Psychological Disorders Psychological Disorders are conditions that affect your thinking, feeling, mood, and behavior. They may be occasional or long-lasting . They can affect your ability to relate to others and function each day.
Post Traumatic Stress Disorder(PTSD)
Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Most people who experience traumatic events do not develop PTSD. People who experience interpersonal violence such as rape, other sexual assaults, being kidnapped, stalking, physical abuse by an intimate partner, and childhood abuse are more likely to develop PTSD than those who experience non-assault based trauma, such as accidents and natural disasters.
Classification System In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 1). PTSD was included in a new category in DSM-5, Trauma- and Stressor-Related Disorders. All conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion.The following criteria apply to adults, adolescents, and children older than 6 years.
Criterion A: stressor Criterion B: intrusion symptoms Criterion C: avoidance Criterion D: negative alterations in cognitions and mood Criterion E: alterations in arousal and reactivity Criterion F: duration Criterion G: functional significance Criterion H: exclusion Incidence PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age. PTSD affects approximately 3.5 percent of U.S. adults every year. The lifetime prevalence of PTSD in adolescents ages 13 -18 is 8%. An estimate one in 11 people will be diagnosed with PTSD in their lifetime.
Types of PTSD
Normal Stress Response: PTSD might begin with a normal stress response, but not all stress responses develop into PTSD. Normal stress responses affect the nervous, endocrine, and immune systems. The physiological effect of the stress response activates the fight-or-freeze response in the body. Acute Stress Disorder: Similar to PTSD, acute stress disorder can also develop after a traumatic event. However, symptoms can start between 3 days and 1 month after the event. Dissociative PTSD: Dissociative PTSD was added to the new version of the (DSM-5) in 2013. A key feature of this form of PTSD is that it does not coexist with other mental health conditions such as depression. Uncomplicated PTSD: Uncomplicated PTSD is also one of the most commonly diagnosed and is highly responsive to treatment. Complex PTSD: Complex PTSD occurs when repeated, or multiple, traumas happen over a period of months, or even years, instead of a traumatic event that happens once and is over – such as a violent attack or car accident. Co-morbid PTSD:Individuals with co-morbid PTSD also have at least one co-occurring mental health condition. Some common co-occurring conditions include: •anxiety disorder •panic disorder •major depressive disorder •substance use disorder Symptoms
PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.
1.Reliving aspects of what happened
2.Alertness or feeling on edge 3.Avoiding feelings or memories 4.Difficult beliefs or feelings
Causes Post-traumatic stress disorder (PTSD) can develop after going through,see or learn about an event involving actual or threatened death ,serious injury or sexual violation.
Treatment Options
1.Cognitive Processing Therapy:At first, you'll talk about the traumatic event with your therapist and how your thoughts related to it have affected your life. Then you'll write in detail about what happened. This process helps you examine how you think about your trauma and figure out new ways to live with it.
2.Prolonged Exposure Therapy:If you've been avoiding things that remind you of the traumatic event, PE will help you confront them.
3.Eye Movement Desensitization and Reprocessing:With EMDR, you might not
have to tell your therapist about your experience. Instead, you concentrate on it while you watch or listen to something they're doing -- maybe moving a hand, flashing a light, or making a sound.
4.Stress Inoculation Training:SIT is a type of CBT. You can do it by yourself or
in a group. You won't have to go into detail about what happened. The focus is more on changing how you deal with the stress from the event.
The following case is based on the development of PTSD on a 13 year old student who experienced sexual abuse and was accompanied by her parents to the General Practice Clinic with complaints of crawling body sensation, heaviness of the head, palpitation and inability to sleep of four weeks duration.She developed worrying thoughts that her future had been put in jeopardy because she may get pregnant for unknown men or get infected with human immunodeficiency Virus (HIV). She was preoccupied with concerns that she would be unable to get married as a single mother with a child. She was concerned that she had lost her virginity. She reported constant crawling body sensations two weeks after the assault that progressively worsened.
IDENTIFICATION OF DATA
Name:XY
Diagnosed Problem:A diagnosis of Post-traumatic stress disorder in an adolescent
secondary to sexual violence was made with a differential of mixed anxiety-depression
Source of referral:accompanied by her parents presented to the General Practice
Clinic with complaints of crawling body sensation, heaviness of the head, palpitation and recurrent inability to sleep of four weeks duration.
CASE HISTORY
The patient is a 13 year old female J.S.3 student. She was the youngest of 6 children in a monogamous setting. Her mother was a 56-year-old accountant with the State Ministry of Budget and father was a 58-year-old self-employed estate surveyor. They lived in a 6 bedroom duplex with water closet system for toilet facilities in the outskirts of the City. They were Christians of the Catholic faith and she was a member of the group called Legion of Mary. The family net monthly income was a minimum of approximately 1,700 dollars and had health insurance coverage for the family.She had a very close relationship with her siblings, parents and at school with teachers and classmates.She had never been managed for any psychiatric illness and never had a similar illness in the past.Her symptoms were preceded 6 weeks before presentation by non-consensual intercourse with two armed robbers that invaded their home at night. The event was her sexual debut and there was no repeat episode thereafter. The robbers did not use a condom and she bled mildly in the process. Robbers ejaculated into her vulva. She had no medical care after the incidence as parents encouraged her to bath and using the lime fruit she was given by her mother, she washed the vulva. She reported constant crawling body sensations two weeks after the assault that progressively worsened. She believed that insects were crawling around her body but any attempt to wipe them off revealed no insect and this was worse when idle. She also had the feeling that her head was too heavy for her neck especially when in school during lectures and she progressively lost concentration in many aspects. About the same time, she developed palpitations and poor sleep. She went to bed at 10 pm but repeatedly woke up at about the time that she was raped. She experienced frequent nightmares of being attacked by men who forcibly demanded sex and would wake up screaming. She felt un-refreshed on awakening. She avoided going to bed alone especially after the lights were switched off and avoided the room as frequently as she could. She noticed that she had flashbacks of the event which made her cry out evoking fear and anxiety similar to the feelings she had the night she was raped. She began to have distressing recollections of the event with her having repeated vivid images of being tied up and raped. She was worried her classmates could get to know and thereafter withdrew from them. Her parents said she had increasingly lost her self-confidence. She stayed longer while bathing, scrubbed her body intensely claiming she was dirty. Male voices sounding assertive, even from TV frightened her, especially in the evenings. She was also described as increasingly withdrawn and anhedonic(inability to feel pleasure).The diagnosis and course of illness were explained to her and her parents. They were informed the stressor was the rape that occurred from the armed robbers and the condition was treatable with drugs and cognitive therapy. She was counselled against the suppression of thoughts and memories connected to the event as it could maintain her symptoms. In particular, she was encouraged to remember the trauma as often aspossible and her parents were counselled to patiently give listening ears to her whenever she shared the memory as the ensuing symptoms overtime will subside. Her parents were counselled against stigmatizing her andadvised to always seek medical help in cases of health issues early. She had a pregnancy test done which was negative. She was advised to see the psychiatrist for psychological support and placed on oral fluoxetine 20mg daily, lorazepam 1mg mornings and 2mg at nights. On follow-up, after two weeks her sleep had improved with fewer nightmares and the episodes of recollections had reduced significantly. She was counselled on positive living. Apart from preoccupation with death as an unmarried girl and still feeling unsafe, other aspects of mental state examination were not impaired. She was to continue oral fluoxetine 20mg daily, lorazepam 1mg at night.On her next appointment, she had seen the psychiatrist who provided with interactive counselling. Concluding Comments
The patient no longer had feelings of being unsafe. She was adherent to medications and had improved significantly with better sleep and no nightmare.Her recollections had ceased and related better with siblings and parents. She had attended one of her group activities in church since the last visit .Her mental state and cognitive function were not impaired. She was to be maintained on fluoxetine 10mg daily and given a 3-month appointment but advised to present to the out-patient department if she had any health issue before the appointment.Her parents were happy about her improvement.
