PTSD

Acute stress response that endures post-exposure

PTSD affects 5% of Australians

Diagnostic criteria

DSM-5 Criteria for PTSD

Requires 4 clusters of symptoms

  • Reliving the event

  • Avoidance of reminders of the event

  • Negative changes in mood and thought

  • Being overly alert or wound up

Exposure to traumatic events can affect a person’s relationship and have psychological and physical effects which may be lifelong

Higher Risk

  • Military, emergency responders, sexual assault survivors, domestic violence victims, refugees, children and ATSI

Trauma informed care

Principles of Trauma-Informed Care

  • Do not harm

  • Embrace a message of hope and optimism that recovery is possible

  • See trauma survivors are unique individuals who have experienced extremely abnormal situations

  • Work to support emotional and physical safety

  • Facilitate choice and empowerment

Consider using a screening tool:

Obtain permission and Sensitively Explore

  • When the event occurred

  • The psychological context

  • Risk factors

    • Comorbid physical trauma and pain

    • Pre-trauma

      • History

      • Mental health

      • Family history

      • Chronic stress

      • Intergenerational trauma

    • Peritrauma

      • Limit social supports

      • Poor coping skills

      • Significant dissociation

      • Limited social supports

      • Blaming of the victim by others

    • Post-trauma

      • Social supports

      • Blaming of the victim by others

      • Failure to access effective treatment

Assessment

  • Suicide risk

  • Psychotic symptoms

  • Duration of symptoms

  • Impact on functioning

  • Associated medical conditions

    • Alcohol, Obesity, Sleep Disturbance, OSA, IBS

  • Comorbid disorders

    • Major Depression

    • Anxiety Disorders

    • Substance Use Disorders

Management

Healthy living strategies

Psychological therapy

  • First-line evidence-based therapies for PTSD include:

    • Trauma‑focused cognitive behavioural therapy (TF‑CBT). It usually includes components of prolonged exposure therapy for desensitisation to the trauma and memories with a focus on restructuring associated pathological belief patterns.

    • Eye Movement Desensitisation and Reprocessing Therapy (EMDR) uses simultaneous focus on the traumatic memory and a simple sensory/cognitive task (e.g., tracking of visual stimulus) to facilitate desensitisation and reprocessing of the memory.

  • Group therapy can be useful for some patients.

Consider pharmacotherapy if:

  • The person is unable to or unwilling to access psychological therapy in a reasonable timeframe

  • Co‑morbid depression or anxiety with treatment indicated

  • Psychological therapy is not appropriate due to unstable personal circumstances (e.g. ongoing domestic violence, incarceration)

  • The patient has not responded to psychological treatment. It may be appropriate to trial alternative treatment models and/or therapists.

Consider the following options, which have the strongest evidence base for treating PTSD in adults:

  • Sertraline

  • Fluoxetine

  • Paroxetine

  • Venlafaxine

E-mental health

Crisis numbers

  • 13YARN: 13‑92‑76 (24 hours, 7 days, crisis support for Aboriginal and Torres Strait Islander patients) 

  • Lifeline – phone 13‑11‑14

  • eHeadspace (patients aged ≤ 25 years) – phone 1800‑650‑890

  • Beyond Blue – phone 1300‑224‑636

  • Suicide Call Back Service – phone 1300‑659‑467

Information

Post-traumatic Stress Disorder – Black Dog Institute

Resources

Reference