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11. Mental/psychical disorders in adults
Post-traumatic stress disorder
A n e v e nt is “tr a um a tic ” w he n s om e one ha s be e n d ir e c tly c onfr onte d w ith
d e a th, e ithe r
by s e e ing a nothe r p e r s on be ing kille d or s e r ious ly injur e d a s the r e s ult of v iole nc e ,
or
by e xp e r ie nc ing s e r ious ha r m , s uc h a s a thr e a t to his / he r life or p hys ic a l inte gr ity
(e .g.
r a p e , tor tur e ). T he s e e v e nts c a us e fe e lings of he lp le s s ne s s a nd hor r or .
I m m e d ia t e , t r a n s it or y d is or d e r s ( p r os t r a t ion , d is or ie n t a t ion , fle e in g,
a ut om a t ic
be ha v iour s , e tc .) a r e to be d is tinguis h e d fr om s e c ond a r y, lon g-la s tin g
p r oble m s tha t
a p p e a r s e v e r a l w e e ks or m onths a fte r the e v e nt: p os t-tr a um a tic s tr e s s , ofte n
a s s oc ia te d
w ith d e p r e s s ion (p a ge 2 9 7 ), or s om e tim e s a c ute p s yc hos is (p a ge 3 0 0 ),
e v e n in p e op le
w ith no his tor y of p s yc hotic s ym p tom s .
P os t-tr a um a tic s tr e s s d is or d e r (P T SD ) is c ha r a c te r is e d by thr e e typ e s of
p s yc hologic a l
r e s p ons e , ge ne r a lly s e e n in c om bina tion:
– Persistent re-experiencing
T he p a tie nt d e s c r ibe s :
•im a ge s , thoughts or p e r c e p tions r e la te d to the tr a um a tic e xp e r ie nc e , w hic h
intr ud e
d e s p ite e ffor ts t o bloc k th e m out , in c lud in g a t n igh t in th e for m of d is tr e s s in g
d ream s;
•fla s hba c ks d ur ing w hic h the p a tie nt “r e liv e s ” p a r ts of the tr a um a tic s c e ne .
– Avoidance
T he p a tie nt tr ie s to a v oid :
•p la c e s , s itua tions a nd p e op le tha t m ight be a s s oc ia te d w ith the tr a um a ;
•ha v ing thoughts or fe e lings r e la te d to the tr a um a ; p a tie nts m a y us e a lc ohol,
d r ugs
or a ny p s yc hotr op ic a ge nts for this p ur p os e .
– Increased arousal
C on s t a n t s t a t e of a le r t , e xa gge r a t e d s t a r t le r e s p on s e , a n xie t y,
in s om n ia , p oor
c on c e n tr a tion. T he p a tie nt m a y d e v e lop s om a tic s ym p tom s s uc h a s
h yp e r te n s ion ,
s w e a ting, s ha king, ta c hyc a r d ia , h e a d a c he , e tc .).
R e -e xp e r ie nc ing is highly d is tr e s s ing a nd c a us e s d is or d e r s tha t m a y w or s e n
ov e r tim e ;
p e op le is ola t e t h e m s e lv e s , be h a v e d iffe r e n t ly, s t op fulfillin g t h e ir
fa m ily/ s oc ia l
obliga tions , a nd e xp e r ie nc e d iffus e p a in a nd m e nta l e xha us tion.
Management
P s yc hologic a l inte r v e ntion is e s s e ntia l to r e d uc e the s uffe r ing, d is a bling
Post-traumatic stress disorder
A n e v e nt is “tr a um a tic ” w he n s om e one ha s be e n d ir e c tly c onfr onte d w ith
d e a th, e ithe r
by s e e ing a nothe r p e r s on be ing kille d or s e r ious ly injur e d a s the r e s ult of v iole nc e ,
or
by e xp e r ie nc ing s e r ious ha r m , s uc h a s a thr e a t to his / he r life or p hys ic a l inte gr ity
(e .g.
r a p e , tor tur e ). T he s e e v e nts c a us e fe e lings of he lp le s s ne s s a nd hor r or .
I m m e d ia t e , t r a n s it or y d is or d e r s ( p r os t r a t ion , d is or ie n t a t ion , fle e in g,
a ut om a t ic
be ha v iour s , e tc .) a r e to be d is tinguis h e d fr om s e c ond a r y, lon g-la s tin g
p r oble m s tha t
a p p e a r s e v e r a l w e e ks or m onths a fte r the e v e nt: p os t-tr a um a tic s tr e s s , ofte n
a s s oc ia te d
w ith d e p r e s s ion (p a ge 2 9 7 ), or s om e tim e s a c ute p s yc hos is (p a ge 3 0 0 ),
e v e n in p e op le
w ith no his tor y of p s yc hotic s ym p tom s .
P os t-tr a um a tic s tr e s s d is or d e r (P T SD ) is c ha r a c te r is e d by thr e e typ e s of
p s yc hologic a l
r e s p ons e , ge ne r a lly s e e n in c om bina tion:
– Persistent re-experiencing
T he p a tie nt d e s c r ibe s :
•im a ge s , thoughts or p e r c e p tions r e la te d to the tr a um a tic e xp e r ie nc e , w hic h
intr ud e
d e s p ite e ffor ts t o bloc k th e m out , in c lud in g a t n igh t in th e for m of d is tr e s s in g
d ream s;
•fla s hba c ks d ur ing w hic h the p a tie nt “r e liv e s ” p a r ts of the tr a um a tic s c e ne .
– Avoidance
T he p a tie nt tr ie s to a v oid :
•p la c e s , s itua tions a nd p e op le tha t m ight be a s s oc ia te d w ith the tr a um a ;
•ha v ing thoughts or fe e lings r e la te d to the tr a um a ; p a tie nts m a y us e a lc ohol,
d r ugs
or a ny p s yc hotr op ic a ge nts for this p ur p os e .
– Increased arousal
C on s t a n t s t a t e of a le r t , e xa gge r a t e d s t a r t le r e s p on s e , a n xie t y,
in s om n ia , p oor
c on c e n tr a tion. T he p a tie nt m a y d e v e lop s om a tic s ym p tom s s uc h a s
h yp e r te n s ion ,
s w e a ting, s ha king, ta c hyc a r d ia , h e a d a c he , e tc .).
R e -e xp e r ie nc ing is highly d is tr e s s ing a nd c a us e s d is or d e r s tha t m a y w or s e n
ov e r tim e ;
p e op le is ola t e t h e m s e lv e s , be h a v e d iffe r e n t ly, s t op fulfillin g t h e ir
fa m ily/ s oc ia l
obliga tions , a nd e xp e r ie nc e d iffus e p a in a nd m e nta l e xha us tion.
Management
P s yc hologic a l inte r v e ntion is e s s e ntia l to r e d uc e the s uffe r ing, d is a bling
