Pathophysiology

1) type of stress disorder with delayed, recurrent development of anxiety after experiencing a traumatic event 2) involves threat of or actual death, injury, or loss of integrity to self or others that is responded to by fear, horror, or helplessness

Signs and Symptoms

1) detachment and loss of emotional responsiveness 2) depersonalization 3) intrusive dreams, thoughts, and flashbacks 4) cues of epidode provoke anxiety 5) active avoidance of stimuli or cue 6) increase startle response, increased arousal, hypervigilance 7) difficulty concentrating 8) irritability 9) variable inability to recall all or part of traumatic event 10) restricted range of affect

Associated Conditions

1) increased incidence of – other anxiety disorders, substance abuse, mood disorders 2) increased incidence with – past psychiatric history, neuroticism

Biochemistry

increased norepinephrine release from locus ceruleus in response to stress

Inheritance/Epidemiology

1) more common in women 2) affects 5-10% of adult Americans

Treatment

Drug intervention – 1) SSRIs (sertraline, fluoxetine) 2) MAOIs (phenelzine) 3) tricyclic antidepressants (imipramine, amitriptyline) 4) sedatives (trazodone) Psychotherapy – 5) dismantling the avoidance behaviors in a progressive manner

Tips for USMLE

if question mentions a 33 year-old woman with a history of two previous psychiatric admissions for depression who is seriously wounded in a bank robbery and two months after the episode is unable to return to her job as a tollbooth attendant, and her family reports that she is withdrawn and irritiable, think PTSD