الفهرس 
PTSD In AdolescentsOnly 14 pages are availabe for public view
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Abstract
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder featuring characteristic symptoms following exposure to a traumatic stressor. PTSD diagnostic symptoms cluster into groupings that relate to reexperience of the trauma (e.g., intrusive memories and nightmares), behavioral and cognitive avoidance of reminders of the trauma, emotional “numbing” (i.e., restricted range of emotional responsiveness), and heightened arousal (e.g., hyper vigilance, exaggerated startle, irritability). In addition, it is increasingly clear that PTSD can be associated with a number of clinical features (e.g., grief, depression, and guilt) that are not central to the diagnostic criteria. Although the emotional relevance of PTSD is well understood, PTSD can also be viewed from a neurocognitive perspective. In fact, memory and attention abnormalities are sufficiently central to the clinical presentation of PTSD that they are incorporated into its diagnostic criteria (American Psychiatric Association, 2000).
Onset of PTSD often occurs within the first few months of experiencing a trauma, but delayed onset may occur after months or years. Acute Stress Disorder may be diagnosed when symptoms appear within the first month after trauma exposure (American Psychiatric Association, 2000).
Exposure to potentially traumatic events is relatively common but development of PTSD symptoms is relatively rare (Keane et al., 2006).
Adolescence is a time of increased brain development (Hales & Yudofsky, 2003). Adolescents are trying to define who they are. In the course of discovering their identities, some adolescents engage in risky behavior and power struggles with parents and experience wide-ranging emotions (Hales & Yudofsky, 2003).
Trauma experienced by adolescents is particularly important because significant physical and emotional growth is occurring at this age (Hales & Yudofsky, 2003).
Traumatic events are increasing nowadays all over the world. They become apparent in Egypt especially during and after revolution of twenty fifth of January 2011.
All children and adolescents face stressful situations during the course of growing up. Most often, stressful events provide healthy learning situations where one gain skills to deal with normal daily stress. Unfortunately, childhood and adolescence is not limited to normal daily stress. Many face highly challenging and dramatic life events. Some of these events are so distressing that mental health can be significantly affected (Shalev, 1996).
The importance of healthy adolescence in forming a stable personality makes the diagnosis and treatment of PTSD to be crucial.
The absence of research about this specific issue at this specific period of time leads to direct this work to study the occurrence of a psychiatric illness as PTSD that is highly related to presence of traumatic stressors, among a sample of adolescent students in Tanta in order to determine the magnitude of the problem.
The subjects for this study were collected from the schools of Tanta, six schools were randomly selected, then random sampling of classes was done and subsequent sampling of students (subjects of the study) was randomly performed.
The students randomly selected from governmental preparatory schools were 81 males and 82 females while those randomly selected from private preparatory schools were 25 males and 25 females. The age of students from preparatory schools ranges from 12 to 15 years.
The students randomly selected from governmental secondary schools were 80 males and 80 females while those randomly selected from private secondary schools were 25 males and 25 females. The age of students from secondary schools was about 16 years, because absence of students of grades two and three during the period of conducting the study.
We also aimed to analyze the following variables statistically:
4- The level of anxiety among students who were included in the study, measured by TMAS as regards the gender differences and the type of school.
5- The occurrence of PTSD among students included in this study, diagnosed by PCL–C as regards the gender differences and the type of school.
6- The co morbid disorders among students who have PTSD in this study, determined by MINI-KID as regards the gender differences and the type of school.
In this study, PTSD was present in 16.31% of adolescent students diagnosed by PCL–C. This occurrence represents a high percentage of this disorder among this age group.
In addition, we found that there was a highly significant increase in the occurrence of PTSD among female students (21.23%) as compared with that found among male students (11.37%), P value = 0.006. These results were similar to those of other studies that indicated the gender differences as regards the occurrence of PTSD.
PTSD was found in 14.55% of students of preparatory schools while it was found in 18.10% of those of secondary schools that represents an insignificant difference while there was a highly significant increase in the occurrence of PTSD among students of governmental schools as compared with that found among students of private schools (P value = 0.004).
The Arabic version of the MINI-Kid was done to students who had a cutoff score of 50 or more on the PCL-C in order to find the co morbid psychiatric disorders that may be present with PTSD.
In this study, the major depressive disorder co morbid with PTSD was found in 33.33% of the total sample and there was no statistical significant gender difference, no statistical significant difference between preparatory and secondary schools, and no statistical significant difference between governmental and private schools as regards the major depressive episode co morbid with PTSD.
In addition, the social phobia co morbid with PTSD was found in 28.99% of the total sample and there was no statistical significant gender difference, no statistical significant difference between preparatory and secondary schools and no statistical significant difference between governmental and private schools as regards the social phobia co morbid with PTSD.
This study showed that there was a very highly statistical significant difference between the level of anxiety among female students and that found among male students (P value < 0.001).
Also, it was showed that there was no statistical significant difference between preparatory and secondary schools as regards the level of anxiety.
Moreover, there was a highly statistical significant difference in the level of anxiety among students of governmental schools as compared with that found among those of private schools (P value < 0.001).
This study also showed that there was a highly significant association between the increased level of anxiety and the occurrence of PTSD. When there was no anxiety in 31.21% of the sample, there was only one case of PTSD that represents 0.24% while PTSD was absent in 30.97%. Moreover, when there was very high anxiety in 19.86%, PTSD was present in 9.93% of them. So, the increased level of anxiety may be a high risk factor to the occurrence of PTSD.
PTSD is notably co morbid with Major Depressive Disorder, Anxiety Disorders (e.g., Panic Disorder, Agoraphobia), and Substance-Related Disorders. These disorders can develop before, during, or after the onset of PTSD. Often, these disorders evolve as a by-product of the distressing PTSD symptoms (Kilpatrick et al., 2003).
The national co morbidity survey (NCS) reported that PTSD may be co morbid with another mental disorder as shown in the following (Kessler et al., 1995):
Major Depressive Disorder (MDD) 48% (means that 48% of PTSD sufferers also had MDD during PTSD’s course)
Generalized Anxiety Disorder 16%
Panic Disorder 9.5%
Social Phobia 28%
Alcohol Abuse/Dependence 40%
Drug Abuse/Dependence 31%
Conduct Disorder 29%
Mania 9%
The psychiatrists have to explain to children that it is very normal for people to have symptoms of PTSD after a traumatic event and Send the message that the emotions they are experiencing are normal, their reactions will not last forever, and that you accept what they are feeling.(McNally et al., 2003).
The degree of parent and family support can influence the occurrence of PTSD. A strong parental and family support system can reduce the onset or severity of PTSD symptoms (Rossman et al., 1997).
Treatment of PTSD consists of pharmacotherapy to treat symptoms, as well as psychotherapy interventions, such as cognitive behavioral therapy (CBT). A combination of both pharmacologic and psychological treatment is the preferred approach. The goal of treatment is to reduce the frequency and severity of symptoms, improve social functioning, and relieve co morbid psychiatric disorders associated with PTSD, such as depression, anxiety, panic attacks, and bipolar disorder (Davidson, 2006).
Parental support influences how well children cope after a traumatic event. Birth, foster, and adoptive parents, kin caregivers, and professionals can help children by (Goodman, 2002):
• Providing a strong supportive presence.
• Modeling and managing their own expression of feelings and coping.
• Establishing routines with flexibility.
• Accepting children’s regressed behaviors while encouraging and supporting a return to age-appropriate activity.
• Helping children use familiar coping strategies.
• Helping children share in maintaining their safety.
• Allowing children to tell their story in words, play, or pictures to acknowledge and normalize their experience.
• Discussing what to do or what has been done to prevent the event from recurring.
• Maintaining a stable, familiar environment.
Children may face trauma that threatens their integrity, safety, or even life. The loss of control, the unpredictability, and the extremely aversive nature of the event or events are the main pathogenic elements. The family is known to pay a vital role in determining the eventual impact of the traumatic experience on the child, and parental support is often determined to be a key mediating factor in how the child experiences and adapts to the victimizing circumstances. The support of a child’s family, along with adequate coping and emotional functioning of the child’s parents, may very well mitigate against the development of PTSD in a child exposed to trauma (Van der Kolk, 2005).
Factors that reduce a person’s chances of developing PTSD include: higher cognitive ability; strong social supports; having a happy, safe childhood in a stable family; and an overall positive outlook/personality (McNally et al., 2003).
Despite the limitations, this study has played an exploratory role in revealing the occurrence, co morbidity and risk factors for PTSD among adolescent students in Tanta.
And lastly, the following points were recommended:
1- Replication of the study on larger sample of adolescents from a variety of geographic locations and different educational systems.
2- Conducting further studies using standard personal interviews with students, parents, and school teachers for better assessment and evaluation of risk factors for the occurrence of PTSD among adolescents.
3- Further studies are needed to investigate the role of sub threshold post traumatic stress symptoms among adolescents as predictor of adulthood PTSD.
4- Further studies are needed to investigate the role of adolescent PTSD as predictor of adulthood PTSD.
5- Reconsideration of school mental health programs by increasing availability of psychiatric services and a teaching program about PTSD.
6- Provision of adequate training for general practitioners for screening of PTSD in adolescents and raising their clinical attention and surveillance for sub threshold post traumatic stress symptoms.
7- Collaboration between psychiatrists and general practitioners aiming to develop comprehensive management including early diagnosis and intervention for PTSD.
8- Educational programs on adolescent mental health should be provided to parents and teachers for early detection of any behavioral changes which may be a part of their PTSD morbidity.