🔑 Key Learning

  • PTSD presents with flashbacks, emotional numbness, and hyperarousal after a traumatic event
    • If symptoms last < 4 weeks, consider Acute Stress Disorder instead
  • Management: Trauma-focused CBT and EMDR are first-line for PTSD
    • SSRIs (sertraline) or venlafaxine are used when therapy is declined or ineffective

🧠 Post-Traumatic Stress Disorder (PTSD)

👀 Clinical Features

  • Re-experiencing the trauma:
    • Nightmares
    • Flashbacks
  • Physical symptoms:
    • Sweating
    • Nausea or vomiting
    • Shaking, pain
  • Negative self-perception
  • Emotional numbing
  • Hyperarousal:
    • Hypervigilance
    • Irritability or aggression

💊 Management (NICE)

  • Do not offer single-session debriefing immediately after trauma
  • Mild symptoms < 4 weeks:
    • Watchful waiting
  • Moderate to severe symptoms with functional impairment:
    • 1st line: Trauma-focused CBT or Eye Movement Desensitisation and Reprocessing (EMDR)
      •  EMDR: Uses guided eye movements while recalling traumatic memories to help reprocess and reduce their emotional impact
    • Medication if:
      • Co-existing depression
      • Declines therapy
      • Therapy ineffective
      • Use sertraline or venlafaxine
      • Consider risperidone in severe cases

🕒 Acute Stress Disorder

👀 Clinical Features

  • Similar to PTSD
  • Occurs within the first 4 weeks after trauma

💊 Management

  • First-line: Trauma-focused CBT
  • Pharmacological: Benzodiazepines may be considered short term for severe anxiety

📝 Exam Clues & Clinchers

  • Nightmares + hypervigilance > 1 month after trauma → PTSD
  • Similar symptoms but within 4 weeks → Acute Stress Disorder
  • First-line PTSD therapy → CBT or EMDR
  • If therapy declined → sertraline or venlafaxine
  • Risperidone may be used in severe, resistant PTSD

🔗 Useful Links and References