Lecture Lecture №№77PostPost--traumatic traumatic stress stress

disorder. Sdisorder. Stresstress--relatedrelated psychosis. Psychiatry of psychosis. Psychiatry of catastrophes and natural catastrophes and natural

calamities.calamities.

LecturerLecturer Savka SSavka S..D.D.

Diagnostic criteria for Diagnostic criteria for pposttraumatic stress disorderosttraumatic stress disorder

A.Existence of a recognizable stressor that would A.Existence of a recognizable stressor that would evoke significant symptoms of distress in almost evoke significant symptoms of distress in almost everyone.everyone.

B.Reexperiencing of the trauma as evidenced by B.Reexperiencing of the trauma as evidenced by at least one of the following:at least one of the following:

1.Recurrent and intrusive recollections of the event.1.Recurrent and intrusive recollections of the event.2.Recurrent dreams of the event.2.Recurrent dreams of the event.3.Sudden acting or feeling as if the traumatic event 3.Sudden acting or feeling as if the traumatic event

were recurring, because of an association with an were recurring, because of an association with an environmental or ideational stimulus.environmental or ideational stimulus.

Diagnostic criteria for Diagnostic criteria for pposttraumatic stress disorderosttraumatic stress disorder

C. Numbing of responsiveness to or C. Numbing of responsiveness to or reduced involvement with the reduced involvement with the external world, beginning some external world, beginning some time after the trauma, as shown by time after the trauma, as shown by at least one of the following:at least one of the following:1.Markedly diminished interest in 1.Markedly diminished interest in one significant activities.one significant activities.2.Feeling of detachment or 2.Feeling of detachment or estrangement from others. estrangement from others. 3.Constricted affect.3.Constricted affect.

Diagnostic criteria for Diagnostic criteria for pposttraumatic stress disorderosttraumatic stress disorder

D. At least 2 of the following symptoms that D. At least 2 of the following symptoms that were not present before the trauma:were not present before the trauma:

1Hyperalertness or exaggerated startle 1Hyperalertness or exaggerated startle response.response.

2 Sleep disturbance.2 Sleep disturbance.3 Guilt about surviving when others have not, 3 Guilt about surviving when others have not,

or about behavior required for survival.or about behavior required for survival.4 Memory impairment or trouble concentrating.4 Memory impairment or trouble concentrating.5 Avoidance of activities that arouse 5 Avoidance of activities that arouse

recollection of the traumatic event.recollection of the traumatic event.6 Intensification of symptoms by exposure to 6 Intensification of symptoms by exposure to

events that symbolize or resemble the events that symbolize or resemble the traumatic event.traumatic event.

Reactive psychosisReactive psychosis I. AcuteI. Acute reactive psychosisreactive psychosis.. II.II. Subacute reactive psychosis Subacute reactive psychosis

(hysteric psychosis).(hysteric psychosis). IIIIII. . Prolonged reactive Prolonged reactive

psychosis.psychosis.

PsychosisPsychosis (from the (from the GreekGreek ψυχή "psyche", for mind/soul, ψυχή "psyche", for mind/soul,

and -ωσις "-osis", for abnormal condition) means and -ωσις "-osis", for abnormal condition) means abnormal condition of the mind, and is a generic abnormal condition of the mind, and is a generic psychiatric term for a mental state often psychiatric term for a mental state often described as involving a "loss of contact with described as involving a "loss of contact with reality". People suffering from psychosis are said reality". People suffering from psychosis are said to be to be psychotic.psychotic.

People experiencing psychosis may report People experiencing psychosis may report hallucinationshallucinations or or delusionaldelusional beliefs, and may beliefs, and may exhibit personality changes and exhibit personality changes and thought disorderthought disorder. . Depending on its severity, this may be Depending on its severity, this may be accompanied by unusual or bizarre behavior, as accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and well as difficulty with social interaction and impairment in carrying out the daily life activities.impairment in carrying out the daily life activities.

Karl Jaspers’s diagnostic criteriaKarl Jaspers’s diagnostic criteria

1) the disorder develops following a 1) the disorder develops following a psychological trauma; psychological trauma; 2) the contents of the patient's experiences 2) the contents of the patient's experiences proceeds from the nature of the stressful event proceeds from the nature of the stressful event and there is psychologically understandable and there is psychologically understandable association between them; association between them; 3) all the course of the disorder is associated 3) all the course of the disorder is associated with the traumatic situation, and its with the traumatic situation, and its disappearance or de-actualization promotes the disappearance or de-actualization promotes the cessation (or improvement) of the disorder.cessation (or improvement) of the disorder.

AcuteAcute reactive psychosisreactive psychosis twilight state; twilight state; reactive stupor; reactive stupor; reactive confusion; reactive confusion; reactive paranoid.reactive paranoid.

Twilight stateTwilight state For the twilight state of consciousness is For the twilight state of consciousness is

characteristic outbreak, briefness and rapid (critical) characteristic outbreak, briefness and rapid (critical) exit from him, shows up disorientation, often with exit from him, shows up disorientation, often with ability to execute enough difficult, but inadequate ability to execute enough difficult, but inadequate actions. Delusions and hallucinations under act of actions. Delusions and hallucinations under act of which a patient can have the flashes of which a patient can have the flashes of aggressively-destructive excitation is possible. aggressively-destructive excitation is possible. Takes place complete amnesia of period of Takes place complete amnesia of period of stupefaction of consciousness.stupefaction of consciousness.

TTwilight statewilight state – appears on the background of fear – appears on the background of fear with mimic and vegetative signs, panic flight from with mimic and vegetative signs, panic flight from place, where happened any unhappy event place, where happened any unhappy event (catastrophe, traffic accident, place of death). It has (catastrophe, traffic accident, place of death). It has duration from 1 hour to 1 day.duration from 1 hour to 1 day.

Twilight stateTwilight state Orientation - deep disorientation in time,

space and self; Perception - high thresholds of sensitivity,

panoramic hallucinations; Memory - no fixation of events, no

recollections of events, which had occurred during the twilight state;

Thinking - incoherence, fragmentary delusions;

Affects - anxiety, rage, disforia; Motor activity - aimlessness,

purposelessnessa.

Objective signs of Objective signs of hallucinationshallucinations

Anxious look. Anxious look. Expression of horror on face.Expression of horror on face. Attempts from someone to be hidden Attempts from someone to be hidden

laying of surrounding to the improper laying of surrounding to the improper talks about him and others like that.talks about him and others like that.

Stopping ears at auditory Stopping ears at auditory hallucinations, deleting from the hallucinations, deleting from the apartment of radio receiver.apartment of radio receiver.

Reactive stuporReactive stupor StuporStupor isis state from oligokinesia to total state from oligokinesia to total

absence of movements. Stupor refers to absence of movements. Stupor refers to a state in which the person is mute, a state in which the person is mute, immobile, and unresponsive, but immobile, and unresponsive, but appears to be conscious because the appears to be conscious because the eyes are open and follow external eyes are open and follow external objects. Mutism (muteness) is revealed objects. Mutism (muteness) is revealed often too. It has duration from several often too. It has duration from several hours to 3 days.hours to 3 days.

Reactive confusionReactive confusionAcute reactive confusion is Acute reactive confusion is

state twilight disorder of state twilight disorder of consciousness with consciousness with psychomotor excitement, psychomotor excitement, fear, constantly verbal fear, constantly verbal production.production.

Reactive paranoidReactive paranoid Acute reactive paranoid – Acute reactive paranoid –

develops acutely with fear, develops acutely with fear, anxiety, paranoid ideas of anxiety, paranoid ideas of relation and persecution. The relation and persecution. The components Kandinski-components Kandinski-Clerambault’s syndrome may be Clerambault’s syndrome may be (syndrome of psychic (syndrome of psychic automatism).automatism).

Subacute reactive psychosis Subacute reactive psychosis (hysteric psychosis).(hysteric psychosis).

hysteric twilight state;hysteric twilight state; pseudodementia;pseudodementia; Ganser’s syndrome;Ganser’s syndrome; hysteric regress of psychic;hysteric regress of psychic; hysteric stupor;hysteric stupor; like-mirage syndrome.like-mirage syndrome.

PseudodementiaPseudodementia patients are giving wrong patients are giving wrong

answersanswers especially,especially, not right not right fulfilling simple action, usually all fulfilling simple action, usually all actions they are making inside actions they are making inside out (white colour they name out (white colour they name black colour etc.), exaggeratedly black colour etc.), exaggeratedly mood and foolish.mood and foolish.

Hysteric stuporHysteric stupor Dissociative stupor is diagnosed on the Dissociative stupor is diagnosed on the

basis of a profound diminution or basis of a profound diminution or absence of voluntary movement and absence of voluntary movement and normal responsiveness to external normal responsiveness to external stimuli such as light, noise, and touch, stimuli such as light, noise, and touch, but examination and investigation but examination and investigation reveal no evidence of a physical cause. reveal no evidence of a physical cause. In addition, there is positive evidence of In addition, there is positive evidence of psychogenic causation in the form of psychogenic causation in the form of recent stressful events or problems. recent stressful events or problems.

Prolonged reactive psychosisProlonged reactive psychosis

1. Reactive depression1. Reactive depression – paranoid - depressive formparanoid - depressive form– asthenic - depressive formasthenic - depressive form– hysteric - depressive formhysteric - depressive form

2. Reactive paranoid2. Reactive paranoid

Reactive depressionReactive depression DDepression is a clinical syndrome epression is a clinical syndrome

consisting of consisting of lowering of mood-tonelowering of mood-tone (feelings of painful dejection), (feelings of painful dejection), difficulty difficulty in thinkingin thinking (slowing down of thinking), (slowing down of thinking), and and psychomotor retardationpsychomotor retardation (the so (the so called depressive triad). Depressive called depressive triad). Depressive patients experience conscious psychic patients experience conscious psychic suffering, anguish, and sometimes suffering, anguish, and sometimes feelings of boredom, despair, guilt or feelings of boredom, despair, guilt or other negative emotions. other negative emotions.

Reactive paranoidReactive paranoid Paranoid syndrome includes

both delusions and hallucinations. Delusions are not systematized among them delusions of persecution prevail, but other themes also occur. This syndrome is the most common of all the delusional syndromes.

Drug TreatmentDrug Treatment Psychotropic medications have a place in Psychotropic medications have a place in

controlling agitation and insomnia. If brief controlling agitation and insomnia. If brief reactive psychosis is suspected initially, reactive psychosis is suspected initially, neuroleptic medications should be limited to neuroleptic medications should be limited to short-term use only and then only when short-term use only and then only when absolutely necessary. If the diagnosis is absolutely necessary. If the diagnosis is suspected after neuroleptic treatment has suspected after neuroleptic treatment has already started, medications should be already started, medications should be discontinued as soon as possible. Symptomatic discontinued as soon as possible. Symptomatic treatment with benzodiazepines will often make treatment with benzodiazepines will often make the patient more comfortable, although these the patient more comfortable, although these agents may not relieve all symptoms in some agents may not relieve all symptoms in some patients.patients.

Psychological TreatmentPsychological Treatment Psychological treatment may take several forms. Psychological treatment may take several forms.

Simply being removed from the crisis and having Simply being removed from the crisis and having the care and attention of the hospital staff may the care and attention of the hospital staff may allay the patient's anxiety enough to permit allay the patient's anxiety enough to permit constructive discussion and problem solving. constructive discussion and problem solving. Once the resources of the staff become Once the resources of the staff become available, the stress may no longer seem available, the stress may no longer seem overwhelming. Enlisting the aid of family overwhelming. Enlisting the aid of family members may also be important for the same members may also be important for the same reason. In individual psychotherapy, encouraging reason. In individual psychotherapy, encouraging the patient to recount the events that led to the the patient to recount the events that led to the breakdown and to discuss their impact and breakdown and to discuss their impact and meaning will facilitate recovery. Longer-term meaning will facilitate recovery. Longer-term psychotherapy directed at more fundamental psychotherapy directed at more fundamental psychological conflicts may be indicated for psychological conflicts may be indicated for some patients.some patients.