Post traumatic Stress Disorder
A 23 year old man after a road traffic accident presents to a psychiatrist with anger, disturbed sleep and avoidance. Which of the following feature helps in the differentiation of post traumatic stress disorder (PTSD) from other disorders?
| A |
Nightmares about the events |
|
| B |
Recall of events and avoidance of similar experiences in PTSD |
|
| C |
Autonomic arousal and anxiety |
|
| D |
Depression |
A 23 year old man after a road traffic accident presents to a psychiatrist with anger, disturbed sleep and avoidance. Which of the following feature helps in the differentiation of post traumatic stress disorder (PTSD) from other disorders?
| A |
Nightmares about the events |
|
| B |
Recall of events and avoidance of similar experiences in PTSD |
|
| C |
Autonomic arousal and anxiety |
|
| D |
Depression |
Post traumatic stress disorder is characterized by a constellation of re experiencing a traumatic event, avoidance of stimuli associated with trauma and presence of hyperarousal symptoms.
Among these the pathognomic feature of PTSD are episodes of re experiencing in the form of flash backs, night mares or intrusive memories, and patients often try to avoid these memories both cognitively and behaviorally.
Although flash backs and nightmares are a symptom of PTSD, on their own they could be seen in various other neurotic or emotional disorders. Hence the answer is Recall of events and avoidance of similar experiences in PTSD. Diagnosis of PTSD requires presence of these 3 features for more than 1 month.
A 15-year-old girl after a horrific road traffic accident had to stay in the hospital for 3 days. Since her discharge she developed a fear of travelling on the road. She often has had nightmares and disturbed sleep. She explained that she often feels like living the car accident repeatedly for 3 months. What is the likely condition?
| A |
Dissociative Accident Disorder |
|
| B |
Specific Phobia |
|
| C |
Post traumatic stress disorder |
|
| D |
Somatoform Disorder |
A 15-year-old girl after a horrific road traffic accident had to stay in the hospital for 3 days. Since her discharge she developed a fear of travelling on the road. She often has had nightmares and disturbed sleep. She explained that she often feels like living the car accident repeatedly for 3 months. What is the likely condition?
| A |
Dissociative Accident Disorder |
|
| B |
Specific Phobia |
|
| C |
Post traumatic stress disorder |
|
| D |
Somatoform Disorder |
The principal features of Post traumatic stress disorder (PTSD) are painful re-experiencing of the event (reliving experience, frightening dream with unrecognisable content in children), avoidance (avoiding the things or places involved in the trauma), emotional numbing and constant hyper arousal (anger, irritability, difficultly falling asleep etc).
Ref: Kaplan and Sadock’s Synopsis of Psychiatry: By Benjamin J. Sadock, Harol I. Kaplan, Virginia A. Sadock, 2007, Page 615; DSM IV, American Psychiatric Association: PTSD.
Post traumatic stress disorder is differentiated from other anxiety disorders by which of the following symptoms?
| A |
Nightmares |
|
| B |
Re-living of past adverse event |
|
| C |
Hypervigilance |
|
| D |
Avoidance |
Post traumatic stress disorder is differentiated from other anxiety disorders by which of the following symptoms?
| A |
Nightmares |
|
| B |
Re-living of past adverse event |
|
| C |
Hypervigilance |
|
| D |
Avoidance |
This question is not about the diagnostic features of PTSD.
This is about the differential diagnosis.
PTSD is an anxiety disorder and it shares symptoms with other disorders.
Important features in distinguishing the condition are given below.
A lady while driving a car meets with an accident. She was admitted in an ICU for 6 months. After being discharged she often gets up in night and feels terrified. She is a afraid to sit in a car again. The diagnosis is
| A |
Anxiety disorder |
|
| B |
Phobia |
|
| C |
Conversion disorder |
|
| D |
Post Traumatic Stress Disorder |
A lady while driving a car meets with an accident. She was admitted in an ICU for 6 months. After being discharged she often gets up in night and feels terrified. She is a afraid to sit in a car again. The diagnosis is
| A |
Anxiety disorder |
|
| B |
Phobia |
|
| C |
Conversion disorder |
|
| D |
Post Traumatic Stress Disorder |
D i.e. Post traumatic stress disorder
Post traumatic stress disorder (PTSD) is differentiated from all other disorders by:
| A |
Nightmares about events |
|
| B |
Autonomic arrousal and anxiety |
|
| C |
Recall of events and avoidance of similar experiences in PTSD |
|
| D |
Depression |
Post traumatic stress disorder (PTSD) is differentiated from all other disorders by:
| A |
Nightmares about events |
|
| B |
Autonomic arrousal and anxiety |
|
| C |
Recall of events and avoidance of similar experiences in PTSD |
|
| D |
Depression |
C i.e. Recall of events and avoidance of similar experiences in PTSD
– PTSD arises as response to traumatic event (criteria A) that is characterized by persistent re-experience (criteria B), persistent avoidance and numbness (C), hyperarousal (D), of > 1 month duration (criteria E) causing significant distress & impaired functioning (criteria F)Q. The onset may be delayed (6 months to years after event).
– PTSD arises as a delayed/protracted response to an exceptionally stressful or catastrophic life event or situation which is likely to cause pervasive distress in almost any person (eg. disaster, war, rape, torture, serious accident). It may develop even after 6 months to years after stressorQ.
– PTSD is characterized by peristent/recurrent intrusive distressing recollections of stressful event either in flashbacks (images, thoughts or perceptions), dreams, reliving experiences, illusions, hallucinations or distress/ physiological reactivity on exposure to reminders of traumatic events. There is marked (persistent) avoidance of stimuli/events or situations that arouse recollection of stressful events and increased arousal (hyperarousal) and numbing of general responsivenessQ.
Partial amnesia for some aspects of stressful events, anhedonia (inability to experience pleasure) and alexithymia (characterized by inability to identify & articulate feelings) may be present.
SSRIs are drug of choice for all of the following conditions except –
| A |
Panic attack |
|
| B |
Social phobia |
|
| C |
Post traumatic stress disorder |
|
| D |
Generalized anxiety disorder |
SSRIs are drug of choice for all of the following conditions except –
| A |
Panic attack |
|
| B |
Social phobia |
|
| C |
Post traumatic stress disorder |
|
| D |
Generalized anxiety disorder |
Ans. is ‘d’ i.e., Generalized anxiety disorder
o For generalized anxiety disorder Benzodiazipines are preferred.
