A Victim of Tsunami has difficulty in overcoming the experience. She still recollects the happenings in dreams and thoughts. The most likely diagnosis is
Ans. a (Post traumatic stress disorder) (Ref: Ahuja Psychiatry 6th/pg. 263)POST TRAUMATIC STRESS DISORDER# PTSD arises as a delayed or protracted response to an exceptionally stressful or catastrophic life event such as disasters, rape, war or torture or serious accident.# The reaction may occur shortly after the trauma (acute stress disorder) or be delayed and subject to recurrence (PTSD).- Acute Stress Disorder: Anxiety lasts < 1 month (but > 2 days).- Post Traumatic Stress Disorder (PTSD): Anxiety lasts > 1 month.# In both syndromes, individuals experience associated symptoms of detachment and loss of emotional responsivity.# Women more likely to be affected than men.# Symptoms of PTSD may develop after a period of latency, within 6 months after the stress or may be delayed beyond this period.# The patient may feel depersonalized and unable to recall specific aspects of the trauma, though typically it is reexpe- rienced through intrusions in thought, dreams, or flashbacks, particularly when clues of the original event are present.# Patients often actively avoid stimuli that precipitate recollections of the trauma and demonstrate a resulting increase in vigilance, arousal, and startle response.# Risk factors for the development of PTSD include a past psychiatric history and personality characteristics of high neuroticism and extroversion. Twin studies show a substantial influence of genetics on all symptoms associated with PTSD, with less evidence for environment effect.# Etiology and Pathophysiology:- In PTSD there are excessive release of norepinephrine from the locus coeruleus in response to stress and increased noradrenergic activity at projection sites in the hippocampus and amygdala.# Rx:- Acute stress reactions are usually self-limited, and treatment typically involves the short-term use of benzodiazepines and supportive/expressive psychotherapy.# TCAs such as imipramine and amitriptyline, the MAOI phenelzine, and the SSRIs (fluoxetine, sertraline, citalopram, paroxetine) can all reduce anxiety, symptoms of intrusion, and avoidance behaviors, as can prazosin.# Trazodone, a sedating antidepressant, is frequently used at night to help with insomnia (50 to 150 mg qhs).# Carbamazepine, valproic acid, or alprazolam have also independently produced improvement in uncontrolled trials.# Psychotherapeutic strategies that encourage the patient to dismantle avoidance behaviors through stepwise focusing on the experience of the traumatic event are the most effective.
Post traumatic stress disorder
Conversion disorder
Panic disorder
Phobia
Anxiety & Stress