Post- PTSD
Traumatic
Stress
Disorder Understan
Traum a, Reco
Mental Res
ding
very, and
ilience
Definition
Post Traumatic Stress Disorder (PTSD) is a mental
disorder affecting children, adolescents and adults who
have survived a traumatic experience or series of
traumatic events.
PTSD was once called shell shock or battle fatigue
syndrome.
Epidemiology
Various research studies have reported that up to 60% of
children and adolescents are exposed to a potentially
traumatic event (PTE).
Of those exposed, only half of them subsequently develop
PTSD.
Only a few of them experience more chronic lifelong
sequelae.
Girls are 4 times more affected than boys.
Etiology
Witnessing domestic violence in the home.
Sustaining a severe injury.
Witnessing or experiencing an act of violence in
school or in the community (e.g., a school
shooting).
Accidents, such as car or plane crashes.
Natural disasters, such as floods or earthquakes.
Acts of war or terrorism.
Violent crimes, such as a home invasion,
kidnapping or murder.
Cont..
Physical, emotional or sexual abuse (either of the child
or of another family member in front of the child).
Neglect.
House fires.
Exposure to violence at school or in the community.
Suicide of a family member or friend.
CLINICAL MANIFESTATIONs
1. Re-experiencing the Trauma
The child continues to mentally relive the traumatic experience
over and over again.
The child may have flashbacks of the event, feeling like he/she
is actually going through the experience again.
Hallucinate scenes, sounds or smells from the experience.
Severe nightmares.
Cannot stop thinking about the traumatic experience, no
matter what he/she does.
2. Avoidance Cont..
The child deliberately avoids any thought, object, place or
situation related to the traumatic experience.
Difficulty remembering details about the event.
Becomes numb to his/her feelings and surroundings as a coping
mechanism.
3. Increased Agitation
Easily startled or frightened.
Trouble falling or staying asleep.
Difficulty concentrating on school work and other routine tasks.
Outbursts of unprovoked or excessive anger.
Cont..
Other Signs and Symptoms
Intense anxiety when separated from family members or around
strangers.
Sad, withdrawn mood.
Loss of interest in activities and subjects previously enjoyed.
Physical or emotional detachment from family and friends.
Regressive behaviours such as bedwetting or thumb sucking.
Physical complaints such as stomachache or headache with no
identifiable medical cause.
Lack of positive emotions.
Acting helpless, hopeless or withdrawn.
Irritability and distractibility.
DIAGNOSIS
History taking and physical examination.
DSM-5 diagnostic criteria for PTSD for children 6
years and younger:
1. Exposure
Exposure to actual or threatened death, serious injury or sexual violence
directly, through a caregiver, or from television/electronic media.
2. Presence of One (or More) Intrusion Symptoms
Recurrent distressing memories.
Nightmares.
Dissociative reactions in which the child feels or acts as if the traumatic event
were recurring (flashbacks).
3. One (or More) of the Following Symptoms Cont..
Avoids thoughts or feelings about the trauma.
Negative alterations in cognition and mood associated with the
traumatic event.
4. Alterations in Arousal and Reactivity
Associated with the traumatic event, as evidenced by two (or more) of
the following:
Irritable behaviour and angry outbursts.
Hypervigilance.
Exaggerated startle response.
Problems with concentration.
Sleep disturbance.
[Link] duration of the disturbance is more than one month.
[Link] disturbance causes clinically significant distress or impairment.
MANAGEMENT
Pharmacological Management
SSRIs such as Citalopram, Fluvoxamine,
Fluoxetine and Sertraline.
TCAs such as Amitriptyline and Isocarboxazid.
Mood stabilizers such as Divalproex and
Lamotrigine.
Atypical antipsychotics such as Aripiprazole
and Quetiapine.
Prazosin.
Cont..
Cognitive Behavioural Therapy (CBT)
Cognitive Therapy
Exposure Therapy
Eye Movement Desensitization and
Reprocessing (EMDR)
Play Therapy
NURSING MANAGEMENT
Assess vital signs and perform nursing assessment.
Assess the child for suicidal or homicidal ideations.
Assess the child’s anxiety level.
Determine the severity of the condition and the course of
treatment or therapy.
Establish a therapeutic relationship with the child and
family members.
Be available to the child and family members for listening
and talking.
Assist the child to develop self-awareness of verbal and non-
verbal behaviours.
Cont..
Provide extra time for care and give the child extra
time to respond to questions.
Encourage the child to express emotions in a safe
environment.
Help the child understand their current behaviours
that may prevent effective healing or treatment.
Teach visualization and relaxation techniques such as
deep breathing and guided imagery.
Provide a calming and reassuring environment.
Thank you