Zurbano, Xamaine C.

Villahermosa, Vencel F.

BN4A Group 3

POSTTRAUMATIC STRESS DISORDER

The development of characteristic symptoms following exposure to an
extreme traumatic stressor involving a personal threat to physical integrity or
to the physical integrity of others. (DSM-IV-TR)
CAUSES
Rape, torture, child abuse, disaster, murder, war, etc.
Physiological/neurochemical/endocrinological alterations
Sympathetic hyperarousal
Limbic system (amygdala dysfunction)
Kindling: neuronal excitability
Risk factor: previous trauma
Signs & Symptoms
Flashbacks
Intrusive recollections
Nightmares
Psychological numbness/amnesia
Irritability
Explosiveness
Self-destruction
Substance abuse
Survivor guilt
Pathophysiology
Distressing/Traumatic Event
(military combat, violent personal assault, being kidnapped or taken hostage,
being tortured, experiencing man-made disasters being diagnosed with
life- threatening illness (APA, 2000))

Characteristic symptoms

Symptoms present for 1 month or more and cause significant interference

with social, occupational, and other areas of functioning

PTSD
*If symptoms are present for <1 month

Acute Stress Disorder

Tests/Exams
DSM-5 Criteria for PTSD
Psychiatric evaluation
Mental Status Exam
No laboratory test can diagnose
Medical Management
ANTIDEPRESSANTS
SSRIs paroxetine, sertraline
first line treatment of choice because of efficacy, tolerability, and
safety ratings (Sadock & Sadock, 2007)
Tricyclic amitriptyline, imipramine
MAOIs phenelzine
ANXIOLYTICS

alprazolam (benzodiazepine) for antidepressant & antipanic effects

buspirone serotonergic properties similar to SSRIs
Other benzodiazepines used despite absence of controlled studies
demonstrating their efficacy in PTSD; addictive less desirable
ANTIHYPERTENSIVES
propanolol (beta blocker) - nightmares, intrusive recollections,
hypervigilance, insomnia, startle responses, angry outburst (Hollander &
Simeon, 2008)
Others
carbamazepine (anticonvulsant, mood stabilizer), valproic acid

(anticonvulsant), lithium carbonate (mood stabilizer) - intrusive

recollections, flashbacks, nightmares, impulsivity, irritability, violent
behavior
Nursing Diagnoses and Interventions
Post-trauma Syndrome
R/T distressing event considered to be outside the range of usual
human experience
Accept client; establish trust
Stay with client during flashbacks
Encourage verbalization
Discuss coping strategies
Assist client to try to comprehend the trauma
Complicated Grieving
R/T loss of self as perceived prior to the trauma or other
actual/perceived losses incurred during/following the event
Acknowledge feelings of guilt or self-blame
Assess clients stage in grief process
Assess impact of trauma on ability to resume ADLs

Assess for self-destructive ideas/behavior

Assess for maladaptive coping (e.g., substance abuse)