Under the ICD-10 code “F43.1”, we find Post-Traumatic Stress Disorder or PTSD.
Is about a disorder that arises as a delayed response to a stressful event or to a situation (brief or long-lasting) of an extremely threatening or catastrophic nature, which in themselves would cause great generalized discomfort in almost the entire population (for example, natural or man-made disasters such as armed combat, serious accidents or being witnessing the violent death of someone in addition to being a victim of torture, terrorism, rape or some other extremely significant crime).
Next we will give a quick review of the Basic information about the diagnosis and treatment of PTSD
The risk factors that have been considered to trigger PTSD are:
In turn, the most frequent traumatic events are:
Initial PTSD Treatment
In subjects with PTSD, the evidence shown by clinical trials that have been controlled and randomized supports starting treatment with psychotherapeutic strategies in addition to use of secondary serotonin reuptake inhibitors (SSRIs) as the first line of intervention.
In relation to psychotherapy, cognitive behavioral therapy has shown evidence of being effective for the reduction of the symptoms presented and the prevention of symptomatic seizure recurrences.
It is known that therapeutic strategies for symptoms that occur between 1 and 3 months after the triggering event are different from those that can be used in those whose symptoms appear or remit after 3 months of exposure to the traumatic event. It is considered that during the first three months after the traumatic event, recovery is almost the general rule.
General guidelines in the management of the disorder
These are other general guidelines that are followed in the initial treatment of this disorder:
Psychological treatment in adults
Cognitive behavioral therapy is the strategy that has proven to be most effective to reduce symptoms and prevent recurrence. The programs where cognitive behavioral therapy is incorporated are classified into three groups:
Trauma-focused (individual treatment)
Focused on stress management (individual treatment)
group therapy
Brief psychological interventions (5 sessions) can be effective if treatment begins in the first months after the traumatic event In turn, the treatment must be regular and continuous (at least once a week) and must be given by the same therapist.
All subjects who present symptoms related to PTSD should be incorporated into a therapeutic program with the cognitive behavioral technique, focused on 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 cognitive behavioral psychotherapy focused on trauma, should be given 8 to 12 sessions, at least once a week, always taught by the same therapist.
Related article: “Cognitive Behavioral Therapy: what is it and what principles is it based on?”
In children and adolescents: diagnosis and treatment
One of the important factors in the development of PTSD in children is related to the parents’ response to the children’s trauma. Furthermore, it must be taken into account that the presence of negative factors in the family nucleus leads to the worsening of trauma, and that the abuse of psychotropic substances or alcohol by parents, the presence of crime, divorce and/or separation of parents or the physical loss of a parent at an early age, 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 its limitations in cognitive and verbal expression skills.
It is necessary look for symptoms of generalized anxiety disorder appropriate to their developmental level such as separation anxiety, stranger anxiety, 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 from 6 to 11 years old, the characteristic clinical picture of PTSD is:
Representation of trauma in play, drawings or verbalizations
Distorted sense of time in what corresponds to the traumatic episode.
Sleep disorders: Dreams about trauma that can generalize to nightmares about monsters, rescues, threats towards him or others.
They may believe that there are different signs or omens that will help them or serve as a warning of possible traumas or disasters.
For these children it makes no sense to talk about a bleak future, since due to their level of development, they have not yet acquired the perspective of the future.
Other indications for intervention in minor patients
Trauma-focused cognitive behavioral psychotherapy is recommended for use in children with severe PTSD symptoms during the first month after the traumatic event. This psychotherapy must be adapted to the age of the boy or girl circumstances and level of development.
It is important to consider give information to 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, suggest taking a medical evaluation 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 present severe PTSD symptoms during the first month.
In children under 7 years of age, pharmacological therapy with SSRIs is not recommended.
In children over 7 years of age pharmacological treatment should not be considered routine the condition and severity of the symptoms should be assessed in addition to comorbidity.
In the case of chronic PTSD, cognitive behavioral psychotherapy focused on trauma should occur 8 to 12 sessions, at least once a week, always taught by the same therapist.
