terrorist attacks of
September 11 on the World Trade Center. He reviewed the advances in the
diagnosis of PTSD, inclusion of its diagnosis in the Diagnostic and Statistical
Manual of Mental Disorders, impact of PTSD in the community, risk factors,
assessment and treatment.
Bisson et al. [2] emphasized on the need to know about PTSD.
According to them, responses to traumatic events vary depending upon the
individual and most of the persons do not suffer with any mental disorder after
traumatic event. Nearly 3% adults suffer from PTSD at any one time and ranging
from 1.9 to 8.8% people suffer lifetime. They also reviewed diagnosis and
treatment for the disease. They identified Cochrane and other relevant
systematic reviews, meta-analyses and other research papers. They also used
evidences from meta-analyses of randomized trials in writing the review
research article.
Shalev et al. [9] reviewed the clinical status of PTSD.
According to them, more than 70% humans experience a traumatic event at some or
other time in their lives, and 31% experience four or even more traumatic
events. PTSD is the most common psychopathological condition which has been
evidenced after experiencing traumatic events. They discussed symptoms of PTSD,
status of diagnosis, neurobiologic characters, treatments available and
clinical implications of the knowledge.
Dopfel et al. [4] reported individual variability in
behaviour and functional networks and mentioned that differences in
vulnerability to PTSD is due to predisposition or trauma exposure, is not
clear. They measured pre-trauma brain-wide neural circuit functional
connectivity, behavioural and corticosterone responses to trauma exposure, and
post trauma anxiety by using the predator scent model of PTSD in rats and a
longitudinal design. They showed that pre-existing circuit function can
predispose animals to differential fearful responses to threats.
Corbett et al. [3] showed that sphingosine-1-phosphate
receptor 3 in the medical prefrontal cortex of rats regulates resilience to
chronic social defeat stress. They also showed that sphingosine-1- phosphate
receptor 3 mRNA in blood of veterans with PTSD gets reduced when compared with
the combat exposed control subjects. They also negatively correlated the
expression of sphingosine-1- phosphate receptor 3 mRNA with the severity of the
symptoms. On the basis of results, they concluded that sphingosine-1-phosphate
receptor 3 is a regulator of stress resilience and sphingolipid receptors are
important substrates of relevance to stress related psychiatric disorders.
Holmes et al. [5] showed that synaptic loss and deficits in
functional connectivity may be considered as symptoms for major depressive
disorder (MDD) and PTSD. They also mentioned that synaptic vesicle glycoprotein
2A can be used to index the number of nerve terminals and that is an indirect
estimate of synaptic density. They showed that lower synaptic density is
associated with the severity of depression and network alterations. They
claimed that their study is the first to show in vivo evidence correlating
lower synaptic density with depression severity and network alterations. This
study may be helpful in treating depression.
Iribarren et al [6] reviewed the current knowledge of PTSD.
They emphasized for the role of allostasis in fundamental research on PTSD.
They also argued in support about the future of clinical and translational
research in PTSD and supported systematic evaluation of the research evidence in
treatment of the disease. They showed a strong correlation of novel sleep EEG
coherence markers with diagnosis and severity of PTSD. For this, they collected
overnight polysomnography data containing EEG across sleep and wake states of
many veterans with PTSD and without PTSD (for control). They calculated brain
coherence markers from EEG signals using a novel approach. They showed that EEG
based brain coherence markers can be used as an objective means for determining
the presence and severity of PTSD [10,11].
Conclusion
Post-traumatic stress disorder (PTSD) is a mental disease
which changes the life of the person. After some distressful event, if a
person’s behaviour changes and does not revert back within reasonable time,
person must consult a specialist doctor and proper treatment must be taken.
Although therapy commonly given may not cure completely, patient’s condition
may improve. There is requirement of more research on PTSD.
Acknowledgement
Author acknowledges the facilities of the Department of Biotechnology,
Ministry of Science and Technology, Government of India, New Delhi (DBT) under
the Bioinformatics Sub Centre as well as M.Sc. Biotechnology program used in
the present work.
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