post – traumatic stress disorder abdul alraiyes md

8/14/2019 Post Traumatic Stress Disorder Abdul Alraiyes MD.

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PTSDPost traumatic stress disorder

Abdul Alraiyes MD.

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PTSD


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PTSDPosttraumatic stress disorder (PTSD), ananxiety disorder that results from exposure to atraumatic event.

Three symptomatic clusters:(1) intrusive/re-experiencing symptoms(2) avoidance symptoms

(3) hyperarousal symptoms

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SLEEP and PTSD

Standard cognitive - behavioral treatment formood and anxiety disorders exclusively focuses

on daytime symptoms, and psychiatrists andpsychologists tend to know little about sleepdisorders due to a lack of training.

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PTSD

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PTSDmany PTSD experts know so little about sleepSleep disorders are neglected not because ofunwillingness, but largely because of ignorance.

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Disturbed sleep is prevalent, has a high impact and isa risk factor for PTSD:

Nightmares 50- 70% less during PSGInsomnia 40-50%PLMs 33%

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Geracioti Jr TD, Baker DG, Ekhator NN, West SA, Hill KK, Bruce AB, et al. CSF norepinephrine concentrations inposttraumaticstress disorder.Psychiatry 2001;158:1227 30.Mellman TA, Kumar A, Kulick-Bell R, Kumar M, Nolan B. Nocturnal/daytime noradrenergicmeasures and sleep incombat-relatedPTSD. Biol Psychiatry 1995;38:174 9


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Objective PrevalenceIn PSG:

More Stage 1Less SWS

More REM to wake and REM to stage 1 short dense REMand more PLMs during REM

REM fragmentation

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PTSD

Discrepancy between the

objective and subjectivesleep complaints

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PTSDDisturbed sleep is a residual symptom after PTSDtreatment

Psychological treatment

Cognitive - behavioral therapy (CBT)eye movement desensitization and reprocessing (EMDR)imagery rehearsal treatment (IRT).

Of the 38 included RCTs, only six included reported theeffects of PTSD treatment on sleep disturbance.

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PTSD

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PTSDDisturbed sleep is a residual symptom after PTSDtreatment

Pharmacotherapy

CyproheptadineSSRIBenzodiazepinesAtypical antipsychotic Olanzapine best results with SSRI

Only 14 placebo-controlled trials have measured the effectsof pharmacological agents on sleep in PTSD patients

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PTSDTreatment for disturbed sleep in PTSD alleviatesPTSD levels

imagery rehearsal treatment (IRT). nightmares reductionIRT with CBT and Sleep hygiene stimulus control. insomniareduction also anxiety, depression and PTSD symptomsreduced

Praszosin nightmares reduction CPAP treatment for SBD nightmares reduction

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PTSDConclusion:

Sleep disturbancesexacerbates the PTSDUnlikely to be secondary to PTSDUnlikely to be the primary problem in PTSD

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PTSDDisturbed sleep:

May well be a risk factor for thedevelopment of PTSD;Seems to develop into separatedisorder(s) during the course of PTSDFrequently exacerbates PTSDsymptom severity.

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PTSD

Clinical implications:

(1) screening for sleep disorders at intake(2) adequate referral or sleep treatment byan appropriate clinician.

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PTSD

Nightmares:

(IRT) imagery rehearsal treatment afterthe CBT and imagery transformationPraszosin

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PTSD

Insomnia:

Sleep hygieneStimulus controlSleep restriction

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PTSD

Research Implications:

Screening for sleep disturbsFollow up sleep measurementSleep focused treatmentImplication of PSG more ambulatory forms.

IRTPraszosin

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PTSD

Questions??

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PTSD

Thank You..

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post – traumatic stress disorder abdul alraiyes md

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