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

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

Why does such a disease occur?

PTSD has the following causes:

• Difficult operation, severe injury. A person experiences his physical failure. Mental breakdowns are possible.
• Despotism and tyranny in the family or in other settings.
• Forced sex.
• Road accident, catastrophe on other modes of transport (ships, planes).
• Participation in hostilities. Military personnel and persons residing in the territory of military operations fall into this category.

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

Post-traumatic syndrome, what is it? 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, improves well-being.

Signs of the disease

PTSD has the following symptoms:

• Constant mental anguish, strong emotional outbursts due to events returning to memory. Painful intrusive memories that come on suddenly. Actual events become unimportant, a person re-lives past situations. panic state provokes the slightest detail, indirectly or directly reminiscent of a traumatic situation.
• Persistent sleep disturbance. Difficulty falling asleep, superficial sleep with frequent dreaming, 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 have a situation or an object that this moment doesn't really exist. Hallucinations occur when taking alcoholic beverages, medicines and spontaneously.
• Desire to commit suicide. The patient loses the meaning of life, seeks to leave it. Does not see the further purpose of existence.
• Rigidity of behavior. The patient reacts sharply to the slightest inconsistency with the expected. There is no softness, affection, tenderness.

The patient reacts sharply to the slightest inconsistency with the expected

• The desire for loneliness, some sociopathy. The patient feels most comfortable at home alone or at work with a minimum number of people. A person is fenced off from any communication, even with relatives.
• Aggression in response to any irritation. The individual is very afraid to feel pain or experience again, reacts very sharply to any real or imaginary event.
• Anxiety. The patient seems to be in a combat stance and is waiting for a blow. He constantly expects a repeat of the traumatic situation.
• specific behavior. Due to mental trauma, during any situation that looks like a dangerous one, a person behaves inappropriately.

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

If a post-traumatic syndrome is detected, then treatment should be mandatory. Otherwise, suicide or a severe mental disorder cannot be avoided.

Post-traumatic syndrome in children

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

There are sharp, harsh reactions to the slightest stimulus

Symptoms child syndrome injuries:

• permanent living in a traumatic situation. The kid initiates and reproduces it;
• sleep disturbances, fear of falling asleep and again being in a traumatic situation;
• apathetic state. The kid doesn't seem to be here. Feeling of complete denial of the present time;
• aggressiveness. The child resembles a stretched spring, which hits painfully at any contact. There are sharp, harsh reactions to the slightest stimulus.

Post-traumatic syndrome in military personnel

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

Psychotherapists assign names to such syndromes, according to the name of the areas where the hostilities took place. For example, there is such a thing as "Afghan" post-traumatic syndrome. Possible "Syrian" or "Iraqi" syndrome in the future.

Post-traumatic syndrome in military personnel

PTS Therapy

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

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

Psychic therapy consists of two moments - the drug factor and psychological assistance. The patient is assigned various drugs. Etiotropic (symptomatic therapy) is widely used to relieve symptoms of the syndrome. A patient with increased excitability is prescribed sedatives. If present physical injury and their consequences - analgesics are prescribed.

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

There is an opinion that it is impossible to cure such a syndrome 100%. Maybe so, but it is quite possible to make a person's life full, to 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 phenomena that cause emotions. negative character. It literally knocks the ground out from under a person’s feet and makes them suffer greatly. Moreover, the consequences of the disorder can manifest themselves for several hours or even several years.

What can cause PTSD?

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

In addition, post-traumatic stress can manifest itself if violence was used against a person or a tragic event took place. personal character: serious injury, prolonged illness both the person himself and his relative, including with a fatal outcome.

The traumatic events triggered by the manifestations of PTSD can be either single, such as during a disaster, or repeated, such as participation in hostilities, 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 or cause a feeling of helplessness.

People react differently to stress, this is due to their emotional susceptibility, level of psychological preparation, mental state. In addition, gender and age play an important role.

Post-traumatic stress disorder often occurs in children and adolescents, as well as women who have been exposed to domestic violence. The risk category for post-traumatic stress includes people who, due to professional activity often face violent actions and stresses - rescuers, policemen, firefighters, etc.

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

Symptoms of post-traumatic stress disorder

Post-traumatic stress disorder, which has a variety of symptoms, can manifest as:

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 frequent phenomenon as a flashback - a sudden immersion of the patient in the past, in which he feels the same as on the day of the tragedy. A person is visited by unpleasant memories, there is a frequent sleep disturbance with difficult dreams, his reactions to stimuli reminiscent of a tragic event are intensified.
2. On the contrary, it seeks to avoid everything that can remind you of the stress experienced. In this case, the memory for the events that caused PTSD is reduced, the state of affect is dulled. A person seems to be alienated from the situation that caused traumatic stress and its consequences.
3. The emergence of startle syndrome (eng. startle - frighten, startle) - an increase in autonomic activation, including an increase in the startle reaction. There is a function of the body that causes an increase in psycho-emotional arousal, which allows you to filter incoming external stimuli, which consciousness perceives as signs of an emergency.

In this case, marked the following symptoms PTSD:

• increased vigilance;
• increased attention to situations similar to threatening signs;
• keeping attention on events that cause anxiety;
• attention spans shrink.

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

With PTSD, indifference to what is happening around, lethargy is often observed. People may strive for new sensations without thinking about the negative consequences, and do not make plans for the future. Relations with the family of a person who has undergone traumatic stress most often deteriorate. He fences himself off from loved ones, more often voluntarily remains alone, and after that he can accuse relatives of inattention.

Behavioral signs of the disorder depend on what the person encountered, for example, after an earthquake, the victim will often position himself towards the door in order to have a chance to quickly leave the premises. After the bombings suffered, people behave cautiously, 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 states are more clearly manifested. To prescribe effective therapy, doctors use clinical classification course of the disorder. There are the following types of PTSD:

1. Anxious. In this case, the person is concerned frequent seizures memories that arise against the background of psycho-emotional overstrain. His sleep is disturbed: he has nightmares, he can suffocate, feel horror and chills. This condition complicates social adaptation, although character traits do not change. AT ordinary life such a patient will in every possible way avoid discussions of the experience, but often agrees to a conversation with a psychologist.
2. Asthenic. With this traumatic stress, there are signs of an exhausted nervous system. The patient becomes lethargic, performance decreases, he feels constant fatigue and apathy. He is able to talk about the event and often independently seeks the help of a psychologist.
3. Dystrophic. This type of PTRS is characterized as embittered and explosive. Patients are in a depressed state, constantly expressing dissatisfaction, and often in a rather explosive form. They withdraw into themselves and try to avoid society, do not complain, so often their condition is detected only because of inadequate 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 experienced stress, but with a deterioration in well-being.

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

Diagnosing PTSD

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

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

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

PTSD in childhood and adolescence

PTSD in children and adolescents is diagnosed quite often, because they are much more sensitive to psychic trauma than adults. In addition, the list of reasons in this case is much wider, since, in addition to the main situations, a severe illness or death of one of the parents, placement in an orphanage or boarding school can cause post-traumatic children in children.

Like adults with PTSD, children tend to avoid situations that remind them of the tragedy. But when reminded, the child may experience emotional overexcitation, manifesting in the form of screaming, crying, inappropriate behavior.

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

Children who have experienced physical violence on themselves can become aggressors in a team of their own kind. Very often they are disturbed 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 can manifest itself in the form of simplification of speech, loss of self-service skills, etc.

In addition, the symptoms of the disorder may include:

• impaired social adaptation: children are not able to present themselves as adults;
• there is isolation, capriciousness, irritability;
• Babies are having a hard time parting with their mother.

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

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

Often children find themselves in a stressful situation without the knowledge of their parents, for example, when they are abused by strangers. The relatives of the child should be worried if he began to sleep badly, cries out in his sleep, he is tormented by nightmares, without apparent reason often irritable or naughty. You should immediately consult with a psychotherapist or child psychologist.

Diagnosing PTSD in children

Exist various methods diagnosing PTSD, one of the most effective is conducting a semi-structured interview that allows you to evaluate traumatic ones. It is carried out for 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 talk about possible events that can cause traumatic stress in children. At right approach it is possible to reduce anxiety and arrange the patient for further communication.
3. Screening. Allows you to find out what kind of traumatic experience the child has. If he himself cannot name such an event, then he is offered to choose them from a ready list.
4. A survey through which a specialist can measure post-traumatic symptoms.
5. The final stage. negative emotions that arise with memories of the tragedy are eliminated.

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

Therapeutic measures for PTSD

The basis of PTSD therapy in both adult patients and children is high-quality psychological assistance from a qualified doctor, which is 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 fully justified, and that he is a full-fledged member of society. In addition, treatment includes various activities:

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

It is important that 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 the progression of the disease. In some cases it is impossible to do without medications are prescribed the following medications:

• antidepressants;
• benzodiazepines;
• normotimics;
• beta-blockers;
• tranquilizers.

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

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

When, after difficult experiences, people have difficulties associated with them, we speak of post-traumatic stress disorder (PTSD). People may notice that thoughts or memories of the traumatic event break into their thoughts, affect their concentration during the day, and appear as dreams at night.

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

Psychopathological re-experiencing

Psychopathological experiences differ from each other and depend on the nature of the psychological trauma. People with such re-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 recall sad events that they have experienced in the past, such as the death of other people.

In addition, these can be frightening memories, because during the time of psychological trauma, a person usually experiences 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 worried and uncomfortable in situations in which they feel vulnerable. They constantly monitor opening and closing doors and behave cautiously in crowded places.

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

Usually psychopathological re-experiences are short-term 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 the conversation, you can make the re-experiencing shorter. In addition, there are medications such as Valium that help people relax in these situations.

Symptoms and Diagnosis

Main symptoms of post-traumatic stress disorder- this is intrusive thoughts about the trauma, hyperexcitation, and sometimes shame, guilt. Sometimes people are unable to experience emotions and behave like robots in Everyday life.

In other words, people don't experience any emotions, or they don't experience any specific emotions like pleasure.

In addition, they constantly feel that they must defend themselves, they are in a state of anxiety, they have 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 if a person has PTSD without checking for symptoms. But in general, PTSD is diagnosed by getting from the patient all the details of the history that happened to him, and then examining the history of each symptom.

There are several diagnostic criteria, and if you observe enough symptoms, then you can diagnose PTSD. However, there are people whose disorders do not meet the diagnostic criteria because they do not have all the symptoms, but nevertheless have symptoms associated with PTSD.

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

Research history

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

However, as a formal diagnosis, the term "post-traumatic stress disorder" appeared only in 1980, that is, quite recently in terms of the history of psychiatry.

During civil war in the United States, the Crimean War, World Wars I and II, the Korean War, the Vietnam War - in all these events at the beginning of the conflict, physicists, psychologists or mental health professionals behaved as if they had forgotten all previous experience of previous wars.

And each time after the completion of one of them, a clinical examination was carried out at a high level for a given historical period.

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

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

Nevertheless, after the Second World War, Dr. Grinker and Spiegel's classic study of pilots appeared, which can be considered an excellent 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 Keane, Dennis Czerny and others, 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 of the important researchers in PTSD 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 US with his aunt, graduated from medical school, became a psychiatrist, and began working with other survivors of the Nazi death camps. While 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.

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

Injury classification

One of the important results of cultural experiences such as war and other major upheavals is that we have begun to expand our appreciation of those situations that can lead to trauma (trauma in adults, trauma in children, physical or sexual abuse), or situations where the patient is a witness to terrible events, and so on.

Thus, PTSD in society does not only cover social groups such as soldiers, for whom PTSD is a noticeable problem.

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

For example, there are situations when people overreact to something that seems completely harmless. This happens, as a rule, because people believe that life as they knew it is over; something deeply tragic and destructive has happened to them, and it is perceived that way by them, even if it looks different to others.

It is easy to get confused in the notation, so it is useful to separate the concept of PTSD from other types of reactions to stress. But you can imagine, for example, that some people have a gap in romantic relationship experienced as the end of life in their usual form.

So, even if the event doesn't end up causing PTSD, doctors have learned to take seriously the impact of this kind of event on people's lives, and they try to help them no matter what adjustment process they go 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, people who are upset and preoccupied with trauma are no longer forced to tell the traumatic story over and over again immediately after the traumatic experience. In the past, however, this was practiced using the technique of "traumatic debriefing", because it was believed that if you can get people to tell their story, then they will feel better.

But it was later discovered that pushing and pushing too hard to tell the story tended to only reinforce the memories and negative reactions to the trauma.

In our time, there are a number of techniques used to very gently lead people into and talk about their memories, counseling or psychotherapy techniques that are very useful.

Among them, progressive exposure therapy, cognitive processing therapy, and eye movement desensitization are the most reliable and practiced.

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

Each in its own way deals with trauma-related memories, replaying trauma, and analyzing those aspects of the traumatic situation that people find most difficult.

Progressive exposure therapy starts with the memory that is associated with the trauma and is the least painful, and learns to relax and not get upset.

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

For example, a woman who has been sexually abused may think that all men are dangerous. In fact, only some men are dangerous, and placing traumatic ideas in a more adapted context is an important part of correcting cognitive distortions.

Eye movement desensitization, in turn, includes elements of two other types of therapy, as well as a third component, in which the therapist distracts the patient by moving the finger from one side to the other and focusing on moving the finger back and forth. This focusing on the finger, which 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 are various practices through which people can learn to relax and manage their emotional reactions, as well as many other therapies. At the same time, people find it both pleasant and useful. Another common aspect of all these therapies is that they all contain a didactic/educational component.

In the days when post-traumatic stress disorder was not yet understood, people came for treatment, but did not understand at all what was happening, and thought that something was wrong with their heart, intestinal tract either 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 very common and treatable, that understanding made them feel better.

Medication treatment

Currently, the evidence for psychotherapy is stronger than that for drug treatment. However, there are several tested medicines that have shown their effectiveness.

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

Formula "Sertraline"

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

These include serotonin and norepinephrine reuptake inhibitors, an example of which is the drug Venlafaxine. Venlafaxine has been investigated for the treatment of PTSD, and there have been several studies of older antidepressants such as Desipramine, Imipramine, Amitriptyline, and monoamine oxidase inhibitors, which are commonly 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 sleep aid.

These medications serve to relieve anxiety, irritability, and usually help patients control their emotions and sleep better. In general, drugs and psychotherapy show the same effectiveness. In clinical practice, one can often observe cases when both psychotherapy and medication are used to treat patients with severe symptoms of PTSD.

Brain tissue bank and SGK1

AT recent times there have been many breakthroughs in PTSD research. One of the most exciting of these comes from Dr. Ronald Duman of Yale University, who worked on the first collection of brain tissue 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 is well versed in this, since he previously studied kidney biology in the context of all possible kidney disease. 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 as a result of studying autopsy tissues. However, samples of the brain tissue of patients with PTSD have never been collected, as this is a rather 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 are correct, while others wrong.

The brain tissue of PTSD tells a lot of interesting things, and there is a story that illustrates this beautifully.

In post-traumatic stress disorder, executive control of emotions, that is, our ability to calm down after being confronted with something frightening, is impaired. external environment. Some of the ways we use to calm ourselves down are distraction.

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

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

Structure of the SGK1 protein

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

Does low SGK1 make any difference? We have bred animals with low levels of SGK1 in the brain, and they are very sensitive to stress, as if they already have PTSD, although they have never been stressed before.

So the observation low level SGK1 in PTSD and low SGK1 in stressed animals 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 such 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 of the strategies that PTSD research should pursue is to look for drugs or other methods, such as exercise, that can increase SGK1 levels.

Alternative fields of study

This brand new strategy to move 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 the possible brain circuits involved in PTSD: how these circuits are distorted, how they are associated with PTSD symptoms (this is learned using functional neuroscanning). From genetic research, we learn about gene variations that affect hypersensitivity to stress.

For example, a previous study suggested that the serotonin transporter gene made children more susceptible to maltreatment. early childhood and increased their chances of developing symptoms of PTSD and depression.

Research of this type is currently underway in children and adults, and recently another cortisol-related gene, FKBP5, has been discovered that may be related to PTSD.

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

Fifteen or even twenty years of research has 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 circuit responsible for regulating mood, as well as in some areas responsible for thinking. and higher cognitive functions.

One of the questions scientists are facing is how can a treatment be developed that not only relieves the symptoms of PTSD, but also helps the brain restore synaptic connections between nerve cells so that the circuits regulate mood more effectively?

And, interestingly enough, Dr. Douman's lab found that when a single dose of ketamine was administered to animals, the circuits actually repaired those 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 a single dose of ketamine. Subsequently, ketamine was given to people with PTSD and they experienced clinical improvements.

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

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

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Post-traumatic disorders do not belong to the class of diseases. These are severe mental changes caused by various stressful conditions. Nature has rewarded human body great endurance and ability to endure even the most heavy loads. At the same time, any individual tries to adapt, adapt to life changes. But a large number of experiences, 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, with the strongest memories of traumatic actions periodically appearing.

For such a disorder, a slight amnesia is characteristic. The patient is unable to recover all the details of the situation.

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 work of the heart, organs of the endocrine and digestive systems worsens.

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.

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

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

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

• hereditary diseases;
• childhood trauma of the psyche;
• diseases various organs and systems;
• lack of family, friendships;
• difficult financial situation.

Reasons for the appearance

The reasons should include different kind experience that one has never experienced before.

They are capable of causing a strong overstrain of his entire emotional sphere.

Most often, the main motivators are military conflict situations. The symptomatology of such neuroses is intensified by the problems of adapting military people to civilian life. But those who are quickly included in 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 psyches appear during the period of influence of a stress factor. Hostages often cease to perceive the situation correctly.

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

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

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

Characteristic symptoms

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

Such attacks are accompanied by an increase in pressure, failure of heart rhythms, the appearance of sweat, and so on. It is hard for a person to come to his senses, it seems to him that the past wants to return to real life. Very often there are illusions, for example, screams or silhouettes of people.

Memories can arise both spontaneously and after meeting with a specific stimulus that reminds of the catastrophe.

The victims try to avoid any reminders of the tragic situation. For example, people with PTSD who have experienced a car accident try not to use that mode of transport whenever possible.

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 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 overstrain practically does not go away. Patients constantly complain of anxiety, shivering from every extra rustle. As a result, the nervous system is gradually depleted.

Constant attacks, tension, nightmares lead to cerebrovascular disease. Decreased physical, mental capacity, attention weakens, irritability increases, creative activity disappears.

A person is so aggressive that he loses his social adaptation skills. He constantly clashes, cannot find a compromise. So 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, the use of drugs.

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

Types of disorder

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

alarming

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

Such people have a hard time undergoing social adaptation, but they easily contact doctors and willingly cooperate with psychologists.

Asthenic

It is characterized by a clear depletion of the nervous system. This state 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 seek professional help on their own.

Dysphoric

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

somatophoric

It is characterized by complaints from the heart, intestines and nervous system. Wherein laboratory research do not detect disease. 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 deformation of character

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

Features of stress in children

considered quite vulnerable childhood when the child's psyche is very receptive.

The disorder in children occurs according to the most different reasons, for example:

• Separation from parents
• the 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 generate a list of criteria by which a diagnosis of post-traumatic stress disorder can be made:

1. Involvement of a person in an emergency situation.
2. Constant flashbacks of horrific experiences (nightmares, anxiety, flashback syndrome, cold sweat, rapid heartbeat).
3. A great desire to get rid of thoughts about what happened, thus deleting what happened from life. The victim will avoid any talk about the situation.
4. The central nervous system is in stressful activity. Sleep is disturbed, outbreaks of aggression occur.
5. The above symptoms continue for a long period.

Medical 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 obsessive memories;
• possible hallucinations.

Therapy with the help of medicines is not performed independently, most often it is used in conjunction with psychotherapy sessions.

When the syndrome occurs mild form, sedatives are prescribed, such as Corvalol, Validol, Valerian.

But there are times when these funds are not enough to stop the vivid symptoms of PTSD. Then antidepressants are used, for example, fluoxetine, sertraline, fluvoxamine.

These medicines have a fairly wide range of actions:

• Mood enhancement;
• removal of anxiety;
• improvement of the state of the nervous system;
• a decrease in the number of permanent memories;
• removal of outbreaks of aggression;
• getting rid of drug and alcohol addiction.

When taking these drugs, you should be aware that at first there may be a deterioration in the condition, an increase in the level of anxiety. That is why doctors advise starting with small doses, and tranquilizers are prescribed in the first days.

Beta-blockers, such as anaprilin, propranolol, atenolol, are considered the basis of PTSD therapy.

When the disease is accompanied by illusions, hallucinations are used antipsychotics, 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.

With the asthenic type, nootropics are required. They can have a stimulating effect on the central nervous system.

Despite the fact that these medicines do not differ in serious contraindications, they can have side effects. Therefore, it is very important to consult with experts.

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 the methods of therapy that will definitely give a positive effect.

The next step will be the direct treatment of PTSD. Doctors are sure that the patient should not leave his memories, but accept them and process them at the subconscious level. For this, developed special programs that help the victim cope with the tragedy.

Excellent results have been shown by procedures in which victims go through what happened to them once again, telling all the details to a psychologist.

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

Allocate 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;
• art therapy.

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

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Post-traumatic stress disorder (PTS, post-traumatic stress disorder - PTSD) - severe violation psyche, due to the external influence of a superstrong traumatic factor. Clinical signs mental disorders arise as a result of violent actions, depletion of the central nervous system, humiliation, fear for the life of loved ones. Pathology develops in the military; individuals who suddenly become aware of their incurable disease; injured in emergencies.

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

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

The syndrome has the ICD-10 code F43.1 and the name "Post-traumatic stress disorder". PTSD is diagnosed and treated 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 bit of history

The ancient Greek historians Herodotus and Lucretius described the signs of PTSD in their writings. They watched the soldiers, who after the war became irritable and anxious, they were tormented by the influx 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 found. The same symptoms were found in patients after a railway accident. In the middle of the 19th century similar condition called "traumatic neurosis". Scientists of the 20th century proved that the signs of such a neurosis intensify over the years, and not weaken. Former prisoners of concentration camps voluntarily said goodbye to an already calm and well-fed life. Similar changes in the psyche were also observed in people who became victims of man-made or natural disasters. Anxiety and fear have forever entered their daily lives. The experience gained over decades has made it possible 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 is manifested by a pronounced clinic.
• Chronic - the symptomatology of the pathology increases within 6 months and is characterized by the depletion of the nervous system, a change in character, and a narrowing of the circle of interests.
• The deformation 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.

The reasons

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

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

PTSD has an undulating course and often provokes a permanent personality change.

The formation of PTSD contribute to:

• moral trauma and shock arising from the loss of a loved one, during the conduct of hostilities and under other traumatic circumstances,
• a feeling of guilt towards the dead or a feeling of guilt about the deed,
• destruction of old ideals and ideas,
• reassessment of the personality, the formation of new ideas about one's own role in the world around.

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

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

In children, the cause of the syndrome is often the divorce of the parents. They often feel guilty about this, they worry that they will see less of one of them. Another actual cause of frustration in the modern cruel world is conflict situations at school. Stronger children may bully the weaker ones, intimidate them, threaten them with reprisals 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 medical and psychotherapeutic treatment. Currently, psychiatrists, psychotherapists and psychologists are studying post-traumatic stress. This is an actual trend in medicine and psychology, the study of which is devoted to scientific works, articles, seminars. Modern psychological trainings more and more often begin with a conversation about post-traumatic stress, diagnostic features and main symptoms.

To stop the further progression of the disease will help the timely introduction of someone else's traumatic experience into your life, emotional self-control, adequate self-esteem, social support.

Symptoms

In PTSD, a traumatic event is compulsively repeated in the minds of patients. Such stress leads to an extremely intense experience and causes suicidal thoughts.

The symptoms of PTSD are:

• Anxiety-phobic states, manifested by tearfulness, nightmares, derealization and depersonalization.
• Constant mental immersion in the events of the past, discomfort and memories of the traumatic situation.
• Intrusive memories of a tragic nature, leading to uncertainty, indecision, fear, irritability, irascibility.
• The desire to avoid everything that can remind you of the stress experienced.
• Memory impairment.
• Apathy, poor relationship with family, loneliness.
• Disruption of contact with needs.
• Feelings of tension and anxiety that do not go away even in sleep.
• Pictures of the experience, "flashing" in the mind.
• Inability to verbally express their emotions.
• antisocial behavior.
• Symptoms of CNS depletion are the development of cerebrosthenia with a decrease in physical activity.
• Emotional coldness or dullness of emotions.
• Social alienation, decreased reaction to surrounding events.
• Anhedonia is the absence of a sense of pleasure, the joy of life.
• Violation of social adaptation and alienation from society.
• Narrowing of consciousness.

Patients cannot be distracted from haunting thoughts and find their salvation in drugs, alcohol, gambling, extreme entertainment. They constantly change jobs, often conflict with family and friends, and tend to wander.

Symptoms of the disease in children are: fear of parting with their parents, the development of phobias, enuresis, infantilism, distrust and aggressive attitude towards others, nightmares, isolation, low self-esteem.

Kinds

Types of post-traumatic syndrome:

1. alarm type characterized by bouts of unmotivated anxiety, which the patient is aware of or feels bodily. Nervous tension does not allow sleep and leads to frequent shift moods. At night, they lack air, sweating and fever, followed by chills. Social adaptation due to increased irritability. To alleviate the condition, people seek to communicate. Patients often seek medical help themselves.
2. Asthenic type manifested by the corresponding signs: lethargy, indifference to everything that happens, increased drowsiness, lack of appetite. Patients are oppressed by their own failure. They easily agree to treatment and gladly respond to the help of loved ones.
3. Dysphoric type is different excessive irritability turning into aggression, resentment, vindictiveness, depression. After outbursts of anger, swearing and fights, patients regret it or experience moral satisfaction. They do not consider themselves in need of medical attention and avoid treatment. This type of pathology often ends with the transition of protest aggressiveness into an inadequate reality.
4. somatophoric type appears clinical signs dysfunctions of internal organs and systems: headache, interruptions in the work of the heart, cardialgia, dyspeptic disorders. Patients get hung up on these symptoms and are afraid to die during the next attack.

Diagnosis and treatment

Diagnosis of post-traumatic syndrome consists in collecting an anamnesis and questioning the patient. Specialists must find out whether the situation that actually occurred threatened the life and health of the patient, whether it caused stress, horror, a sense of helplessness and moral feelings of 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.

The treatment of PTSD is complex, including medication and psychotherapeutic effects.

Specialists appoint following groups psychotropic drugs:

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

1. Cognitive-behavioral psychotherapy - correction negative thoughts, feelings and behavior of patients, allowing to avoid serious life problems. The purpose of such treatment is to change your stereotype of thinking. If you cannot change the situation, then you need to change your attitude towards it. CPT allows you to stop the main symptoms of mental disorders and achieve stable remission after a course of therapy. At the same time, the risk of recurrence of the disease is reduced, the effectiveness of drug treatment is increased, erroneous attitudes of thinking and behavior are eliminated, and personal problems are solved.
2. Eye movement desensitization and processing 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 ordinary dreams, patients are tormented by nightmares at night and frequent awakenings. Repeated series of eye movements unblock and accelerate the process of assimilation of the received information and processing of traumatic experience.
3. Rational psychotherapy is an explanation to the patient of 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. Blackcurrants, mint, corn, celery, and nuts are considered beneficial for PTSD.

To strengthen the nervous system, improve sleep and correction increased irritability use the following tools:

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 poor prognostic signs.

Self-treatment is possible with a mild form of the syndrome. With the help of drug 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 end their lives by suicide.

Video: psychologist about post-traumatic syndrome

Video: PTSD Documentary