Post Traumatic Stress Disorder, also known as PTSD, is one of the most widespread, costly, and least understood of the many anxiety disorders. PTSD is a neurotic condition that is linked to stressors of traumatic events. Post Traumatic Stress Disorder is normally a delayed response to the unpleasant effects of extreme events of a catastrophic nature (Rumyantseva & Stepanov, 2008). Many people with this disorder experience a strong sensation of fear and may also feel of helpless. These feelings disturb the person’s perception of their own security (Dieperink, 2005). There has been interest for more than a century in the psychological and behavioral effects of trauma. However, the empirical research in this area is only about twenty-years old (Roy-Byrne, 2002). In this paper I will review three empirically supported articles simultaneously in effort to better describe how to diagnose this disease, manage its effects, and treat the patients.
Post Traumatic Stress Disorder causes clinically significant severe emotional states in social, professional, or other important aspects of life. The diagnosis of PTSD requires the occurrence of a traumatic incident, so it is reasonable to suggest that the stressor, its duration, and its meaning should have considerable influences on the occurrence and clinical features of the long-term psychopathological response. It is important to establish the ordinary clinical features and differences of Post Traumatic Stress Disorder due to the different stressors. This is vital not only in the theoretical aspects, but also in the practical aspects (Rumyantseva & Stepanov, 2008).
Dieperink suggests the options to treat patients with Post Traumatic Stress Disorder could include exposure therapy, group psychotherapy, inpatient therapy, and individual therapy, among other. However, not everyone with PTSD would be a candidate for exposure therapy, although it is often considered an initial treatment for people with PTSD (Dieperink, 2005). According to Roy-Byrne, studies have not looked into the possible medications outside of benzodiazepines & neuroleptics. None of the prior studies examined the differences between treatments within large mental health networks (Roy-Byrne, 2002). There have been relatively well researched studies in exposure therapy & a number of medications. These studies have been found to be extremely effective in the treatment patients. However, it has been difficult to find a single therapy to be consistently successful for patients with PTSD. Dieperink says that the Food and Drug Administration has only approved two medications for the treatment of Post Traumatic Stress Disorder: Sertraline and Paroxetine. Selective serotonin reuptake inhibitors are considered the first-line medication for the treatment of Post Traumatic Stress Disorder. To Better understand what constitutes effective treatment for patients with PTSD, one must take the first step to determine what is being done in PTSD studies at this time (Dieperink, 2005). The following is a study regarding workers in the Chernobyl disaster that were diagnosed with Post Traumatic Stress Disorder
Rumyantseva and Stepanov studied the cases of a group of sixty-six patients regarding their involvement in combat actions and working in the post-Chernobyl atomic energy station clean-up. The test used several diagnostic methods including, structured clinical interviews, clinical PTSD diagnostic scales, and Gorovits scales for the self-evaluation of traumatic events. Thirty of the subjects were involved in combat actions and the other thirty-three were clean-up workers. The mean ages of the patients were 27 ± 2.8 years for the combatants and 43.7 ± 4.5 years for the clean-up workers. Combatant patients had incomplete higher education and corresponding training for military action. Most clean-up workers had higher education, though some had some mid-level specialist education. They were observed for 5 to 6 years and again 15 to 17 years after involvement in the stress situations. After 5–6 years after Chernobyl, the combatants had rare (1–2 times per month) episodes of minimal or moderate, controllable levels of distress in situations that reminded them of the event. Emphasis was placed on the features of the stress situations in both groups. Combatants had directly experienced a fear of being killed or wounded, horror of capture, torture, and humiliation. They were involved in battle and special operations and they had witnessed the deaths of many of their peers. Most combatants spent around six months in military action zones. The result was exceeded the individual’s exceeded their ability to cope. They were confronted with constant vigilance, perceptions of a hostile environment, and the need to make rapid responses to sources of threat. A completely different type of stress occurred in Chernobyl clean-up workers who had to deal with can be considered a prolonged traumatic event. The social-psychological consequences of this disaster were observed for 19 years. The catastrophe was an extraordinary event, the first of its type in human experience. As a result, Chronic Post Traumatic Stress Disorder was diagnosed in all the patients studied.
When combatants were presented with real threats, flashbacks were seen. These flashbacks were mainly in “hypngagogic/hypnopompic states” or when they were intoxicated with alcohol. These flashbacks were of moderate intensity. Patients were able to maintain partial control of their actions by sustaining a link with the outside world. In their dreams, combatants saw many people that were unable to protect themselves, being captured, shooting, detonations, and others. They would often state that they were being surrounded and that the enemies were close. In the dreams, they would fire back with their guns but the bullets would come out of the barrel in slow motion. Also, the bullets did not fly or seem to come out of the barrel and fall. The patients considered these dreams as nightmarish. When they woke up, they struggled to get back to sleep. Many of the patients that were seeking medical help preferred to use alcohol to help them sleep. There were signs indicating difficulties in concentrating or even maintaining minimal levels of attention in several combatants and virtually all clean-up workers. At the psychological level, most members of this group experienced increased symptoms and depression with feelings of fear, guilt, despair, impotence, hopelessness, and grief. The patients lacked trust in the help and treatment proposed for them, including psychotherapeutic treatment. They thought treatment was impossible and their condition was irreversible. Most people ultimately characterized themselves by the passive-aggressive social role of a victim.
The main principle at the core of the treatment of patients with PTSD is the ability to recognize the priority of psychotherapy and the use of antidepressants with primarily anxiolytic effects and minimal side effects in small doses. Psychotherapy included a variety of psychotherapeutic approaches. Therapies used included psychological debriefing for individuals, evidence-based psychotherapy; cognitive behavioral therapy as a disclosure treatment and progressive desensitization, which must be done individually for patients of this group.
There was a particular curiosity in the use of Coaxil in patients Post Traumatic Stress Disorder. It is associated with the establishment of its ability to change the neuroendocrine response to stress. It can prevent stress-induced behavioral and cognitive insufficiency in animals and corrects the responses of stress, not only weakening the stress-induced changes in the hypothalamus, but also assisting in the reversal of those changes. Preclinical and preliminary clinical data have shown evidence that Coaxil can be effective in the treatment of the specific and nonspecific symptoms of PTSD (Rumyantseva & Stepanov, 2008).
Post Traumatic Stress Disorder is a very complicated disease. Although scientists have come a long way in diagnosing and treating PTSD, it is clear that much more research may be needed to fully treat these patients. Post Traumatic Stress Disorder is extremely widespread and has become very expensive to treat and manage. Ideally, we should be taking steps toward relieving the experience of fear and helpless in those affected with this disorder. It is reasonable to assume that patients with PTSD can be rehabilitated and live normal lives without the stressors associated with this condition.
My reaction to writing this paper is a mixed one. I was a bit overwhelmed with the notion of having to read a published article in an area that I am unfamiliar with. However, after spending some time dissecting each one, I have developed and appreciation for the well written ones. These articles are very dense in information for their size and a lot can be learned from reading them. There are others that were a bit difficult to read and left me wanting to know more information than what was given. However, I learned a great deal from this assignment. I have a new appreciation for the complexities of this disorder and I have enjoyed reading the articles.
Rumyantseva, GM & Stepanov, AL (2008). Post-Traumatic Stress Disorder in Different Types of Stress (clinical features and treatment). Neuroscience and Behavioral Physiology, Vol. 38, No. 1.
Dieperink, Erbes, Leskela, & Kaloupek (2005). Comparison of Treatment for Post-Traumatic Stress Disorder among Three Department of Veterans Affairs Medical Centers. Military Medicine. Volume 170.
Ray-Byrne, MD (2000). Post-Traumatic Stress Disorder: Diagnosis, Management and Treatment. The American Journal of Psychiatry, 159, 4.