Post-traumatic stress disorder (PTSD)

Any psychiatrist, medical psychologist, psychotherapist will instantly decipher these four letters: «pe-te-es-er», – sounding like a short burst of automatic weapons. Starting out since 1980, Post-traumatic stress disorder (PTSD, PTSD) is included in all editions and revisions of the International Classification of Diseases; in DSM-I (first edition of the Diagnostic and Statistical Manual of Mental Disorders) a more general diagnosis «Reaction to severe stress» was included yet in 1952.

It often happens that any scientific term, defined clearly and clearly, has very specific boundaries, scope of content and scope, – suddenly becomes extremely popular «in broad masses». Such a word is used (to the place and not to the place) in everyday speech, it seems clear, it turns into an object of jokes and a topic of anecdotes, – as a result, the original meaning of the term is completely emasculated. Something similar happened with the word «stress». Today we talk about stress often, a lot, witty, carefree, ironic. Say, our whole life – continuous stress, and you need them periodically «take off» (to the ringing of, so to speak, glasses).

According to Hans Selye, For the creator of the world-recognized theory of adaptive reactions, the stress state does not need to be removed: this is the body’s normal response to any change in external conditions, it is the automatic mobilization of internal resources, adaptation, preservation of internal homeostasis and the accumulation of new experience. But Selye distinguished concepts «stress» and «distress»; in the second case, the force of an external stressor, physical or informational, exceeds the adaptive capabilities of the organism and leads to certain negative consequences.

Today’s world, on the one hand, is more humane, safer and more peaceful. With another – not so much. The difference, rather, is that we started talking about problems that no one was interested in at the state and international levels before (about family violence, for example, or about child abuse, about the social stigmatization of the mentally ill, about the victims of repression and war crimes, about the situation of refugees, etc.); we began to voice these problems, investigate, assess their medical and social significance, and discuss them at world and international forums. And grabbed their heads together.

Notorious «Vietnamese syndrome», – from which, it is generally believed, began the detailed development of the concept of PTSD and methods of therapeutic response, – turned out to be the focus of attention of American specialists and the general public not for clinical or theoretical reasons, but for economic reasons. So that it does not sound so cynical, let’s put it differently: in medical and social. The fact is that for any state (even one as rich as the United States) this is simply unbearable damage: young, strong, physically healthy men drink too much, become drug addicts, are treated by psychiatrists for depression, neurotic and other mental disorders, receive benefits for years, commit unexplained and unmotivated crimes from the category of especially grave ones, commit suicide, go as fighters to the criminal environment or to terrorists, remain lonely and childless, cannot stay in any job if it involves contact with people.

Not only was the socioeconomic burden of mental illness dramatically underestimated 50-70 years ago (you knew, say, that half of the leading causes of disability and a third «lost» years of life by DALY – is it neuropsychiatric?); in the case of PTSD, the antisocial specificity described above is added to this..

Causes

Among main reasons – aggressive attack, threat of death, rape, incl. using blackmail, using a defenseless or dependent position; physical or psychological torture, natural and man-made disasters, social upheavals (revolutions, terrorism, mass repressions, genocide, financial and economic crises, epidemics, forced displacement to other regions, etc.), religious, ethnic, cultural conflicts. PTSD is a separate problem. in children and adolescents: neglect of parental responsibilities, poverty and socio-pedagogical neglect, abuse (not only in the so-called dysfunctional, but also in completely harmonious, for a prying eyes, families), corruption, labor or sexual slavery.

Reliable risk factors include heredity, congenital and acquired psychological characteristics (characterological, neurophysiological, personal), the presence of traumatic experiences in an early history (faced with a shocking situation in adulthood, such persons are much more prone to developing PTSD); lack of support from the state and their own family. Some authors also report on the possible role of neuroinfections, TBI, somatic diseases, and other debilitating factors..

Symptoms

In contrast to the acute stress response, PTSD develops after some, sometimes quite a long time after traumatic events (from several weeks to several months or even years). The clinic is very diverse, the possible symptoms are numerous, – however, their main groups are repeated in almost all cases.

Very characteristic symptoms also include decreased social and general activity, motivation, energy, productivity, empathy (ability to imagine and «feel» the other person’s feelings, share them). Many sufferers seek loneliness and solitude out of fear., – conscious or unconscious, – face again the slightest reminder of the experience.

Difficulties are typical with concentration and memorization, explosiveness (uncontrolled «explosive» affects on the smallest occasion), severe dyssomnia (sleep disorders of one type or another), sharply reduced self-esteem, suicidal thoughts, an increased level of anxiety, constant expectation of danger or threat. In many cases, there are significantly pronounced disorders of the autonomic nervous system: sweating, weakness, fainting or syncope, tachycardia, dizziness, etc..

Diagnostics

Despite the polymorphism of the clinical picture, in the vast majority of cases it is quite specific and confidently recognized by a specialist. The difficulties of diagnosis here are, rather, common to psychiatry. The patient can aggravate (exaggerate) the actual symptoms, if this promises him certain advantages (for example, mitigation of punishment if he is guilty in the situation and other people have suffered); can, on the contrary, dissimulate, hide a number of symptoms and manifestations that seem to him shameful, socially condemned or too painful for verbalization. In addition, many patients suffer from depressive alexithymia (difficulty or inability to verbally express their emotions, feelings, experiences, memories). Finally, the clinic can be complicated by the symptoms of concomitant disorders (obsessive-compulsive disorder, depression, alcoholism, psychopathic adjustment disorder, etc.).

Carefully studied anamnesis, a detailed clinical interview-interview is conducted (including with relatives or friends, if available), an experimental psychological examination is prescribed. In general, fairly clear protocols for the diagnosis of post-traumatic stress disorder and its differentiation from symptomatically similar diseases have been developed and successfully applied..

Treatment

On a case-by-case basis drug regimen is selected exclusively on an individual basis, so it makes no sense to talk about general principles. In some cases, antidepressants are shown, in the first place, in others, anxiolytics, in others, you can do without «lungs» daytime tranquilizers. It should be remembered and taken into account the need for compulsory parallel treatment of comorbid disorders.

Attempts have been made on numerous occasions to develop effective preventive measures for PTSD for members of the «groups of potential risk». However, to date, there are no evidence-based reports of the success of such efforts..