Post Traumatic Stress Disorder

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Post Traumatic Stress Disorder JANIS CARTER & GERARD BYRNE Department of Psychiatry University of Queensland janiscarter@onaustralia.com.au www.therapywithyoga.com . g.byrne@psychiatry.uq.edu.au

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Overview of the presentation What is it? Why is it imperative? Key Symptoms of PTSD Causal elements adding to the advancement of PTSD How to survey or analyze? Sorts of evaluation devices and the cases of appraisal apparatuses Treatments accessible? Yoga : elective treatment for PTSD : individual experience Reflective practice: Case concentrate on

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What is it? It is a confusion taking after serious injury where the person keeping in mind the end goal to adapt to inward turmoil builds up a star grouping of manifestations including re-encountering side effects, evasion indications and excitement side effects. In spite of the fact that these side effects are an adjustment, over the long haul they are maladaptive for the individual and society .

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Why is it critical? Kessler et al: Lifetime predominance 7.8% Women 10.4 and men 5.0% More pervasive in war veterans – 25% US war veterans PTSD sufferers at hazard to creating other psychiatric issue particularly liquor reliance

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Why is it critical? 65% (M) & half (F) presented to injury – numerous various injuries 12 month predominance of PTSD – 1.33% (US 3.9%) 2% (M) & 3% (F) presented to injury in their lifetime had PTSD in recent months Rape 8.4% (M), 9.2% (W) Sexual attack 11.8% (M), 5.5% (F) Combat 4.7% (M) Life debilitating mishap 1.5 (M), 1.7 (F) Natural calamity .3 (M), 1.3 (F) Australian National Survey of Mental Health (Creamer, Burgess , & McFarlane, 2002

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Negative results of PTSD in individual, family, society Withdrawn and not imparting Prone to displeasure regarding stirred with rest, outrage, hypervigilance side effects Potentially sound young fellows harmed in private connections and ability to adapt

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Key side effects PTSD Re-encountering injury Flashbacks Nightmares Avoidance Social trips Films of war and savagery Capacity for personal connections Arousal Anger Poor rest Hypervigilant and startle

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Factors adding to advancement of PTSD Pre-injury chance components Trauma – related variables Post injury elements

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Factors adding to improvement of PTSD : Pre-injury hazard elements Biological systems Psychological instruments

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Factors adding to advancement of PTSD : Pre-injury chance elements Biological Genetic inclination – (ref) Attenuated cortisol levels – (Hawk, et al, 2000)

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Factors adding to improvement of PTSD : Pre-injury chance elements Psychological Pre-existing sorrow and uneasiness issue Early history of affliction and introduction to traumatic occasions Cognitive-behavioral Distortion in mapping, essential presumption, and programmed musings Maladaptive learning Fear molding & Avoidance learning Psychodynamic

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Factors adding to improvement of PTSD : Pre-injury chance elements Psychodynamic Ego – Dystonic/sense of self protection parts of PTSD Difficulty in coordinating the injury pictures/convictions about the self to make an intelligible self story The cognizant personality tries to acclimatize into conventional experience The meddling contemplations ascend from the oblivious, especially, when the cognizant personality can't guard itself Beliefs, for example, one's conviction is in one's control Images of viciousness/damage/close passing Ref: Brewin, Dalgliesh and Joseph, 1996

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Factors adding to improvement of PTSD : Trauma – related elements Type of injury eg Interpersonal injury Perceived level of life danger Predictability and controllability Duration and recurrence

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Factors adding to advancement of PTSD : Post injury elements Level of social bolster Validation of the experience Opportunities to "process" the injury

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Why Diagnose and Categorize? A method for understanding our perceptions of the world. In medicinal services as a reason for building up an arrangement for administration

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Diagnostic Criteria: DSMIV Criterion A: The injury DSM-IV Diagnostic Criteria for Post Traumatic Stress Disorder A. The individual has been presented to a traumatic occasion in which both of the accompanying were available: The individual experienced, saw, or was defied with an occasion or occasions that included genuine or undermined demise or genuine harm, or a danger to the physical trustworthiness of self or others. The individual's reaction included serious dread, weakness, or repulsiveness. Note: In youngsters, this might be communicated rather by complicated or disturbed conduct

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Diagnostic criteria: DSMIV cont Criterion B: Re-encountering B. The traumatic occasion is tenaciously re-experienced in (at least one) of the accompanying ways: intermittent and meddling upsetting memories of the occasion, including pictures, musings, or discernments. Note: In youthful youngsters, monotonous play may happen in which subjects or parts of the injury are communicated. intermittent troubling dreams of the occasion. Note: In kids, there might panic dreams without conspicuous substance.

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Diagnostic criteria: DSMIV cont Criterion B: Re-encountering cont acting or feeling as though the traumatic occasion were repeating (incorporates a feeling of remembering the experience, fantasies, mind flights, and dissociative flashback scenes, including those that happen on arousing or when inebriated). Note: in youthful kids, injury particular re-institution may happen. Exceptional mental misery at introduction to inside or outside signs that symbolize or take after a part of the traumatic occasion. physiological reactivity on presentation to inward or outside prompts that symbolize or take after a part of the traumatic occasion.

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Diagnostic criteria: DSMIV cont Criterion C: Avoidance C. Tireless shirking of jolts connected with the injury and desensitizing of general responsiveness (not present before the injury), as demonstrated by (at least three) of the accompanying: endeavors to evade considerations, sentiments, or discussions connected with the injury endeavors to stay away from exercises, places, or individuals that stimulate memories of the injury

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Diagnostic criteria: DSMIV cont Criterion C: Avoidance cont failure to review a critical part of the injury especially lessened intrigue or support in noteworthy exercises sentiment separation or antagonism from others confined scope of effect (e.g., not able to have cherishing emotions) feeling of a foreshortened future (e.g., does not hope to have a vocation, marriage, kids, or an ordinary life expectancy)

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Diagnostic criteria: DSMIV cont Criterion D : Arousal D. Determined manifestations of expanded excitement (not present before the injury), as showed by (at least two) of the accompanying: trouble falling or staying unconscious crabbiness or upheavals of outrage trouble concentrating hypervigilance overstated startle reaction

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Diagnostic criteria: DSMIV cont Criterion E: Duration of unsettling influence E. Span of the aggravation (indications in Criteria B, C, and D) is over 1 month.

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Diagnostic criteria: DSMIV cont Criterion F: Significant pain F. The aggravation causes clinically critical pain or impedance in social, word related, or other essential territories of working

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Diagnostic criteria: DSMIV cont Specify if: Acute: if term of manifestations is under 3 months Chronic: If span of indications is 3 months or more

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Diagnostic criteria: DSMIV cont Specify if: With Delayed Onset: if onset of side effects is no less than 6 months after the stressor

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Diagnostic criteria: DSMIV cont Patient must meet criteria A-F for the analysis to be made

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Assessment of PTSD Structured Diagnostic Interview – Aim: Confirming conclusion Structured Clinical Interview for DSM (SCID) Structured Interview for PTSD (SI-PTSD) Clinician-Administered PTSD Scale (CAPS) PTSD Interview PTSD Symptom Scale Interview (PSS-I) Self report surveys : Aim: Screening Impact of Event Scale-updated (IES-R) Mississippi Scale for Combat-Related PTSD Keane PTSD Scale of the MMPI-2 Penn Inventory for Posttraumatic Stress Posttraumatic Diagnostic Scale (PTDS) PTSD agenda (PCL) Los Angeles Symptom agenda (LASC)

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Example of screening for PTSD Are you disturbed by any striking recollections or undesirable dreams? Do you maintain a strategic distance from things which help you to remember any occasion from the past? Do you on occasion feel sincerely numb? Is it true that you are fractious or always tense? ACPMH, Australian Center for Posttraumatic psychological wellness

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Example of Structured Diagnostic Interview evaluation strategies: Davidson Scale STRUCTURED INTERVIEW FOR POST TRAUMATIC STRESS DISORDER (SI-PTSD: Adapted for DSM-IV from Davidson et al, 1989) A. EXPERIENCE OF TRAUMA Have you ever encountered a to a great degree distressing occasion, for example, genuine physical damage, battle, assault, ambush, imprisonment, being abducted, being singed, seeing death toll, or your own life being undermined, obliteration of property, risk or mischief to your family? (In the event that yes) How could you have been able to you respond? Tests : What do you recall about it? Is it safe to say that you were presented to battle?

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Davidson Scale: Were you a POW? To what extent would you say you were in that circumstance? What was the most exceedingly bad thing about it for you? How old would you say you were at the season of this occasion? NB: If more than one occasion, relate the accompanying inquiries to the event that gives off an impression of being most firmly identified with indications.

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Davidson Scale cont Criterion A: The injury A.1 Has the subject experienced, saw, or been gone up against with an occasion or occasions that included genuine or debilitated demise or genuine damage, or a danger to the physical uprightness of self or others? In the event that yes, did the individual's reaction include serious dread, defenselessness, or frightfulness? Yes: Continue with meeting No: Terminate

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Davidson Scale cont A.2 Define the e

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