post-traumatic stress syndrome (PTSD)

see also:

• stress

• extreme emotionally stressful events may lead to delayed post-traumatic stress syndrome in susceptible people
• this can be an intractable, difficult to treat condition where memories of a highly emotional event in the past keep flooding back, often triggered by similar emotional states, resulting in recurrent fear states and chronic psycho-somatic illness.
• fear memories:
  • the memories stored during extreme emotional states have different properties to our “normal” memories including:
    • requirement for elevated sympathothomimetic hormones for the memories to be initially stored
      • it appears beta blockers that cross the blood brain barrier such as propranolol, when given at the time of the emotional event and for the next week, will block the memories being stored
    • the memory tends to be extremely detailed, including the smells present, vivid imagery & sounds, etc
  • like normal memories, requires new protein synthesis for the delayed consolidation of the memory - up until it is consolidated, the memory is quite fragile:
    • the protein synthesis blocking agent, anisomycin, when given to experimental rats after the initial “fear” event resulted in the rats not displaying fear to the same stressor 24hrs later - either the fear memory was lost or the retrieval mechanism for it is blocked in which case, the memory may be retrieved at a later date by similar emotional states.
    • in fact, when the same associative stimulus to the stressor was given to the rats, their amygdala became active but the rat did not respond to it suggesting the memory is indeed still there and ready to generate a fear response, but that the infralimbic portion of the brain was signalling that a fear response was not needed.
• who will encounter long term psychiatric problems after trauma?
  • in general, the initial response is not predictive & immediate problems such as nightmares, difficulty sleeping, obsessive thoughts about the trauma, feeling emotionally numb, memory problems, anxiety, fear, increased state of arousal such as always being on edge and irritable tend to be universal.
  • most people start to resolve these issues after the first month, those that still have symptoms at 4 months will probably have symptoms at 4 yrs, and if left untreated, some symptoms may persist for decades.
  • there is some suggestion that those with smaller than normal hippocampus may be susceptible
  • it is difficult to predict susceptible patients in the first 2 weeks

• stressors:
  • military service or civilian exposure to combat (high risk)
  • involvement in rescue missions, exposure to natural disasters
  • emigration from areas of social & political unrest
  • childhood abuse
  • serious accidents
  • criminal assaults such as being held at gunpoint, hostage situations, torture, terrorism
  • rape or attempted rape
  • witnessing a shooting or devastating traumatic event
  • sudden unexpected loss of a loved one
• inner-city residence
• females, youth, pre-existing anxiety/depression
• behavioural problems before age 15yrs
• FH psychiatric illness 

• debriefing - does this help or will it serve to consolidate the fearful memories?
• delayed counselling and social supports
• psycho-education
• normalise the reaction to the event
  • relieve irrational guilt
  • facilitate emotional recalling & retelling of the event
  • provide training in anxiety management techniques
• propranolol at the time of trauma:
  • current research by LeDoux and Nader is underway to see if this will prevent the fearful memories being retained - but will may prevent any “good” memories from the event being retained, and will also mean that the majority who would not be susceptible are not allowed to learn and grow from the experience, after all it is our memories - good or bad that define who we are.
• changing the content of memories or altering their emotional tonalities, however desirable to alleviate guilty or painful consciousness, could subtly reshape who we are,  
• will this reduce our ability to empathise with others who may have an embarrassing or traumatic experience
• will it mean that individuals can avoid the painful, awkward memories and lose their usual checking mechanism on their behaviour and perpetuate anti-social behaviours?
• will becoming numb to life's sharpest arrows make us numb to life's greatest joys?
• it seems the main obstacle to this prevention, assuming it works, is to determine the minority who will be at risk of post-traumatic stress syndrome.

• psychotherapies including cognitive therapy, exposure therapy
• anti-depressants such as SSRIs
• short term hypnotics
• development of sleep hygiene measures
• relaxation therapies
• adjunctive anxiolytics such as buspirone