Under the code “F43.1” of the ICD-10, we find Post-Traumatic Stress Disorder or PTSD.

It is a disorder that arises as a late response to a stressful event or to a situation (brief or long-lasting) of a highly threatening or catastrophic nature, which would in itself cause widespread distress in almost the entire population (e.g. natural or man-made disasters such as armed combat, serious accidents or witnessing someone’s violent death in addition to being a victim of torture, terrorism, rape or some other highly significant crime).

Below is a quick review of the basic information on the diagnosis and treatment of PTSD .

Risk factors for this disorder

The risk factors that have been considered may trigger PTSD are

  • Age at which Trauma occurs
  • Schooling
  • IQ
  • Ethnicity
  • Personal history of psychiatric history
  • Report of child abuse or other adverse events
  • Family history of psychiatric illness
  • Severity of Trauma
  • Post-traumatic stress
  • Post-trauma social support

In turn, the most frequent traumatic events are

  • Threat, sexual harassment by telephone
  • Rape
  • Witnessing violence
  • Physical attack
  • Accidents
  • Warfare

Initial treatment of PTSD

In subjects with PTSD the evidence shown by clinical trials that have been controlled and randomized, support starting treatment with psychotherapeutic strategies in addition to the use of secondary serotonin reuptake inhibitors (SSRIs) as a first line of intervention.

In relation to psychotherapy, cognitive behavioural therapy has shown evidence of being effective for the reduction of symptoms presented and the prevention of symptomatic recurrences of crisis.

Therapeutic strategies for symptoms that occur 1-3 months after the triggering event are known to be different from those that can be used in those whose symptoms occur or remit after 3 months of exposure to the traumatic event.It is considered that during the first 3 months after the traumatic event, recovery is almost the rule.

General Guidelines for Managing the Disorder

Other general guidelines followed in the initial treatment of this disorder are:

  • Develop a management plan considering the characteristics of the subject, the type of traumatic event, the previous history, the severity of the damage.
  • From the beginning the plan must detail the treatment selected as well as the time and results expected . If the management plan is incorporated in a sequential manner, this will allow an evaluation of the effects of the treatment.
  • The health professional can much more easily identify any changes during the therapeutic process, such as worsening, improvement or the appearance of some other symptom.
  • It is recommended to start treatment with paroxetine or sertraline under the following scheme: Paroxetine: 20 to 40 mg. maximum 60 mg.Sertraline: Start with 50-100 mg. and increase by 50 mg. every 5 days up to a maximum of 200 mg.
  • The use of neuroleptics as monotherapy for PTSD is not recommended. Atypical neuroleptics such as olanzapine or risperidone should be used for the management of associated psychotic symptoms.
  • In patients who persist with severe nightmares despite the use of SSRIs it is suggested to add topiramate 50 to 150 mg.
  • The addition of prazocin to SSRI treatment is recommended for patients who persist with PTSD-associated nightmares and have not responded to topiramate treatment.

Psychological treatment in adults

Cognitive behavioural therapy is the strategy that has proven to be most effective in reducing symptoms and preventing recurrence. The programs in which cognitive behavioral therapy is incorporated are classified into three groups:

  • Trauma-focused (individual treatment)
  • Focus on stress management (individual treatment)
  • Group therapy

Brief psychological interventions (5 sessions) can be effective if treatment starts in the first months after the traumatic event . In turn, treatment should be regular and continuous (at least once a week) and should be given by the same therapist.

All subjects presenting PTSD-related symptoms should be incorporated into a therapeutic program with the cognitive-behavioral technique, focused on the trauma.It is important to consider the time since the event occurred and the onset of PTSD symptoms to define the therapeutic plan

In the case of chronic PTSD , trauma-focused cognitive behavioral psychotherapy should be given 8-12 sessions, at least once a week, always by the same therapist.

In children and adolescents: diagnosis and treatment

One of the most important factors in the development of PTSD in children relates to the parents’ response to the child’s trauma. It should also be noted that the presence of negative factors in the family nucleus leads to worsening of the trauma, and that parental substance or alcohol abuse, the presence of crime, divorce and/or parental separation, or the early physical loss of a parent are some of the most common factors found in children with PTSD.

In preschool children the presentation of symptoms related to PTSD is not specific, given their limitations in cognitive and verbal expression skills.

It is necessary to look for symptoms of generalized anxiety disorder appropriate to their level of development , such as separation anxiety, anxiety in front of strangers, fears of monsters or animals, avoidance of situations that may or may not be related to the trauma, sleep disorders, and concern about certain words or symbols that may or may not have an apparent connection to the trauma.

In children aged 6 to 11, the characteristic clinical picture of PTSD is:

  • Representation of trauma in play, drawings or verbalizations
  • Sense of time distorted by the traumatic event.
  • Sleep disorders: dreams about trauma that can generalize to nightmares about monsters, rescues, threats to him or others.
  • They may believe that there are different signs or omens that will help or warn them of possible trauma or disaster.
  • There is no point in talking about a bleak future for these children, as their level of development means that they have not yet acquired the perspective of the future.

Other indications for intervention in minor patients

Trauma-focused cognitive behavioral therapy is recommended for children with severe symptoms of PTSD during the first month after the traumatic event. This psychotherapy should be adapted to the age of the child , circumstances and level of development.

It is important to consider giving information to the parents or guardians of the child when they are treated in an emergency department for a traumatic event. Briefly explain the symptoms that the child may present, such as changes in sleep status, nightmares, difficulty concentrating and irritability, suggesting that a medical evaluation be carried out when these symptoms persist for more than a month.

Trauma-focused cognitive behavioral therapy is the therapeutic strategy that should be offered to all children who have severe PTSD symptoms in the first month.

  • Drug therapy with SSRIs is not recommended for children under the age of 7.
  • In children older than 7 years , drug treatment should not be considered routine , the condition and severity of symptoms should be assessed in addition to comorbidity.
  • In the case of chronic PTSD, trauma-focused cognitive-behavioral psychotherapy should be given 8-12 sessions, at least once a week, always by the same therapist.