Louisville Medicine Volume 69, Issue 2 - Page 14

( continued from page 11 )
» Excessive , unrealistic guilt » Difficulty taking time for oneself
» Difficulty asking for help : “ I ’ m self-sufficient and have always managed .”
Myths abound about how to intervene early in PTSD . If the “ fight or flight ” response continues to fire , and the excessive anxiety continues unabated , then the memory of the traumatic episode ( s ) develops into “ fear conditioning .”
Myth # 1 ) In studies of traumatizing events , psychological debriefing , in which the trauma victim talks about it in the immediate aftermath with a trained and sympathetic counselor , has been found more likely to do harm than good . It is better not to dwell on the event .
Myth # 2 ) The PTSD behaviors are simply normal responses to grossly abnormal circumstances .
Myth # 3 ) Critical Incident Stress Debriefing ( CISD ) is the best option . This was the major intervention following 9 / 11 – allowing people to vent for one to three hours and relive the traumatic experience – this also may be more harmful than helpful . In seven controlled studies post 9 / 11 measuring clinical outcomes after various interventions within one month of various kinds of psychological trauma , the analysis found no benefit from CISD , and suggested a detrimental effect for many .
According to the recently updated Cochrane review , “ Compulsory debriefing of victims of trauma should cease . A more appropriate response could involve a ‘ screen and treat ’ model .” also for 10 days , to blunt the unpleasant urgency of faster heart rate and raised blood pressure .
Pain increases the traumatic nature of the experience , so aggressively treating acute pain can lessen risk of PTSD .
The best evidence for psychotropic medications rests with the SSRIs and SNRIs . These medications can help if PTSD has already developed , but do not prevent PTSD .
Remember , benzodiazepines and anti-anxiety actually make PTSD symptoms worse .
So what do practicing physicians need to know about preventing PTSD ? Knowing your patient is a significant start . There is no proven medical treatment that prevents the development of PTSD in psychologically vulnerable populations . There is no FDA approved medication that prevents the development of “ fear conditioning ,” the fear one learns in association with specific stimuli . Meds that do help in the short term are propranolol and perhaps Trazodone for sleep . SSRIs can help if symptoms persist longer than three to four weeks . Primarily , be informative and supportive . Listen carefully as a witness to their suffering , but once only . Do not encourage repeated tellings : repetition increases the impact and imprint of trauma . Instead , encourage them to focus on relaxation techniques ( breathing exercises work ) and recommend socialization ( isolation creates inflammation ).
Most of all , be positive and future oriented . When the healing begins , we all become stronger in those broken places !
Dr . Wernert , MHA , is the Executive Medical Director of Norton Medical Group and practices with Norton Behavioral Medicine .
Myth # 4 ) Anti-anxiety medications can mitigate the symptoms of PTSD . In fact , anxiolytic classes such as benzodiazepines make the symptoms worse , by increasing disinhibition . Dependency can develop rapidly ; using them creates harm , not help .
• What does work ?
• Programs such as DART ( Deployment Anxiety Reduction Training ) are effective programs in military units likely to be exposed to combat trauma . The training involves educating the soldiers about how to recognize the physical and emotional symptoms of acute stress response they can expect to experience , and teaching them exercises to monitor and control stress . The goal is to have combatants complete the training within hours of experiencing a traumatic battlefield event . Such programs are being adapted to civilian populations .
Adrenergic blocking agents within a few hours after a catastrophic event are helpful . The VA uses Propranolol 40 mg po qid x 10 days , longer is not more helpful . For smaller , older or female patients , we often start at 10 mg tid-qid and work up to response ,