Individuals who have experienced a severe traumatic event often develop post-traumatic stress disorder (PTSD). The precipitating event has to have caused the patient to believe that death, serious injury, or a threat to the physical integrity of the self or others occurred in some way.
In order to meet diagnostic criteria for PTSD, symptoms must be present for at least one month. Approximately 11.8% of primary care patients fit this bill, according to a recent study. As more military personnel return to the United States with PTSD symptoms, now is the perfect time to refresh our knowledge on treating this disorder.
Many of the patients with PTSD have nightmares related to the traumatic events they experienced. These nightmares may consist of the actual event being replayed, but not always. Sometimes traumatic themes emerge. Patients with PTSD will often wake frightened, and many will relate their dream to the actual traumatic event. These dreams and nightmares can exacerbate emotional distress.
Don’t forget to ask patients with PTSD about comorbid conditions such as depression, anxiety and alcohol or drug abuse. Many patients try to self medicate to help promote sleep and ease anxiety. These issues need to also be addressed during treatment.
Have patients keep morning diaries about what they dreamed the night before. One treatment technique is asking the patient to write down what happened in the dream, and then create an altered ending. Ask the patient to imagine the outcome they would like to see occur. Then advise them to think about this different outcome before they go to sleep. This is referred to as image-rehearsal therapy, and has demonstrated benefit in several studies.
Pharmacological treatment for PTSD includes selective seratonin reuptake inhibitors, the two most common of which are Paxil and Zoloft. If nightmares continue to persist, a low dose of prazosin in the evening can be helpful. Use the lowest dose possible to alleviate the nightmares and also monitor the patient for BP changes.
Psychotherapy should also be suggested, so check your area for therapists who specialize in this disorder. Several local and national groups can also be a source for more information.
Support is key for PTSD. Patients need to know that there is help and that they do not have to suffer alone. Realize you may be the first person that a patient trusts enough to share their traumatic experience, and take it as an opportunity to make a huge difference in a patient’s life.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.