 
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.
Post-traumatic stress disorder increases in children with extended
ICU stays after cardiac surgery
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."
-------------------------
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
source site: click here
Traumatic Events Common In Childhood, But Not PTSD
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."
----------------------------
Article adapted by Medical News Today
from original press release.
----------------------------
(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
source site: click here
Adolescent Children Of Cancer Patients Suffer Post-Traumatic Stress
Symptoms
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.
----------------------------
Article adapted by Medical News Today from
original press release.
----------------------------
Catalogue no: 1101
Source: Emma Ross
ECCO-the European CanCer Conference
source site: click here
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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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