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Suggest treatment for post traumatic stress disorder

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Posted on Mon, 25 May 2015
Question: Hi, Looking for someone who knows a bit about PTSD.
My niece has been diagnosed with PTSD. She is 20. Trauma seems to be related to the attempted suicide of her brother and abusive relationship with ex=partner. She has had two medical events, that no one seems to be able to explain (which concerns her) and I was wondering if they could be a part of the trauma response. In the lead up to both incidents, she had high levels of anxiety, had not slept for days, intrusive thoughts, was hypervigalant and "felt like adrenaline was coursing through her body". Her voice was shaky and she found it difficult to sit still. She had no appetite and had lost weight (6 kgs to be under 50kgs) The event involved uncontrollable vomiting (the second included diarrheoa), shaking, goose bumps, and sweating. I observed her eyes rolling back in her head. She was hot then cold. Her fingers were white and cold. She said tingly. The ambulance said she was hypothermic and bradycardic. Her ECG showed cardiac rhythm changes and she was subsequently given potassium and vitamin b intravenously. Is this a fawn response to trauma? She has also had smaller events involving bradycardia after believeing her house had been broken into.
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Answered by Dr. Manisha Gopal (33 minutes later)
Brief Answer:
can be panic attacks, repeat ecg to check heart

Detailed Answer:
Hello,

Your neice seems to have severe anxiety presently and the episode of bradycardia, goose bumps and temperature changes can be like panic attacks..may be with electrolytes or metabolic component as she didnt sleep properly prior to the episodes and was under great level of stress..

she needs both medicine (anti anxiety ) as well as therapy sessions with someone trained in handling cases of ptsd.
As for the diagnosis, ptsd is usually diagnosed when a person had undergone severe life threatening trauma- like: earthquake survivors,or rape victims or someone in war areas or seen violent crimes etc. And then the person has repeated flashbacks of that particular event.

So, may be she somehow fits into ptsd (as the other symptoms are not provided in detail by you) but anxiety disorder is also one of her likely diagnosis.

For bradycardia- it will be good to get her ecg done again now in order to see of there are any changes seen...if not then the episodes were probably due to stress.

She is on prozac. It is a good drug for depression and anxiety but many a times can increase the anxiety levels (paradoxically),so,check if its the case with her..?

There are many good options available which are best for treating such presentations.

Quitiapine- is good for her, safe and mild and also takes care of anxiety and sleep.

She must take care of sleep...temazepam is good...needs sleep for 5-7 hours.

make her learn relaxation or deep breathing to be able to have better control of herself in anxiety situations and have less of panic attacks..

Wish you luck.

Please feel free to ask more queries for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Manisha Gopal (43 minutes later)
Hi

Can you explain how stress leads to bradycardia? Would it be useful to monitor her hear rate to anticipate panic / anxiety attack
doctor
Answered by Dr. Manisha Gopal (6 hours later)
Brief Answer:
no direct link but stress itself can harm heart..

Detailed Answer:
Hello,

You are very right in asking about the relation between bradycardia and anxiety attacks..but I cant give any direct link..nor there is any wide evidence for the same..

However, if we see...we know that many times stress give rise to heart attacks and other cardiac event commonly. So, in her case also,we see that the common factor before both the events was : stress.

I think it will be better to make her stress free and prevent the attacks rather than focussing on heart rate monitoring solely. You may do both but the main thing will be to keep her happy and peaceful.

As I said before - she should be put on anti anxiety meds to reduce and stop anxiety attacks.

Stress is a very bad thing for both body and mind..no one can be healthy under chronic stressful conditions. So, if you want to be proactive in keeping a track of her heart rate..its Ok..but, do make a plan to lessen her stress as well.

Wish you good luck.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Manisha Gopal

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Suggest treatment for post traumatic stress disorder

Brief Answer: can be panic attacks, repeat ecg to check heart Detailed Answer: Hello, Your neice seems to have severe anxiety presently and the episode of bradycardia, goose bumps and temperature changes can be like panic attacks..may be with electrolytes or metabolic component as she didnt sleep properly prior to the episodes and was under great level of stress.. she needs both medicine (anti anxiety ) as well as therapy sessions with someone trained in handling cases of ptsd. As for the diagnosis, ptsd is usually diagnosed when a person had undergone severe life threatening trauma- like: earthquake survivors,or rape victims or someone in war areas or seen violent crimes etc. And then the person has repeated flashbacks of that particular event. So, may be she somehow fits into ptsd (as the other symptoms are not provided in detail by you) but anxiety disorder is also one of her likely diagnosis. For bradycardia- it will be good to get her ecg done again now in order to see of there are any changes seen...if not then the episodes were probably due to stress. She is on prozac. It is a good drug for depression and anxiety but many a times can increase the anxiety levels (paradoxically),so,check if its the case with her..? There are many good options available which are best for treating such presentations. Quitiapine- is good for her, safe and mild and also takes care of anxiety and sleep. She must take care of sleep...temazepam is good...needs sleep for 5-7 hours. make her learn relaxation or deep breathing to be able to have better control of herself in anxiety situations and have less of panic attacks.. Wish you luck. Please feel free to ask more queries for clarification. Dr. Manisha Gopal MD Neuropsychiatry