Post-traumatic stress condition. Is it possible for post-traumatic shock symptoms to return after successful treatment and rehabilitation? History of the study of post-traumatic stress syndrome

At work, in family life, personal relationships Various phenomena arise and we do not always like them. Sometimes we can react painfully to everyday situations. Post-traumatic syndrome is a pathological condition of the body caused by a strong violation mental system person. It occurs in cases of severe mental trauma or prolonged, frequently occurring stressful situations.

Why does this disease occur?

Post-traumatic syndrome has the following causes:

• Complex operation, serious injury. A person experiences his physical failure. Mental breakdowns are possible.
• Despotism and tyranny in the family or in other settings.
• Having forced sex.
• Road traffic accident, disaster on other types of transport (ships, planes).
• Participation in hostilities. This category includes military personnel and persons living in the territory of military operations.

Participation in hostilities, this category includes military personnel and persons living in the territory of hostilities

What is post-traumatic syndrome? The disease is the result of a traumatic effect on the human body, and the load is complex (physical and mental). The individual needs special treatment. Gives positive results psychological correction. It relieves vegetative symptoms, corrects mood, and improves well-being.

Signs of the disease

Post-traumatic syndrome has the following symptoms:

• Constant mental anguish, strong emotional outbursts due to events returning to memory. Tormenting intrusive memories that appear suddenly. Actual events become unimportant, a person relives past situations. Panic state provoked by the slightest detail, indirectly or directly reminiscent of a traumatic situation.
• Persistent sleep disturbance. Difficulty falling asleep, shallow sleep with frequent dreams, sleepwalking, waking up in the middle of the night. A person feels overwhelmed in the morning, with a heavy head.
• Visual pseudo-visions. A person suddenly seems to be in a situation or object that he this moment doesn't really exist. Hallucinations occur when taking alcoholic drinks, medicines and spontaneously.
• Desire to commit suicide. The patient loses the meaning of life and strives to leave it. Does not see any further purpose of existence.
• Rigidity of behavior. The patient reacts sharply to the slightest discrepancy with what was expected. There is no softness, affection, tenderness.

The patient reacts sharply to the slightest discrepancy with the expected

• Desire for loneliness, some sociopathic behavior. The patient feels most comfortable at home alone or at work with a minimum number of people. The person isolates himself from any communication, even with family.
• Aggression in response to any irritation. The individual is very afraid to feel pain or experience again and reacts very sharply to any real or imaginary event.
• Anxiety. The patient seems to be in a fighting stance and is waiting for a blow. He constantly expects a repetition of the traumatic situation.
• Specific behavior. Due to mental trauma, during any situation similar to a dangerous one, a person behaves inappropriately.

It is not necessary for the patient to have all symptoms. There are 4 types of temperament, many character traits, so the same traumatic situation causes different reactions and symptoms. An experienced doctor only needs a few signs to correctly classify the patient’s condition.

If post-traumatic syndrome is detected, then treatment must be carried out. Otherwise, suicide or severe mental disorder cannot be avoided.

Post-traumatic syndrome in children

Children's body in force age characteristics, increased need in love, care and support, reacts especially sharply to dramatic life events.

There are sharp, harsh reactions to the slightest irritant

Symptoms childhood syndrome injuries:

• constant living in a traumatic situation. The baby initiates and reproduces it;
• sleep disturbances, fear of falling asleep and again ending up in a traumatic situation;
• apathetic state. It’s as if the baby is not here. Feeling of complete denial of the present time;
• aggressiveness. The child resembles a tense spring that hits painfully on any contact. There are sharp, harsh reactions to the slightest irritant.

Post-traumatic syndrome in military personnel

People who have gone through war, the death of friends and the death of loved ones will almost never be able to live the same way. This is a very difficult, traumatic, catastrophic situation that always leaves a scar on the soul. A person’s value system can completely change. A complete or partial change in habitual behavior is possible. Not every psyche is able to withstand such a load. Symptomatic and autonomic disorders are observed.

Psychotherapists assign names to such syndromes, based on the names of the areas where military operations took place. For example, there is such a thing as “Afghan” post-traumatic syndrome. A “Syrian” or “Iraqi” syndrome is possible in the future.

Post-traumatic syndrome in military personnel

PTS therapy

The psyche is the subtle structure of a person. Functioning and normal life activity in general depend on its condition. Post-traumatic syndrome is treated comprehensively:

• physical manifestations are removed (pain, dysfunction, concussions, bruises, fractures);
• mental correction is carried out.

Mental therapy consists of two aspects - medication and psychological assistance. The patient is prescribed various drugs. Etiotropic (symptomatic therapy) is widely used to relieve symptoms of the syndrome. With increased excitability, the patient is prescribed sedatives. If present physical injuries and their consequences - analgesics are prescribed.

Psychotherapist conducts special study, during which it identifies the cause of the traumatic syndrome, its main components, and fears. The doctor’s task is to help the patient understand his behavior, understand the motives of his actions, and learn to control his actions and mood.

There is an opinion that such a syndrome cannot be cured 100%. Maybe so, but it is quite possible to make a person’s life complete and adapt him to society. With proper treatment and a favorable life situation, such a disease will remain only a memory.

PTSD (post-traumatic stress disorder) is a condition that occurs against the background of traumatic situations. Such a reaction of the body can be called severe, because it is accompanied by painful deviations, which often persist for a long time.

An event that traumatizes the psyche is somewhat different from other events that cause emotions negative character. It literally knocks the ground out from under a person’s feet and makes him suffer greatly. Moreover, the consequences of the disorder can manifest themselves for several hours or even several years.

What can cause PTRS?

There are a number of situations that most often cause fasting traumatic stress New syndrome is a mass disaster that leads to death: wars, natural disasters, man-made disasters, terrorist attack, physical attack.

In addition, post-traumatic stress disorder can occur if violence has been used against a person or a tragic event has occurred. personal character: serious injury, long illness both the person himself and his relative, including fatalities.

Traumatic events that provoke manifestations of PTSD can be either single, for example, during a disaster, or multiple, for example, participation in combat, short-term or long-term.

The intensity of symptoms depends on how hard a person experiences a traumatic situation. psychological disorder. PTSD occurs when circumstances cause a feeling of helplessness.

People react to stress differently, this is due to their emotional sensitivity, level of psychological preparation, and state of mind. In addition, a person’s gender and age play an important role.

Post-traumatic disorders often occur in children and adolescents, as well as women who have been exposed to domestic violence. People at risk for post-traumatic stress include people who, due to professional activity often face violent actions and stress - rescuers, police officers, firefighters, etc.

The diagnosis of PTSD is often made to patients suffering from any kind of addiction - drugs, alcohol, medications.

Symptoms of Post-Traumatic Stress Disorder

Post-traumatic stress disorder, which has varying symptoms, may include:

1. A person replays past events in his head over and over again, and experiences all the traumatic sensations again. Psychotherapy for PTSD highlights such a common phenomenon as a flashback - a sudden immersion of the patient in the past, in which he feels the same way as on the day of the tragedy. A person is visited by unpleasant memories, frequent sleep disturbances with difficult dreams occur, and his reactions to stimuli reminiscent of the tragic event intensify.
2. On the contrary, he strives to avoid anything that may remind him of the stress he has experienced. In this case, memory for the events that caused PTSD is reduced, and the state of affect is dulled. The person seems to be alienated from the situation that caused the traumatic stress and its consequences.
3. The occurrence of startle syndrome (eng. startle - to scare, to flinch) is an increase in autonomic activation, including an increase in the fear reaction. There is a function of the body that causes an increase in psycho-emotional arousal, which makes it possible to filter incoming external stimuli, which the consciousness perceives as signs of an emergency situation.

In this case, it is noted following symptoms PTSD:

• increased vigilance;
• increased attention to situations similar to threatening signs;
• maintaining attention on events that cause anxiety;
• attention spans are narrowing.

Often, post-traumatic disorders are accompanied by impaired memory functions: a person experiences difficulty remembering and retaining information not related to the stress experienced. However, such failures do not refer to true memory damage, but are a difficulty in concentrating on situations that do not remind one of the trauma.

With PTSD, indifference to what is happening around and lethargy are often observed. People may seek new experiences without thinking about the negative consequences and do not make plans for the future. Relationships with family of a person who has suffered traumatic stress most often deteriorate. He isolates himself from his loved ones, more often voluntarily remains alone, and then can accuse his relatives of inattention.

Behavioral signs of the disorder depend on what the person has encountered, for example, after an earthquake, the victim will be more likely to move towards the door in order to have a chance to quickly leave the room. After the bombings, people behave warily when entering the house, closing and curtaining the windows.

Clinical types of post-traumatic stress syndrome

Post-traumatic stress leads to various symptoms, however, in different cases certain conditions are more pronounced. To prescribe effective therapy, doctors use clinical classification course of the disorder. The following types of PTSD are distinguished:

1. Anxious. In this case, the person is bothered frequent attacks memories arising against the background of psycho-emotional stress. His sleep is disturbed: he has nightmares, may suffocate, feel horror and chills. This condition complicates social adaptation, although character traits do not change. IN ordinary life such a patient will in every possible way avoid discussing his experiences, but often agrees to a conversation with a psychologist.
2. Asthenic. With this traumatic stress, signs of a depleted nervous system are observed. The patient becomes lethargic, performance decreases, he feels constant fatigue and apathy. He is able to talk about the event that happened and often independently seeks the help of a psychologist.
3. Dystrophic. This type of PTRS is characterized as angry and explosive. Patients are depressed, constantly expressing dissatisfaction, often in a rather explosive form. They withdraw into themselves and try to avoid society, do not complain, so often their condition is revealed only because of inappropriate behavior.
4. Somatoform. Its development is associated with a delayed form of PTSD and is accompanied by multiple symptoms in the gastrointestinal tract, cardiovascular and nervous systems. The patient may complain of colic, heartburn, pain in the heart, diarrhea and other symptoms, but most often specialists do not detect any diseases. Against the background of such symptoms, patients experience obsessive states, but they are not associated with the stress experienced, but with a deterioration in well-being.

At similar illness patients calmly communicate with others, but they do not seek psychological help, attending consultations with other specialists - a cardiologist, neurologist, therapist, etc.

Diagnosing PTSD

To establish a diagnosis of PT stress, a specialist evaluates the following criteria:

1. To what extent was the patient involved in an extreme situation: was there a threat to the life of the person himself, loved ones or others, what was the reaction to the critical phenomenon that arose.
2. Is a person haunted by obsessive memories of tragic events: the reaction of the visceral nervous system to stressful events similar to the experience, the presence of a flashback state, disturbing dreams
3. The desire to forget the events that caused post-traumatic stress, which occurs on a subconscious level.
4. Increased stress activity of the central nervous system, which causes severe symptoms.

Besides, diagnostic criteria PTSD includes an assessment of the duration of pathological symptoms (the minimum indicator should be 1 month) and a violation of adaptation in society.

PTSD in childhood and adolescence

PTSD in children and adolescents is diagnosed quite often, because they react much more sensitively to mental trauma than adults. In addition, the list of reasons in this case is much wider, since, in addition to the main situations, post-traumatic stress in children can be caused by a serious illness or the death of one of the parents, placement in an orphanage or boarding school.

Like adults with PTSD, children tend to exclude situations that remind them of the tragedy. But when reminded, the child may become emotionally overexcited, manifesting itself in the form of screaming, crying, and inappropriate behavior.

According to research, children are much less likely to experience unpleasant memories of tragic events, and their nervous system tolerates them more easily. Therefore, young patients tend to experience a traumatic situation over and over again. This can be found in the child’s drawings and games, and their monotony is often noted.

Children who have experienced physical violence themselves can become aggressors in a group of their own kind. Very often they are bothered by nightmares, so they are afraid to go to bed and do not get enough sleep.

In preschoolers, traumatic stress can cause regression: the child begins not only to lag behind in development, but begins to behave like a toddler. This may manifest itself in the form of simplification of speech, loss of self-care skills, etc.

In addition, symptoms of the disorder may include:

• impaired social adaptation: children are not able to imagine themselves as adults;
• there is isolation, capriciousness, irritability;
• Children have a hard time separating from their mother.

How is PTSD diagnosed in children? There are a number of nuances here, since identifying the syndrome in children is much more difficult than in adults. And at the same time, the consequences can be more serious, for example, mental and physical developmental delays caused by PTSD will be difficult to correct without timely correction.

In addition, traumatic stress can lead to irreversible character deformations, including adolescence Antisocial behavior often occurs.

Often children find themselves in stressful situations without their parents' knowledge, for example, when they are exposed to violence from strangers. The child’s loved ones should be concerned if he begins to sleep poorly, cries out in his sleep, is tormented by nightmares, without apparent reason often gets irritated or capricious. You should immediately consult a psychotherapist or child psychologist.

Diagnosing PTSD in children

Exist various methods Diagnosis of PTSD, one of the most effective is considered to be a semi-structured interview that allows you to assess traumatic symptoms. It is administered to children from the age of 10 using a three-point scale.

The structure of the interview is as follows:

1. The specialist establishes contact with the patient.
2. An introductory discussion about possible events that can cause traumatic stress in children. At the right approach it is possible to reduce anxiety and position the patient for further communication.
3. Screening. Allows you to find out what traumatic experience the child has. If he himself cannot name such an event, then he is asked to select them from a ready-made list.
4. A survey through which a specialist can measure post-traumatic symptoms.
5. The final stage. Negative emotions, which arise when remembering the tragedy, are eliminated.

This approach makes it possible to determine the degree of development of the syndrome and prescribe the most effective treatment.

Treatment options for PTSD

The basis of treatment for PTSD in both adult patients and children is high-quality psychological assistance from a qualified doctor, provided by a psychiatrist or psychotherapist. First of all, the specialist sets himself the task of explaining to the patient that his condition and behavior are completely justified, and he is a full-fledged member of society. In addition, treatment includes various activities:

• training in communication skills that allows a person to return to society;
• reduction of symptoms of the disorder;
• application various techniques- hypnosis, relaxation, auto-training, art and occupational therapy, etc.

It is important that the therapy gives the patient hope for a future life, and for this the specialist helps him create a clear picture.

The effectiveness of treatment depends on various factors, including advanced stages of the disease. In some cases it is impossible to do without medications, the following drugs are prescribed:

• antidepressants;
• benzodiazepines;
• mood stabilizers;
• beta blockers;
• tranquilizers.

Unfortunately, prevention of PTSD is impossible, because most tragedies happen suddenly, and the person is not prepared for it. However, it is important to identify the symptoms of this syndrome as early as possible and ensure that the victim receives timely psychological help.

Post-traumatic stress condition or syndrome is an ailment that can unsettle not only a child, but even strong body and a man in spirit. This condition is extremely difficult to experience, and experts warn: it is not recommended to fight it alone, only collaboration in the family and with the doctor will help overcome stress.

When, after difficult experiences, people experience difficulties associated with them, we talk about post-traumatic stress disorder (PTSD). People may notice thoughts or memories of the traumatic event intruding into their thoughts, affecting their concentration during the day, and appearing as dreams at night.

Waking dreams are also possible, and they can seem so real that the person may feel as if they are reliving the same traumatic experience. Sometimes such re-experiencing is called psychopathological re-experiencing.

Psychopathological re-experiences

Psychopathological experiences differ from each other and depend on the nature of the psychological trauma. People with such experiences usually have the most acute symptoms post-traumatic stress disorder.

One of the features of these experiences is intrusive memories and thoughts about the trauma. Patients usually remember sad events that they experienced in the past, such as the death of other people.

In addition, these can be frightening memories because when a person experiences a psychological trauma, they usually experience intense fear.

Sometimes memories of the past make a person feel guilty, sad or afraid. Even if a person does not specifically remember, but simply encounters something that reminds him of the trauma, he begins to feel tension, anxiety and insecurity.

For example, we often notice that soldiers coming home from war zones are constantly anxious and uncomfortable in situations in which they feel vulnerable. They constantly watch for doors opening and closing and act cautiously in crowded places.

In addition, their arousal system is quickly activated, and they are often tense, irritable, and have anxiety attacks. They may experience this even when they are not thinking about the injury.

Typically, psychopathological experiences are short-lived and last one or two minutes. But when a person experiences psychopathological re-experiencing, they react poorly to external stimuli.

However, if you are talking to a person with a psychopathological re-experiencing and can engage them in conversation, you can make the re-experiencing shorter. There are also medications, such as Valium, that can help people relax in these situations.

Symptoms and diagnosis

Main symptoms of post-traumatic stress disorder- This intrusive thoughts about the trauma received, hyperarousal, and sometimes shame, guilt. Sometimes people cannot feel emotions and act like robots in Everyday life.

In other words, people do not experience any emotions or do not experience any specific emotions such as pleasure.

In addition, they constantly feel like they have to defend themselves, they are in a state of anxiety, and they experience some symptoms of depression. These are the main groups of symptoms of post-traumatic stress disorder.

It would be nice if there was some kind of biological test that would tell us whether a person has PTSD without checking for symptoms. But in general, PTSD is diagnosed by getting every detail of the patient's history of what happened to them and then examining the history of each symptom.

There are several diagnostic criteria, and if you observe enough symptoms, you may be diagnosed with PTSD. However, there are people whose disorder does not meet diagnostic criteria because they do not have all the symptoms but still have symptoms associated with PTSD.

Sometimes, even if you don't fully meet the diagnostic criteria, you still need help managing your symptoms.

History of research

It is interesting that researchers, relying on literature, turning to the Iliad and other historical sources, have proven that people at all times realized that scary experience a person will always respond with a strong emotional reaction.

However, the term “post-traumatic stress disorder” did not appear as a formal diagnosis until 1980, which is quite recent in terms of the history of psychiatry.

During Civil War in the USA, the Crimean War, the First and Second World Wars, the Korean War, the Vietnam War - in all these events, at the beginning of the conflict, physicists, psychologists or mental health specialists behaved as if they had forgotten all previous experience of previous wars.

And each time, at the end of one of them, a clinical examination was carried out at a level that was high for this historical period.

Soldiers during the Battle of the Somme in World War I, many of whom suffered "trench shock"
During the First World War, much work was done on what was then called trench shock, or traumatic neurosis.

In the US, psychiatrist Abram Kardiner wrote extensively on this topic, and Sigmund Freud wrote about it at the end of the First World War and during the Second. When people see so much trauma, a serious understanding of the phenomenon begins, but on the other hand, there seems to be a tendency that in society, after major traumatic periods, knowledge about trauma and its importance is gradually lost.

However, after World War II, Dr. Grinker and Spiegel's classic study of pilots appeared, which can be considered a remarkable description of post-traumatic stress disorder.

In the late 1950s and early 1960s, a group of psychiatrists studied PTSD. Robert J. Lifton was one of them, as was my father, Henry Crystal. After that there was a whole group of people, including Matt Friedman, Terry Keene, Dennis Cerny, etc., who worked with Vietnam veterans, as well as many other researchers from around the world, such as Leo Eitinger and Lars Weiseth. This is a field of research, this problem is relevant in all countries, and in each country there are people who study this phenomenon and contribute to the common work.

One important PTSD researcher was my father, Henry Crystal, who passed away last year. He was one of the survivors of Auschwitz and also went through other camps. When he was released from the camps, he decided to try medical school.

He eventually moved to the United States with his aunt, graduated from medical school, became involved in psychiatry, and began working with other survivors of Nazi death camps. Examining other survivors claiming disability benefits, he carefully studied their cases, which became one of the most early descriptions post-traumatic stress disorder syndrome.

He was a psychoanalyst, so he tried to develop psychotherapeutic approaches from a psychoanalytic point of view, which included elements behavioral psychology, cognitive neuroscience and other disciplinary fields that interested him.

In this way, he developed some improvements in therapy to help people with PTSD, who often had difficulty expressing emotions and feelings.

Classification of injury

One important outcome of cultural experiences such as war and other major shocks is that we have begun to broaden our appreciation of those situations that can lead to trauma (adult trauma, childhood trauma, physical or sexual abuse), or situations where the patient witnesses terrible events and so on.

Thus, PTSD in society extends beyond social groups such as soldiers for whom PTSD is a prominent problem.

What is often misunderstood about PTSD is that it doesn't matter how bad the events were from the other person's perspective. Although there are attempts to classify or in some sense narrow the set of events that would be considered truly traumatic, for individuals The cause of injury is not so much the objective danger of the event as its subjective meaning.

For example, there are situations when people react sharply to something that seems completely harmless. This usually happens because people believe that life as they knew it is over; something deeply tragic and destructive happened to them, and they perceive it that way, even if it looks different to others.

It's easy to get confused by the labels, so it's useful to differentiate the concept of PTSD from other types of stress reactions. But you can imagine, for example, that some people have a gap in romantic relationships is experienced as the end of life in the form familiar to them.

So, even if the event does not ultimately cause PTSD, doctors have learned to take seriously the impact of these types of events on people's lives, and they try to help them no matter what adjustment process they are going through.

Treatment with psychotherapy

The most common type of treatment for PTSD is, on the one hand, either psychotherapy or psychological counseling, on the other hand, the use of special drugs.

Today, no one anymore forces people who are upset and preoccupied with trauma to tell a traumatic story over and over again immediately after a traumatic experience. In the past, however, this was practiced using the technique of “traumatic debriefing,” because it was believed that if people could tell their story, they would feel better.

But it was later discovered that too much insistence and pushing to tell the story tended to intensify memories and negative reactions to the trauma.

Nowadays there are a number of techniques that are used to very gently lead people to their memories and talk about them - counseling or psychotherapeutic techniques that are very useful.

Among them, the most reliable and practiced are progressive exposure therapy, correction of cognitive distortions (cognitive processing therapy) and eye movement desensitization.

These therapies have a lot in common: they all start by teaching people to relax, because for these therapies to be effective, they need to be able to relax and be relaxed when working with trauma.

Each deals in a different way with trauma-related memories, trauma re-enactment, and analysis of those aspects of the traumatic situation that people find most difficult.

In progressive exposure therapy, one begins with a memory that is associated with the trauma and is least painful, and learns to relax and not become upset.

Then they move on to the next moment, which is more painful, and so on. In the correction of cognitive distortions there are similar procedures, but in addition, work is carried out in which the patient tries to correct incorrect ideas, assumptions or conclusions drawn from traumatic experiences.

For example, a woman who has been sexually assaulted may think that all men are dangerous. In reality, only some men are dangerous, and putting traumatic ideas into a more adaptive context is an important part of correcting cognitive distortions.

Eye movement desensitization, in turn, includes elements of the other two types of therapy, as well as a third component in which the therapist distracts the patient by having him move his finger from one side to the other and focus on moving the finger back and forth. This focusing on a finger that is not related to the trauma is a technique that helps some people relax during a traumatic memory.

There are also other techniques that are beginning to be explored. For example, there are mindfulness-based therapies. They represent various practices through which people can learn to relax and their emotional reactions can be managed, as well as many other therapies. At the same time, people find it both pleasant and useful. Another common aspect of all of these therapies is that they all contain a didactic/educational component.

In the days when PTSD was not yet understood, people came for treatment but didn't really understand what was going on and thought there was something wrong with their heart. intestinal tract either their head or something bad was happening to them, but they did not understand what it was. Lack of understanding was a source of anxiety and problems. So when doctors explained to these people what PTSD was and that the symptoms they were experiencing were common and treatable, that understanding helped people feel better.

Treatment with medications

Currently, the evidence supporting psychotherapy is stronger than that supporting drug treatment. However, there are several tested medications that have been shown to be effective.

Both drugs approved for treatment in the United States are antidepressants and have a similar mechanism of action. They belong to selective serotonin reuptake inhibitors, and one of them is called Sertraline, and the other is Paroxetine.

Sertraline formula

These are standard antidepressant medications designed to treat depression. They have some impact on PTSD patients and help many of them. There are also many other related drugs with relatively proven effectiveness.

These include serotonin and norepinephrine reuptake inhibitors, an example of which is the drug Venlafaxine. Venlafaxine has been studied for the treatment of PTSD, and there have also been several studies of older antidepressants such as Desipramine, Imipramine, Amitriptyline, and monoamine oxidase inhibitors, which are often prescribed in Europe and other parts of the world.

Some medications used in clinical practice, do not have a sufficient number of theoretical justifications for use. These include antipsychotic drugs second generation, benzodiazepines such as Valium, anticonvulsants such as Lamotrigine, and the typical antidepressant Trazodone, which is often prescribed as a sleeping pill.

Such medications are used to relieve anxiety, increased excitability, and usually help patients better control their emotions and normalize sleep. In general terms, medications and psychotherapy show equal effectiveness. In clinical practice, it is often possible to observe cases where both psychotherapy and medications are used to treat patients with severe symptoms of PTSD.

Brain Tissue Bank and SGK1

IN Lately There have been many breakthroughs in PTSD research. One of the most exciting among them comes from Dr. Ronald Duman of Yale University, who worked with the first brain tissue collection in the field of PTSD.

From a medical point of view, if a patient has some kind of kidney problem, there is a high probability that the attending physician has a good understanding of it, since he has previously studied kidney biology in the context of all possible kidney diseases. The doctor will look at the kidney cells under a microscope and determine what is happening to them.

The same approach has been extremely effective in some cases of neuropsychiatry: scientists have been able to learn a lot about the biology of Alzheimer's disease, schizophrenia and depression by studying autopsy tissue. However, brain tissue samples from patients with PTSD have never been collected, as this is a fairly narrow area of ​​research.

With the support of the Department of Veterans Affairs, the first attempts to collect a collection of PTSD brain tissue began in 2016, and the first study based on it was published, which, as expected, showed that only part of our ideas about PTSD is correct, while others wrong.

PTSD brain tissue tells us many interesting things, and there is a story that illustrates it perfectly.

In post-traumatic stress disorder, executive control of emotions, or our ability to calm down after encountering something frightening, is impaired. external environment. Some of the techniques we use to calm ourselves down are distractions.

For example, when we say, “It's okay, don't worry,” our brain's frontal cortex is responsible for this calming effect. The brain bank now contains tissue from the frontal cortex of PTSD, and Dr. Duman has been studying mRNA levels in this tissue. mRNAs are the products of genes that code for the proteins that make up our brains.

It turned out that the levels of an mRNA called SGK1 were particularly low in the frontal cortex. SGK1 has never been studied in the field of PTSD before, but it is small degree associated with cortisol, a stress hormone that is released in people during stressful situations.

SGK1 protein structure

To understand what low levels of SGK1 might mean, we decided to study stress, and the first thing we found was the observation that SGK1 levels were reduced in the brains of animals exposed to stress. Our second step, which was especially interesting, was to ask the question: “What happens if the level of SGK1 itself is low?

Does low SGK1 make a difference? We bred animals with low levels of SGK1 in the brain, and they were very sensitive to stress, as if they already had PTSD, even though they had never been exposed to stress before.

So the observation low level SGK1 in PTSD and low SGK1 in animals under stress means that low SGK1 makes a person more anxious.

What happens if you increase the level of SGK1? Dr. Duman used a special technique to create these conditions and then maintain high level SGK1. It turns out that in this case the animals do not develop PTSD. In other words, they become resistant to stress.

This suggests that perhaps one strategy PTSD research should pursue is to look for drugs or other methods, such as exercise, that can increase SGK1 levels.

Alternative areas of research

This completely new strategy of moving from molecular signals in brain tissue to a new drug has never been used in PTSD before, but is now feasible. There are also many other exciting areas.

From the results of brain scans, we learn about possible brain circuits involved in PTSD: how these circuits are distorted, how they relate to PTSD symptoms (this is learned through functional neuroscanning). From genetic studies we learn about gene variations that affect increased sensitivity to stress.

For example, previous research suggested that the serotonin transporter gene contributed to children's greater sensitivity to maltreatment in early childhood and increased their chances of developing symptoms of PTSD and depression.

This type of research is now being actively conducted in children and adults, and another cortisol-related gene, FKBP5, has recently been discovered, changes in which may be related to PTSD.

In particular there is one interesting example how biology translates into new treatments. We are currently testing a new drug for PTSD in 2016 that has been used to treat depression and pain syndromes, - anesthesia drug ketamine.

Fifteen or even twenty years of research have shown that when animals are exposed to uncontrolled, prolonged stress, over time they begin to lose synaptic connections (connections between nerve cells in the brain) in the brain circuitry responsible for regulating mood, as well as in some areas responsible for thinking and higher cognitive functions.

One of the questions facing scientists is how can we develop treatments that aim not only at relieving the symptoms of PTSD, but also at helping the brain restore synaptic connections between nerve cells so that circuits are more effective at regulating mood?

And, interestingly enough, Dr. Duman's lab found that when a single dose of ketamine was administered to animals, the circuits actually restored these synapses.

It's an incredible thing to look through a microscope and actually see these new "dendritic spines" grow within an hour or two of one dose of ketamine. Subsequently, ketamine was given to people with PTSD and they experienced clinical improvements.

This is another exciting area where drugs are being developed not only based on visible symptoms diseases, but also in the context of the functioning of brain circuits. This is a rational, scientific approach.

Thus, from a biological point of view, there is now a lot of interesting research being conducted, work is underway to study and disseminate psychotherapy, research on genetics continues, and attempts are being made to develop medical supplies. Much of what is happening has the potential to change the way we think about things related to PTSD.

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Post-traumatic disorders do not belong to a class of diseases. These are severe mental changes caused by various stressful conditions. Nature rewarded human body great endurance and ability to withstand even the most heavy loads. At the same time, any individual tries to adapt, adapt to life changes. But a large number of experiences and traumas drive a person into a certain state, which gradually turns into a syndrome.

What is the essence of the disorder?

Post-traumatic stress syndrome manifests itself in the form of a variety of symptoms of mental disorders. The person falls into a state of extreme anxiety, and periodically strong memories of traumatic actions appear.

This disorder is characterized by slight amnesia. The patient is unable to reconstruct all the details of the situation that occurred.

Strong nervous tension, nightmares gradually lead to the appearance of cerebrasthenic syndrome, which indicates damage to the central nervous system. At the same time, the functioning of the heart, endocrine and digestive system organs deteriorates.

Post-traumatic disorders are on the list of the most common psychological problems.

Moreover, the female half of society is exposed to them more often than the male half.

From a psychological point of view, post-traumatic stress does not always take on a pathological form. The main factor is the level of passion of a person in an extraordinary situation. Also, its appearance depends on a number of external factors.

Age and gender play a significant role. Young children, elderly people, and women are most susceptible to post-traumatic syndrome. No less significant are the living conditions of a person, especially after experiencing stressful events.

Experts identify a number of individual characteristics that increase the risk of developing post-traumatic syndrome:

• Hereditary diseases;
• childhood mental trauma;
• diseases different organs and systems;
• lack of family and friendships;
• difficult financial situation.

Reasons for appearance

The reasons include various kinds an experience that a person has absolutely not encountered before.

They can cause severe overstrain of his entire emotional sphere.

Most often, the main motivators are military conflict situations. The symptoms of such neuroses are intensified by the problems of military people adapting to civilian life. But those who quickly integrate into social life are much less likely to suffer from post-traumatic disorders.

Post-war stress can be supplemented by another depressing factor - captivity. Here serious violations mental disorders appear during the period of influence of a stress factor. Hostages often cease to correctly perceive the current situation.

Prolonged existence in fear, anxiety and humiliation causes severe nervous strain, which requires long-term rehabilitation.

Victims of sexual violence and people who have experienced severe beatings are prone to post-traumatic syndrome.

As for people who have survived various natural and car accidents, the risk of this syndrome depends on the magnitude of the losses: loved ones, property, and so on. Such individuals very often develop an additional feeling of guilt.

Characteristic symptoms

Constant memories of specific traumatic events are clear signs of post-traumatic stress disorder. They appear like pictures from days gone by. At the same time, the victim feels anxiety and irresistible helplessness.

Such attacks are accompanied by increased blood pressure, irregular heart rhythms, the appearance of sweat, and so on. It’s hard for a person to come to his senses; it seems to him that the past wants to return to real life. Very often illusions appear, for example, screams or silhouettes of people.

Memories can arise either spontaneously or after meeting a specific stimulus that reminds of the disaster that occurred.

Victims try to avoid any reminders of the tragic situation. For example, people with PTSD syndrome who have survived a car accident try, if possible, not to travel by this type of transport.

The syndrome is accompanied by sleep disturbances, where moments of disaster emerge. Sometimes such dreams are so frequent that a person ceases to distinguish them from reality. Here you definitely need the help of a specialist.

TO frequent signs Stress disorder is attributed to the death of people. The patient exaggerates his responsibility so much that he experiences absurd accusations.

Any traumatic situation causes a feeling of alertness. A person is terrified of the appearance of terrible memories. Such nervous tension practically does not go away. Patients constantly complain of anxiety, flinching from every extra rustle. As a result, the nervous system is gradually depleted.

Constant attacks, tension, nightmares lead to cerebrovascular disease. Physical mental performance, attention weakens, irritability increases, creative activity disappears.

A person is so aggressive that he loses his social adaptation skills. He constantly conflicts and cannot find a compromise. So he gradually sinks into loneliness, which significantly worsens the situation.

An individual who suffers from this syndrome does not think about the future, does not make plans, he plunges headlong into his terrible past. There is a desire for suicide and drug use.

It has been proven that people with post-traumatic syndrome rarely see a doctor; they try to relieve attacks with the help of psychotropic drugs. Often such self-medication has negative consequences.

Types of disorder

Experts have created a medical classification of types of PTSD, which helps to choose the right treatment regimen for this disorder.

Anxious

Characterized by constant tension and frequent manifestation of memories. Patients suffer from insomnia and nightmares. They very often experience shortness of breath, fever, and sweating.

Such people have difficulty adapting socially, but they easily communicate with doctors and willingly cooperate with psychologists.

Asthenic

Characterized by obvious exhaustion of the nervous system. This condition confirmed by weakness, lethargy, lack of desire to work. People are not interested in life. Despite the fact that insomnia is absent in this case, it is still difficult for them to get out of bed, and during the day they are constantly in some kind of half-asleep. Asthenics are able to independently seek professional help.

Dysphoric

Differs in bright embitterment. The patient is in a darkened state. Internal discontent comes out in the form of aggression. Such people are withdrawn, so they themselves do not make contact with doctors.

Somatophoric

Characterized by complaints from the heart, intestines and nervous system. Wherein laboratory research do not detect diseases. People suffering from PTSD are obsessed with their health. They constantly think that they will die from some kind of heart disease.

Types of violation

Depending on the signs of the syndrome and the duration of the latent period, the following types are distinguished:

Spicy

Strong manifestation all signs of this syndrome for 3 months.

Chronic

The manifestation of the main symptoms decreases, but the depletion of the central nervous system increases.

Acute post-traumatic character deformation

Depletion of the central nervous system, but without special symptoms PTSD. This occurs when the patient is in chronic condition stress and does not receive timely psychological help.

Features of stress in children

Considered quite vulnerable childhood when the child’s psyche is very receptive.

The disorder in children occurs due to the most various reasons, For example:

• Separation from parents;
• a loss loved one;
• severe injuries;
• stressful situations in the family, including violence;
• problems at school and much more.

All possible consequences are observed in the following symptoms:

1. Constant thoughts about the traumatic factor through conversations with parents, friends, in a playful way;
2. sleep disturbance, nightmares;
3. , indifference, inattention;
4. aggression, irritability.

Diagnostics

Experts spent a long time clinical observations and were able to create a list of criteria by which a diagnosis of post-traumatic stress disorder can be made:

1. Human involvement in an emergency situation.
2. Constant memories of terrible experiences (nightmares, anxiety, flashback syndrome, cold sweat, increased heart rate).
3. There is a great desire to get rid of thoughts about what happened, thus erasing what happened from life. The victim will avoid any conversations about the current situation.
4. The central nervous system is in stress activity. Sleep is disturbed, outbursts of aggression occur.
5. The above symptoms continue for a long period.

Drug treatment

This condition requires the use of medications in the following cases:

• Constant pressure;
• anxiety;
• a sharp deterioration in mood;
• increased frequency of attacks of intrusive memories;
• possible hallucinations.

Therapy with medication is not done independently; most often it is used in conjunction with psychotherapy sessions.

When the syndrome occurs in mild form, sedatives are prescribed, such as Corvalol, validol, valerian.

But there are cases when these remedies are not enough to relieve the severe symptoms of PTSD. Then antidepressants are used, for example, fluoxetine, sertraline, fluvoxamine.

These medications have a fairly wide range of actions:

• Increased mood;
• anxiety relief;
• improvement of the nervous system;
• reduction in the number of permanent memories;
• removing outbursts of aggression;
• getting rid of drug and alcohol addiction.

When taking these medications, you should be aware that at first the condition may worsen and the level of anxiety may increase. That is why doctors advise starting with small doses, and in the first days they prescribe tranquilizers.

Beta blockers such as anaprilin, propranolol, and atenolol are considered the mainstay of treatment for PTSD.

When the disease is accompanied by illusions and hallucinations, antipsychotics are used, which have a calming effect.

The correct treatment for severe stages of PTSD, without obvious signs of anxiety, is to use tranquilizers from the benzodiazepine group. But when anxiety arises, Tranxen, Xanax or Seduxen are used.

For the asthenic type, nootropics are necessarily prescribed. They can have a stimulating effect on the central nervous system.

Despite the fact that these medications do not have serious contraindications, they may have side effects. Therefore, it is very important to consult with specialists.

Psychotherapy

It is very important in the post-stress period and most often it is carried out in several stages.

The first stage involves establishing trust between the psychologist and the patient. The specialist tries to convey to the victim the full severity of this syndrome and justify treatment methods that are sure to have a positive effect.

The next step will be the actual treatment of PTSD. Doctors are confident that the patient should not run away from his memories, but accept them and process them at the subconscious level. Designed for this purpose special programs that help the victim cope with the tragedy.

Excellent results have been shown by procedures in which victims re-experience what once happened to them, telling all the details to a psychologist.

Among the new options for dealing with persistent memories, the technique of rapid eye movements occupies a special place. Psychocorrection of feelings of guilt was also effective.

There are both individual sessions and group sessions, where people are united by a similar problem. There are also options for family activities, this applies to children.

Additional methods of psychotherapy include:

• Hypnosis;
• auto-trainings;
• relaxation;
• therapy through art.

The last stage is considered to be assistance from a psychologist in making plans for the future. After all, very often patients do not have life goals and cannot set them.

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Post-traumatic syndrome (PTS, post-traumatic stress disorder - PTSD) - serious violation psyche, caused by the external influence of a super-strong traumatic factor. Clinical signs mental disorders arise as a result of violent actions, depletion of the central nervous system, humiliation, fear for the lives of loved ones. Pathology develops in the military; persons who suddenly learned about their incurable disease; victims in emergency situations.

The characteristic symptoms of PTS are: psycho-emotional stress, painful memories, anxiety, fear. Memories of a traumatic situation arise in fits and starts when encountering stimuli. They often become sounds, smells, faces and pictures from the past. Due to constant nervous overstrain, sleep is disturbed, the central nervous system is depleted, and dysfunction of internal organs and systems develops. Psychotraumatic events have a stressful effect on a person, which leads to depression, isolation, and fixation on the situation. Similar signs persist for a long time, the syndrome progresses steadily, causing the patient significant suffering.

Post-traumatic stress disorder often develops in children and older adults. This is due to their low resistance to stress, poor development of compensatory mechanisms, mental rigidity and loss of its adaptive capabilities. Women suffer from this syndrome much more often than men.

The syndrome has ICD-10 code F43.1 and the name “Post-traumatic stress disorder.” Diagnosis and treatment of PTSD is carried out by specialists in the field of psychiatry, psychotherapy, and psychology. After talking with the patient and collecting anamnestic data, doctors prescribe medication and psychotherapy.

A little history

The ancient Greek historians Herodotus and Lucretius described the signs of PTSD in their writings. They observed soldiers who, after the war, became irritable and anxious, tormented by a flood of unpleasant memories.

Many years later, when examining former soldiers, increased excitability, fixation on difficult memories, immersion in one’s own thoughts, and uncontrollable aggression were discovered. The same symptoms were identified in patients after a train accident. In the middle of the 19th century similar condition called “traumatic neurosis”. Scientists of the 20th century proved that the signs of such neurosis intensify over the years, rather than weakening. Former concentration camp prisoners voluntarily said goodbye to an already calm and well-fed life. Similar mental changes have also been observed in people who have become victims of man-made or natural disasters. Anxiety and fear have forever entered their daily lives. The experience accumulated over decades has allowed us to formulate the modern concept of the disease. Currently, medical scientists associate PTSD with emotional experiences and psychoneurotic disorders caused not only by extraordinary natural and social events, but also by social and domestic violence.

Classification

There are four types of PTSD:

• Acute - the syndrome lasts 2-3 months and manifests itself with a pronounced clinical picture.
• Chronic - the symptoms of the pathology increase over 6 months and are characterized by exhaustion of the nervous system, a change in character, and a narrowing of the range of interests.
• The deformational type develops in patients with a long-term chronic mental disorder, leading to the development of anxiety, phobias, and neuroses.
• Delayed - symptoms appear six months after the injury. Various external stimuli can provoke its occurrence.

Causes

The main cause of PTSD is stress disorder that occurs after a tragic event. Traumatic factors or situations that can lead to the development of the syndrome:

1. armed conflicts,
2. disasters,
3. terrorist attacks,
4. physical violence,
5. torture,
6. attack,
7. brutal beating and robbery,
8. child theft,
9. incurable disease,
10. death of loved ones,
11. miscarriages.

Post-traumatic syndrome has an undulating course and often provokes persistent personality changes.

The formation of PTSD is promoted by:

• moral injury and shock that arise from the loss of a loved one, during military operations and under other traumatic circumstances,
• a feeling of guilt towards the dead or a feeling of guilt about what was done,
• destruction of old ideals and ideas,
• reassessment of personality, the formation of new ideas about one’s own role in the world around us.

According to statistics, those most at risk of developing PTSD are:

1. victims of violent acts,
2. witnesses to rape and murder,
3. persons with high sensitivity and poor mental health,
4. doctors, rescuers and journalists present on duty at the scene of the incident,
5. women experiencing domestic violence
6. persons with a family history of psychopathology and suicide,
7. socially lonely people - without family and friends,
8. persons who received severe injuries and mutilations in childhood,
9. prostitutes,
10. policemen,
11. persons with a tendency to neurotic reactions,
12. people with antisocial behavior - alcoholics, drug addicts, mentally ill people.

In children, the cause of the syndrome is often the divorce of their parents. They often feel guilty for this and worry that they will see less of one of them. Another pressing cause of disorder in today’s cruel world is conflict situations at school. Stronger children can mock weaker ones, intimidate them, and threaten them with violence if they complain to their elders. PTSD also develops as a result of child abuse and neglect by relatives. Regular exposure to a traumatic factor leads to emotional exhaustion.

Post-traumatic syndrome is a consequence of severe mental trauma that requires medication and psychotherapeutic treatment. Currently, psychiatrists, psychotherapists and psychologists are studying post-traumatic stress. This is a current trend in medicine and psychology, the study of which is devoted to scientific works, articles, and seminars. Modern psychological trainings increasingly begin with a conversation about post-traumatic stress state, diagnostic features and main symptoms.

The timely introduction of someone else’s traumatic experience into your life, emotional self-control, adequate self-esteem, social support.

Symptoms

With PTSD, a traumatic event is obsessively repeated in the minds of patients. Such stress leads to extremely intense feelings and causes thoughts of suicide.

Symptoms of PTSD are:

• Anxiety-phobic states, manifested by tearfulness, nightmares, derealization and depersonalization.
• Constant mental immersion in past events discomfort and memories of the traumatic situation.
• Intrusive memories of a tragic nature, leading to uncertainty, indecision, fear, irritability, and temper.
• The desire to avoid everything that may remind you of the stress experienced.
• Memory impairment.
• Apathy, poor relationships with family, loneliness.
• Loss of contact with needs.
• A feeling of tension and anxiety that does not go away even in sleep.
• Pictures of the experience “flash” in the mind.
• Inability to verbally express your emotions.
• Antisocial behavior.
• Symptoms of central nervous system depletion are the development of cerebrospinal gravis with decreased physical activity.
• Emotional coldness or dullness of emotions.
• Social alienation, decreased reaction to surrounding events.
• Anhedonia is the absence of a feeling of pleasure, joy of life.
• Violation of social adaptation and alienation from society.
• Narrowing of consciousness.

Patients cannot escape from haunting thoughts and find their salvation in drugs, alcohol, gambling, and extreme entertainment. They constantly change jobs, often have conflicts with family and friends, and have a tendency to wander.

Symptoms of the disease in children are: fear of separation from parents, development of phobias, enuresis, infantilism, mistrust and aggressive attitude towards others, nightmares, isolation, low self-esteem.

Kinds

Types of PTSD:

1. Anxious type characterized by attacks of unmotivated anxiety, which the patient is aware of or feels physically. Nervous overstrain prevents you from sleeping and leads to frequent changes moods. At night they lack air, sweating and fever occur, followed by chills. Social adaptation caused by increased irritability. To alleviate the condition, people strive for communication. Patients often seek medical help themselves.
2. Asthenic type is manifested by the corresponding signs: lethargy, indifference to everything that is happening, increased drowsiness, lack of appetite. Patients are depressed by their own inadequacy. They easily agree to treatment and happily respond to the help of loved ones.
3. Dysphoric type is different excessive irritability, turning into aggression, touchiness, vindictiveness, depression. After outbursts of anger, swearing and fighting, patients regret it or experience moral satisfaction. They do not consider themselves in need of a doctor's help and avoid treatment. This type of pathology often ends with the transition of protest aggressiveness into inadequate reality.
4. Somatophoric type manifests itself clinical signs dysfunctions of internal organs and systems: headache, interruptions in heart function, cardialgia, dyspeptic disorders. Patients become fixated on these symptoms and are afraid of dying during the next attack.

Diagnosis and treatment

Diagnosis of post-traumatic syndrome consists of collecting anamnesis and interviewing the patient. Specialists must find out whether the situation that occurred really threatened the life and health of the patient, whether it caused stress, horror, a feeling of helplessness and moral distress for the victim.

Specialists must identify at least three symptoms characteristic of the pathology in the patient. Their duration should not be less than a month.

Treatment of PTSD is complex, including medication and psychotherapy.

Specialists prescribe the following groups psychotropic drugs:

Psychotherapeutic methods of influence are divided into individual and group. During sessions, patients are immersed in their memories and re-experience the traumatic situation under the supervision of a professional psychotherapist. By using behavioral psychotherapy Patients gradually become accustomed to trigger factors. To do this, doctors provoke attacks, starting with the weakest clues.

1. Cognitive-behavioral psychotherapy - correction negative thoughts, feelings and behavior of patients, allowing to avoid serious life problems. The goal of such treatment is to change your thinking pattern. If you cannot change the situation, then you need to change your attitude towards it. CPT allows you to relieve the main symptoms of mental disorders and achieve stable remission after a course of therapy. At the same time, the risk of relapse of the disease is reduced, the effectiveness of drug treatment is increased, erroneous attitudes of thinking and behavior are eliminated, and personal problems are resolved.
2. Desensitization and processing by eye movements provides self-healing in psychotraumatic situations. This method is based on the theory that any traumatic information is processed by the brain during sleep. Psychological trauma disrupts this process. Instead of normal dreams, patients are tormented at night by nightmares and frequent awakenings. Repeated series of eye movements unblock and accelerate the process of assimilation of received information and processing of traumatic experience.
3. Rational psychotherapy – explaining to the patient the causes and mechanisms of the disease.
4. Positive therapy - the existence of problems and diseases, as well as ways to overcome them.
5. Auxiliary methods - hypnotherapy, muscle relaxation, auto-training, active visualization of positive images.

Folk remedies that improve the functioning of the nervous system: infusion of sage, calendula, motherwort, chamomile. Black currants, mint, corn, celery and nuts are considered beneficial for PTSD.

To strengthen the nervous system, improve sleep and correct increased irritability the following means are used:

The severity and type of PTSD determines the prognosis. Acute forms of pathology are relatively easy to treat. Chronic syndrome leads to pathological development personality. Narcotic and alcohol addiction, narcissistic and avoidant personality traits are unfavorable prognostic indicators.

Self-healing is possible with a mild form of the syndrome. With the help of medication and psychotherapy, it reduces the risk of developing negative consequences. Not all patients recognize themselves as sick and visit a doctor. About 30% of patients with advanced forms of PTSD commit suicide.

Video: psychologist about post-traumatic syndrome

Video: Documentary on PTSD