Integrative Psychiatry and TMS

The person has been exposed to a traumatic event in which both of the following were present:

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1. the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death, serious injury, or a threat to the physical integrity of the self/others

2. the person’s response involved intense fear, helplessness, or horror

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The traumatic event is persistently experienced in one (or more) of the following ways:

1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.

2. recurrent distressing dreams of the event

3. acting or feeling as if the traumatic event were recurring (including a sense of reliving the experience, illusions, hallucinations, and flashback episodes, including those that occur on awakening or when intoxicated with drugs or alcohol)

4. intense psychological distress and reactivity when exposed to internal or external cues that symbolize or resemble an aspect of the traumatic event.

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Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

1. efforts to avoid thoughts, feelings, or conversations associated with the trauma

2. efforts to avoid activities, places or people that arouse recollections of the trauma

3. inability to recall an important aspect of the trauma

4. markedly diminished interest or participation in significant activities

5. feeling of detachment or estrangement from others

6. restricted range of affect (e.g., unable to have loving feelings)

7. sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

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Persistent symptoms of increased arousal (not present before trauma), as indicated by two (or more) of the following:

1. difficulty falling asleep or staying asleep

2. irritability or outbursts of anger

3. difficulty concentrating

4. hyper-vigilance

5. exaggerated startle response

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The treatment of PTSD requires a complex approach. Psychotherapy needs to be individualized according to the patient’s history and symptoms. Other various methods may also typically be used, including hypnosis, behavioral, and cognitive therapy. One of the newest psychotherapeutic techniques is EMDR (Eye Movement Desensitization and Reprocessing), in which the patient focuses on the lateral movements of the clinician’s finger while maintaining a mental image of the traumatic event. This technique can be highly effective. Furthermore, in some cases, group therapy and family counseling should be implemented.

The medications used for Pharmacotherapy must be individualized according the symptoms. Anti-depressants, mostly frequently the SSRIs, are used when depression and anxiety are dominant.