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Children & Post Traumatic Stress Disorder

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Post-Traumatic Stress Disorder

"I was raped when I was 25 years old. For a long time, I spoke about the rape as though it was something that happened to someone else. I was very aware that it had happened to me, but there was just no feeling.

"Then I started having flashbacks. They kind of came over me like a splash of water. I would be terrified. Suddenly I was reliving the rape. Every instant was startling. I wasn't aware of anything around me, I was in a bubble, just kind of floating. And it was scary. Having a flashback can wring you out.

"The rape happened the week before Thanksgiving, and I can't believe the anxiety and fear I feel every year around the anniversary date. It's as though I've seen a werewolf. I can't relax, can't sleep, don't want to be with anyone. I wonder whether I'll ever be free of this terrible problem."

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Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. Anniversaries of the traumatic event are often very difficult.

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Post-traumatic stress disorder (PTSD) is a debilitating condition that can develop following a terrifying event. Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. PTSD was first brought to public attention by war veterans, but it can result from any number of traumatic incidents. These include violent attacks such as mugging, rape, or torture; being kidnapped or held captive; child abuse; serious accidents such as car or train wrecks; and natural disasters such as floods or earthquakes. The event that triggers PTSD may be something that threatened the person's life or the life of someone close to him or her. Or it could be something witnessed, such as massive death and destruction after a building is bombed or a plane crashes.

Whatever the source of the problem, some people with PTSD repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They may also experience other sleep problems, feel detached or numb, or be easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent. Things that remind them of the trauma may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of the traumatic event are often very difficult.

PTSD affects about 5.2 million adult Americans.1 Women are more likely than men to develop PTSD.7 It can occur at any age, including childhood,8 and there is some evidence that susceptibility to PTSD may run in families.9 The disorder is often accompanied by depression, substance abuse, or one or more other anxiety disorders.4 In severe cases, the person may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was deliberately initiated by a person—such as a rape or kidnapping.

Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, may lose touch with reality and believe that the traumatic event is happening all over again.

Not every traumatized person gets full-blown PTSD, or experiences PTSD at all. PTSD is diagnosed only if the symptoms last more than a month. In those who do develop PTSD, symptoms usually begin within 3 months of the trauma, and the course of the illness varies. Some people recover within 6 months, others have symptoms that last much longer. In some cases, the condition may be chronic. Occasionally, the illness doesn't show up until years after the traumatic event.

People with PTSD can be helped by medications and carefully targeted psychotherapy.

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Post-traumatic stress disorder increases in children with extended ICU stays after cardiac surgery

Main Category: Pediatrics / Children's Health
Article Date: 08 Apr 2004 - 0:00 PDT

A study published in the April issue of The Journal of Pediatrics shows that the occurrence of Post-traumatic Stress Disorder (PTSD) increases significantly in school-age children who experience extended stays in the Intensive Care Unit (ICU) following cardiac surgery.

The study, led by Dana Connolly, Ph.D., Assistant Professor of Pediatrics at New York University School of Medicine in collaboration with Michael Artman, M.D., Director of Pediatric Cardiology at New York University School of Medicine, is the first of its kind to examine the psychosocial responses of school-age children to cardiac surgery. Forty-three families participated in the study, which took place at New York University Medical Center and Children's Medical Center in Dallas. The children from five-to- twelve years of age underwent cardiac surgery for congenital heart defects. Each child was evaluated pre- and post-operatively for PTSD using tools that determine anxiety disorders, nonverbal reasoning, and temperament. None of the children showed signs of PTSD before surgery.

During the post-surgical assessment, researchers found that characteristics of PTSD increased in children who stayed in the ICU for more than 48 hours after surgery. After hospitalization, five (12%) of the children met diagnostic criteria for PTSD, and five (12%) exhibited some of the characteristics of PTSD, including disorganized behavior, nightmares, sleep disorders, and concentration problems. Children exhibiting signs of PTSD were referred to pediatric psychiatrists for further evaluation.

"It's important for parents to look for behavioral changes such as bed wetting, night screams, clinging, and concentration problems once the child comes home from surgery," says Dr. Connolly. Despite efforts to minimize the stress and emotional trauma that can be associated with heart surgery for children and their families, the study showed, for the first time, a clinically significant risk of PTSD after cardiac surgery in pediatric patients.

According to Dr. Artman, "Even though this was a relatively small sample, it is impressive that roughly 1 in 10 children develop full blown post-traumatic stress disorder after undergoing heart surgery. The only factor we found that seemed to correlate with PTSD was a stay of more than 48 hours in the ICU, which is really not very long. Presently, we don't know what factors in the ICU might be contributing, but our new findings clearly demonstrate the need for future research."

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Congenital heart disease affects 1 in 100 newborn babies each year, according to the American Heart Association, and is the most common form of birth defect. In the United States, approximately 35,000 children are born with a structural heart defect every year, and many require surgery.

For additional information contact NYU's Department of Pediatric Cardiology at 212-263-5940.

Contact: Deborah Coble
deborah.coble@med.nyu.edu
212-404-3522
New York University Medical Center and School of Medicine

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Traumatic Events Common In Childhood, But Not PTSD

Main Category: Pediatrics / Children's Health
Also Included In: Psychology / Psychiatry
Article Date: 11 May 2007 - 5:00 PST

Potentially traumatic events are common in children but do not typically result in post-traumatic stress symptoms or disorder, according to a report in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Post-traumatic stress disorder (PTSD) is a unique psychiatric diagnosis because it requires an initiating event, such as war, rape, natural disaster or serious illness, according to background information in the article. In children, the list of events that could lead to PTSD includes a parent being sent to prison, sudden separation from a loved one and learning of a traumatic event occurring to a loved one.

William E. Copeland, Ph.D., and colleagues at Duke University Medical Center, Durham, N.C., conducted annual interviews with 1,420 children from age 9, 11 or 13 through age 16. Between 1993 and 2000, participants and their parents were interviewed in separate rooms and asked about traumatic events that may have occurred in the previous year. In addition, they reported any symptoms of post-traumatic stress that the children displayed, including compulsive behaviors to suppress memories, panic attacks and engaging in dangerous activities.

More than two-thirds of the children reportedly experienced at least one traumatic event by age 16, including 30.8 with exposure to one event and 37 percent to multiple events. The most common events were witnessing or learning about a trauma that affected others - known as "vicarious" events.

Of those, 13.4 percent of those developed some post-traumatic stress symptoms by age 16, but less than 0.5 percent met the criteria for PTSD. About 9.1 percent experienced painful recall, or distressing memories or images of the traumatic event, and 2.2 percent had a milder, sub-clinical form of PTSD. "Violent or sexual trauma were associated with the highest rates of symptoms," the authors write. "The post-traumatic stress symptoms were predicted by previous exposure to multiple traumas, anxiety disorders and family adversity." In addition, symptoms were more likely to occur among older children.

Children exposed to trauma had nearly double the rates of psychiatric disorders of those who were not (except for substance use disorders). "Across childhood, the children who experience trauma are often those with anxiety, depressive and disruptive behavior disorders, a finding supported in the present study," the authors write. "This likely reflects common liability conveyed from a limited set of family risk factors."

"In the general population of children, potentially traumatic events are fairly common and do not often result in post-traumatic stress symptoms, except after multiple traumas or a history of anxiety," they conclude. "The prognosis after the first lifetime trauma exposure was generally favorable. Apart from PTSD, traumatic events are related to many forms of psychopathology, with the strongest links being with anxiety and depressive disorders."

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Article adapted by Medical News Today from original press release.
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(Arch Gen Psychiatry. 2007;64:577-584)

This study was supported by grants from the National Institute of Mental Health, National Institute on Drug Abuse and the William T. Grant Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


Contact: Tracey Koepke
JAMA and Archives Journals

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Adolescent Children Of Cancer Patients Suffer Post-Traumatic Stress Symptoms

Main Category: Anxiety / Stress
Also Included In: Pediatrics / Children's Health;  Psychology / Psychiatry;  Cancer / Oncology
Article Date: 28 Sep 2007 - 6:00 PST

A new study by Dutch researchers has found that adolescents may suffer from severe symptoms of post-traumatic stress when a parent is recently diagnosed with cancer and that parents tend to underestimate the problems.

A cancer diagnosis is among those life experiences that can be so stressful that it is traumatic. While only a fraction of people who develop post-traumatic stress symptoms (PTSS) go on to develop post-traumatic stress disorder (PTSD), the symptoms can cause emotional problems later in life. Much is known about the psychological effect that cancer has on a patient and a spouse, but the consequences of a parent's cancer on children are more poorly understood.

The study, presented at the European Cancer Conference (ECCO 14) in Barcelona, is the first to examine PTSS over time in adolescent children of cancer patients.

Dr Gea Huizinga, a health scientist and research fellow at the University Medical Center in Groningen, The Netherlands, examined the prevalence of PTSS, emotional and behavioural problems in 49 adolescents during the first year after a parent's cancer diagnosis. The children and each of their parents completed questionnaires three times over the year -- within four months after the diagnosis and at six and twelve months after the first survey.

"At the first assessment, 29 percent of the children reported clinically elevated PTSS, which means they needed psychological help, but the proportion suffering symptoms dropped to 16 percent at the second assessment and then to 14 percent at the third," Huizinga said.

"PTSS levels shortly after the parent's diagnosis appeared comparable to those seen in our earlier study of adolescents surveyed one to five years after their parent's diagnosis," Huizinga added. "The two studies together suggest that PTSS related to parental cancer fluctuate over time, decreasing during the first year after diagnosis and resurging during the years following."

One of the most important findings of the latest study concerned how aware parents were of the magnitude of the effect the cancer had on their children.

"It appeared that parents were under the impression that children with more severe PTSS experienced problems in fewer emotional, behavioural and cognitive areas than the children themselves reported," Huizinga said. "The results could indicate that the level of emotional and behavioural problems of children with more severe PTSS is underestimated by the ill parents and even more so by their partners."

The study found that ill parents were more able to pick up on their children's distress if the PTSS was particularly severe, but they still reported fewer problems than the adolescents themselves did.

Spouses did not observe any problems in their children in the period shortly after the diagnosis, although they noticed slightly more later in the year.

"It seems that ill parents were better able to judge the situation. They may be more alert to changes in their children's behaviour than spouses because of a sense of guilt over their illness," Huizinga suggested. "It may also be that spouses were less sensitive to their children's functioning because they were often working outside the home, or more focused on the wellbeing of the partner with cancer, their own emotions and on increased household tasks."

"Our study also found that children with more PTSS had more emotional and behavioural problems, and vice versa. This suggests that children who already have psychosocial problems have more difficulty in coping with their parent's cancer than children who are doing well," Huizinga said.

Emotional problems consist of withdrawal, physical complaints and anxiety or depression. Behavioural problems consist of actions that are aggressive or delinquent. Post-traumatic stress symptoms include recurrent and intrusive distressing memories of the event and avoidance of thoughts, feelings or conversations associated with it. Behavioural problems in adolescents with more PTSS were evident in the beginning of the study, but tended to disappear as time went on, while emotional problems seemed to persist.

Healthcare professionals should be made aware of the prevalence of PTSS in children of a parent with cancer, Huizinga said, adding that parents, particularly the spouses of the cancer patients, may benefit from information on children's reactions and how to seek professional help, if necessary.

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Article adapted by Medical News Today from original press release.
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Catalogue no: 1101

Source: Emma Ross

ECCO-the European CanCer Conference

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Traumatic Stress Induces Brain Change in Children
 
By Michael Smith, Senior Staff Writer, MedPage Today
STANFORD, Calif., March 5 - Children with post-traumatic stress disorder, similar to adults, show physical changes in the brain, according to researchers here.

In a pilot study of 15 children, higher PTSD scores & higher cortisol levels were significantly (P<0.05) correlated with relative decreases over time in the volume of the right hippocampus, reported Victor Carrion, M.D., of Stanford & colleagues, reported in the March issue of Pediatrics.

On the other hand, there was no correlation with changes in the left hippocampal volume, Dr. Carrion & colleagues found.

In adults, PTSD is associated with lower hippocampal volumes compared with adults who don't have stress disorder, Dr. Carrion & colleagues noted, but such a relation hasn't been shown in children.

Because animal studies show that the stress hormone cortisol can be neurotoxic to the hippocampus, the researcher hypothesized that children with high levels of cortisol at the beginning of a 12- to 18-month study period would show changes in hippocampal volume.

They enrolled 15 children (9 girls) with an average age of 10.4 & a PTSD score of 12 or greater on the PTSD Reaction Index. The children's stress scores - including hyperarousal - were evaluated using the Clinician-Administered PTSD Scale for Children & Adolescents.

The children were suffering from PTSD after undergoing physical, emotional or sexual abuse, witnessing violence, or experiencing lasting separation & loss, Dr. Carrion said.

"We're not talking about the stress of doing your homework or fighting with your dad," Dr. Carrion said. "We're talking about traumatic stress. These kids feel like they're stuck in the middle of a street with a truck barreling down at them."

Cortisol was measured by taking saliva swabs 4 times a day for 3 days at the beginning of the study, Dr. Carrion & colleagues said & hippocampal volume was measured at the beginning & end of the study using magnetic resonance imaging.

The researchers calculated hippocampal volume changes both as a simple subtraction of the end volume from the beginning volume & adjusted to account for maturation & sex. The changes were then examined for possible correlation with severity of PTSD, hyperarousal & initial cortisol levels.

Analysis found:

  • None of the PTSD markers was associated with the left hippocampal volume.
  • PTSD scores & cortisol levels were correlated with simple hippocampal volume changes at P<0.05 & hyperarousal was correlated at P<0.01.
  • All 3 markers were correlated with the adjusted hippocampal volume change at P<0.05.

Dr. Carrion said the study is "a snapshot" of the effect of PTSD on the young brain & can't say anything about functional changes in memory processing & emotion.

"One common treatment for PTSD is to help a sufferer develop a narrative of the traumatic experience," he said. "But if the stress of the event is affecting areas of the brain responsible for processing information & incorporating it into a story, that treatment may not be as effective."

He said future research may find better ways to help children with PTSD, as well as uncover the reasons that some children are more resilient than others.

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Anxiety Disorders

References

1Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census estimated residential population age 18 to 54 on July 1, 1998. Unpublished.

2Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.

3The NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No. 98-4268. Rockville, MD: National Institute of Mental Health, 1998.

4Regier DA, Rae DS, Narrow WE, et al. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry Supplement, 1998; (34): 24-8.

5Kushner MG, Sher KJ, Beitman BD. The relation between alcohol problems and the anxiety disorders. American Journal of Psychiatry, 1990; 147(6): 685-95.

6Wonderlich SA, Mitchell JE. Eating disorders and comorbidity: empirical, conceptual, and clinical implications. Psychopharmacology Bulletin, 1997; 33(3): 381-90.

7Davidson JR. Trauma: the impact of post-traumatic stress disorder. Journal of Psychopharmacology, 2000; 14(2 Suppl 1): S5-S12.

8Margolin G, Gordis EB. The effects of family and community violence on children. Annual Review of Psychology, 2000; 51: 445-79.

9Yehuda R. Biological factors associated with susceptibility to posttraumatic stress disorder. Canadian Journal of Psychiatry, 1999; 44(1): 34-9.

10Bourdon KH, Boyd JH, Rae DS, et al. Gender differences in phobias: results of the ECA community survey. Journal of Anxiety Disorders, 1988; 2: 227-41.

11Kendler KS, Walters EE, Truett KR, et al. A twin-family study of self-report symptoms of panic-phobia and somatization. Behavior Genetics, 1995; 25(6): 499-515.

12Boyd JH, Rae DS, Thompson JW, et al. Phobia: prevalence and risk factors. Social Psychiatry and Psychiatric Epidemiology, 1990; 25(6): 314-23.

13Kendler KS, Neale MC, Kessler RC, et al. Generalized anxiety disorder in women. A population-based twin study. Archives of General Psychiatry, 1992; 49(4): 267-72.

14LeDoux J. Fear and the brain: where have we been, and where are we going? Biological Psychiatry, 1998; 44(12): 1229-38.

15Bremner JD, Randall P, Scott TM, et al. MRI-based measurement of hippocampal volume in combat-related posttraumatic stress disorder. American Journal of Psychiatry, 1995; 152: 973-81.

16Stein MB, Hanna C, Koverola C, et al. Structural brain changes in PTSD: does trauma alter neuroanatomy? In: Yehuda R, McFarlane AC, eds. Psychobiology of posttraumatic stress disorder. Annals of the New York Academy of Sciences, 821. New York: The New York Academy of Sciences, 1997.

17Rauch SL, Savage CR. Neuroimaging and neuropsychology of the striatum. Bridging basic science and clinical practice. Psychiatric Clinics of North America, 1997; 20(4): 741-68.

18Gould E, Reeves AJ, Fallah M, et al. Hippocampal neurogenesis in adult Old World primates. Proceedings of the National Academy of Sciences USA, 1999, 96(9): 5263-7.

19Hyman SE, Rudorfer MV. Anxiety disorders. In: Dale DC, Federman DD, eds. Scientific American Medicine. Volume 3. New York: Healtheon/WebMD Corp., 2000, Sect. 13, Subsect. VIII.

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