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==Introduction== | ==Introduction== | ||
| + | ==Epidemiology== | ||
| + | ===Physcial Abuse=== | ||
| + | Of the adults caring for a child, the parents (and particularly the mothers) are most likely to physically abuse child. | ||
| + | Adolescent fatalities from abuse are most often caused by the fathers, while both parents contribute equally to death of children. | ||
| + | ==Natural Disasters and Other Large-Scale Events== | ||
| + | *Screening of victims for PTSD and other mental health needs is most effective when at least a few weeks since the traumatic event had passed. | ||
| + | *Parents and relatives, who themselves are often affected by the disaster, may not recognize the child's symptoms and needs. Outreach and follow-up are thus essential. | ||
| + | ==Treatment of Trauma and PTSD== | ||
| + | ===What Parents Should and Shouldn't Do=== | ||
| + | A child needs to cope and process a traumatic experience. To a great detriment, parents may be tempted to avoid mentioning the traumatic event, to try and distract the child when he remembers it, or to pretend that nothing happened. Instead, caregivers should provide emotional support to the child and help reestablish structure in child's life after the trauma, by encouraging age-appropriate activities and discussions. This is particularly if the traumatic experience involved loss of a parent/relative who played a central role in his or her life. In a case of death of a caregiver, a child needs to grieve the loss, not unlike the rest of the family. A child should be offered to participate in family rituals (including a funeral), but not forced to. | ||
==Pharmacological Management of PTSD== | ==Pharmacological Management of PTSD== | ||
Revision as of 16:19, 22 October 2010
Contents
Introduction
Epidemiology
Physcial Abuse
Of the adults caring for a child, the parents (and particularly the mothers) are most likely to physically abuse child. Adolescent fatalities from abuse are most often caused by the fathers, while both parents contribute equally to death of children.
Natural Disasters and Other Large-Scale Events
- Screening of victims for PTSD and other mental health needs is most effective when at least a few weeks since the traumatic event had passed.
- Parents and relatives, who themselves are often affected by the disaster, may not recognize the child's symptoms and needs. Outreach and follow-up are thus essential.
Treatment of Trauma and PTSD
What Parents Should and Shouldn't Do
A child needs to cope and process a traumatic experience. To a great detriment, parents may be tempted to avoid mentioning the traumatic event, to try and distract the child when he remembers it, or to pretend that nothing happened. Instead, caregivers should provide emotional support to the child and help reestablish structure in child's life after the trauma, by encouraging age-appropriate activities and discussions. This is particularly if the traumatic experience involved loss of a parent/relative who played a central role in his or her life. In a case of death of a caregiver, a child needs to grieve the loss, not unlike the rest of the family. A child should be offered to participate in family rituals (including a funeral), but not forced to.
Pharmacological Management of PTSD
How to Think about Medications for PTSD
As with many other disorders in child and adolescent psychiatry, the medications do not serve a curative role in PTSD treatment. Rather, they are used for two broad purposes:
- To alleviate disabling symptoms and comorbidities associated with PTSD, such as emotional hyperarrousal, sleep disturbances, anxiety, irritability, and anger outbursts, with goals to restore functioning and return to normal developmental trajectory.
- To assist the child undergoing a psychotherapeutic intervention in dealing with and processing of traumatic and emotional content.
Which Medications Are Used for PTSD
- Use of SSRIs is supported by substantial body of evidence in adult PTSD; SSRIs have been shown to improve symptoms in each of the three symptom categories. Pediatric studies of SSRIs for symptoms of PTSD are scarce, and their clinical use is extrapolated from adult literature. Thus, careful monitoring and balancing known risks and potential benefits of SSRIs use are necessary.
- Alpha-2 adrenergic blockers, such us clonidine and guanfacine, have been used successfully to relieve symptoms of hyperarrousal and impulsivity. Guanfacine may help with PTSD-associated nightmares.
Antipsychotics have been used in adults with PTSD. While they are used widely in many pediatric disorders, their efficacy in pediatric PTSD had not been investigated. Antiepileptics may also have a role in PTSD symptom relief, but research into their efficacy is lacking as well.
Nefazodone and imipramine, medications that have been used successfully in adult PTSD, are not used in children. The evidence for their efficacy is either anecdotal or contradictory. Adverse effects, particularly hepatotoxicity of nefazodone, leave little justification for the use of these drugs in pediatric PTSD.
Further Reading
Stamatakos M, Campo JV. Psychopharmocologic treatment of traumatized youth. CurrOpinPeds 2010; 22:599
Horrigan J. Guanfacine for PTSD nightmares. JAACAP 1996; 35:1247