I Monograph (Contd : Delving Into History )

Delving into History

A number of eponyms of PTSD have been described in the wars that have taken place in the West till now (Hyams, Wignall and Roswell, 1996). During the American Civil War, a condition was described called the Irritable Heart. In World War I, it was called Effort Syndrome. In World War II, it became Combat Stress Reaction. During the Vietnam War it came to be called Post Traumatic Stress Disorder which name has, by and far, stuck. During Gulf War I it came to be called the Gulf War Syndrome and after the Second Gulf War, it is likely to be labelled the Gulf WarII Syndrome, or something to that effect. All these disorders, if seriously studied, involved certain symptoms in common. These were fatigue, shortness of breath, palpitations, headache, excessive sweating, dizziness, disturbed sleep, fainting (difficulty in concentration and forgetfulness as symptoms were added to PTSD and Gulf War Syndrome). Thus, these are only different names for the same phenomenon. What is heartening to note is that they are amenable to psychiatric treatment with psychotherapy and psychotropic medication.

Numerous psychopharmacological agents are found useful in PTSD, mainly the Selective Serotonin Re-uptake Inhibitors (SSRIs) like sertraline, paroxetine and also fluoxetine. Even tricyclics like imipramine and amitryptaline have a role to play in therapeutic doses (that is, as used to treat depression, a therapeutic trial lasting for eight weeks atleast, with medication continued for atleast one year before withdrawal can be thought of). Haloperidol or other potent antipsychotic may be used to control agitation and /or aggression that may accompany the PTSD. Psychotherapy of the psychodynamic type, including abreaction and resultant catharsis, can be useful, care being taken to avoid this in the psychotic patient. Behaviour therapy, cognitive therapy and hypnosis also have a role to play , as do removal from sources of stress, support from family and friends, and encouragement to relax and ensuring good sleep ( if necessary with appropriate medication). EMDR (Eye Movement Desensitization and Reprocessing) also helps, even in children (Chemtob, Nakashima and Carlson, 2002). Group therapy can be useful as it helps sharing of the traumatic experience with others. Similarly, family therapy can be useful to enlist support of the spouse in helping the patient overcome the traumatic experience.