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Post-traumatic stress disorder and bereavement

Around one-third of PTSD presentations are the result of ‘interpersonal-network traumatic experiences’, which include death of a loved one.62Most bereaved people will react to some degree when experiencing reminders of the suicide, however those with PTSD experience marked cognitive, affective and behavioural responses, which lead to considerable social, occupational and interpersonal dysfunction.63

PTSD is characterised by:

  • intrusive thoughts
  • nightmares and flashbacks of past traumatic events
  • avoidance of reminders of trauma
  • hypervigilance
  • sleep disturbance.40,63

PSTD screening is recommended for suicide bereaved individuals, but screening is only likely to be beneficial when high quality services are available.64,65The PTSD checklist (PCL-5), a 20-item self-report measure, can be used to screen patients for PTSD and monitor the severity of symptoms over time.66

Both pharmacotherapy and psychotherapy (eg cognitive behavioural therapy, exposure therapy) have been shown to have benefits in PTSD.67,68

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edn (DSM-5). Arlington: American Psychiatric Association, 2013.
  2. Kessler RC, Rose S, Koenen KC, et al. How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health Surveys. World Psychiatry 2014;13(3):265–74.
  3. Sareen J. Posttraumatic stress disorder in adults: Epidemiology, pathophysiology, clinical manifestations, course, and diagnosis. UpToDate, 2015.  [Accessed 3 March 2016].
  4. Wilson JF. Posttraumatic stress disorder needs to be recognized in primary care. Ann Intern Med 2007;146(8):617–20.
  5. Zatzick D, Roy-Byrne P, Russo J, et al. A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors. Arch Gen Psychiatry 2004;61(5):498–506.
  6. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. J Trauma Stress 2015;28(6):489–98.
  7. Rothbaum BO. Pharmacotherapy for posttraumatic stress disorder in adults. UpToDate, 2015. [Accessed 7 March 2016].
  8. Rothbaum BO. Psychotherapy for posttraumatic stress disorder in adults. UpToDate, 2015. [Accessed 7 March 2016].

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After suicide: A resource for GPs