Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that occurs as a result of a serious and brutal event, which has caused a life-threatening or threatening state of physical integrity: natural disaster, bombardment, attack, rape or other assault, car accident, etc. The patient may have been involved themselves or witnessed the death or accident of others. The subject’s immediate reaction is often marked by intense fear, followed by more or less prolonged state of shock (incapacity, depersonalisation), followed by gradual improvement and then possibly a “latency phase” during which patients returns to their normal state. After a few weeks, months or sometimes years, symptoms reappear, including :

a repetition syndrome marked by re-experience of the trauma (nightmares, flashbacks during the day, feelings of imminent death)

anxiety symptoms (generalised anxiety, phobias, avoidance), especially in situations similar to those in which the initial event occurred

depressive symptoms leading to blunted emotions, pessimism with fatigue and suicidal thoughts.

The main complications of PTSD are depressive disorders and addictions to alcohol, drugs or benzodiazepines.

Exposure to a serious or traumatic event can cause significant psychological sequelae in 4 to 10% of people who have experienced it. The persistence of these symptoms beyond several weeks constitutes PTSD. The chronic progression over several years concerns 20% of patients suffering from PTSD, and the high risk of relapse concerns 20% of patients treated, within 5 years following cessation of therapy.

The best means of prevention of post-traumatic pathologies is the early care of people subjected to violent trauma, with principally psychological support to verbalise the anxiety and evoke the event and emotions felt. It is also necessary to inform the subject about possible early complications that may occur, and simple methods, such as relaxation, to control them. Well codified techniques inherited from military methods (“psychological debriefing”), individually or in groups, can be useful in the prevention of PTSD, but they must be well mastered by trained professionals, at the risk of otherwise causing an aggravation of the symptoms.

Treatments - the promise of research:

Once the disorder has set in, the usual treatment is psychotherapeutic, mainly cognitive behavioural therapy (CBT). A recent technique, increasingly used, because of its effectiveness is EMDR (Eye Movement Desensitisation and Reprocessing), based on mental recovery of traumatic memories associated with attention capture by rhythmic horizontal eye movements.

Drug treatments most often have limited effects in severe and established PTSD. The most promising molecules are antidepressants which act on the emotional symptoms associated with PTSD, and in particular on depressive symptoms when they exist, but can also relieve at least partially the most specific symptoms of the disorder which are those of reliving the trauma (flashbacks, nightmares, etc.).

Over the past two decades, great strides have been made in basic and clinical research in understanding the physiological bases of the disorder. This research has improved early intervention policy for people who have just experienced a serious event. However, a significant proportion of people with post-traumatic stress do not see a specialist until the disorder has become permanent.

Research must continue so we can better understand the biological and neuropsychological basis of the chronic development of the disorder and identify factors for the prognosis of relapse after treatment.