先来学习PTSD知识, 很多人经常把PTSD和depression混1起. 下面报告是记录Dr.G谈话内容和读完他给我的医学资料总结.  

Pls be advised that I'm not a MD or medical student, the following information does not substitute for advice or information provided by your physician, pls consult your physician for further information on specific medical conditions or symptoms that u may have..

什么是PTSD ?

Post-traumatic Stress Disorder是指亲身经历或看到traumatic event发生,特别是当生命受到死亡威胁后的1种延迟性压力反应. Traumatic event发生后的3月内出现symptom叫acute PTSD, 超过3月叫complex PTSD, 6月~2年以后才出现叫delayed onset PTSD, 如果不到1月就出现叫acute stress disorder. (我是属于acute PTSD)  

PTSD最早是在Vietnam veteran中被发现的, 1980正式写入DSM-III, 才引起世人的注意. Symptoms: nightmares, flashbacks, staying asleep, feelings of intense distress and Intense physical reactions when reminded of the trauma, Inability to remember important aspects of the trauma, irritability or outbursts of anger, loss of interest in activities and life, guilt or self-blame, anorexia, increased anxiety and emotional arousal, feeling detached from others and emotionally numb, feeling jumpy and easily startled, hypervigilance, depression and hopelessness, physical aches and pains, suicidal thoughts and feelings etc….

War, Natural disasters, Accident, Childbirth (baby blues is the typical symptom of PTSD, wow, unbelievable~!) School bullying, Physical abuse, Bereavement, Kidnapping, Terrorist attacks, Serious illness, etc. 

生理影响
1. Brain wave changes, Brain chemical reactions changes etc.
2. Sympathetic nervous system overreacting, Fright reaction increases, Sleep disorder, Neural hormonal changes, Stress reaction increases, Risk of depression increases etc.
3. Symptoms appear, headache, dyspepsia, compromised immunity system, dizziness etc.

人脑的Hippocampus负责认知和记忆, Amygdala被称为brain’s fear center负责恐惧,惊吓, anxious的情绪反应, Cortisol是负责steroid hormone. 因为受到强大的惊吓刺激后, 人脑的原始生存本能为了保证身体的安全而做出“Fight (violent) vs. Run (autism, fear)”的选择. 

PTSD产生的过程:

Traumatic event occurs --> Limbic system --> Hypothalamus-->
a) Corticotropin releasing factor (CRF)--> Pituitary gland--> ACTH--> Adrenal Gland
b)Sympathetic Nervous System---> Adrenal Gland 

1. Pressure release: Anxiety management, Relaxation training, Assertiveness training , Breathing retraining, Eye movement desensitization & reprocessing (EMDR), Positive thinking, Self-talking, Thought-stopping, Psychoeducation, Critical incidence stress debriefing etc.
2. Therapy: Cognitive processing therapy (CPT), Exposure therapy, Role play, Psychodrama,  Imaging rehearsal therapy, psychologicalde briefing, brief symptom inventory, Impact of event scale, Imaging rehearsal therapy etc.    
3. Medication: Anxiolytic, Antidepressants, Sleeping pills etc.

1. Trauma 越激列，病征持续越长威胁就越大, 特别是面临过死亡威胁或财产损失超大
2. 当事人对情感挑战的综和应对能力.
3. 发生的Traumatic event对当事人的意义
4. 连续多次发生的Traumatic event要比单1发生, 需要更多时间恢复
5. Flexible working schedule, plenty of time to relax

很多人把PSTD和depression混合, 虽然2者之间overlap但发病起点却完全不同.

什么叫 Depression?

Depression from just feeling unhappy or sad, it’s like more intense, lasts longer and has a large negative impact on a person's life, symptoms are:

1. Depressed mood for almost every day and for the majority of the day.
2. Loss of interest or pleasure in activities.
3. Considerable weight loss or weight gain.
4. Difficulties falling asleep or sleeping too much.
5. Feeling worthless or guilty.
6. Difficulties concentrating and/or making decisions.
7. Feeling constantly on edge and restless or lethargic and "slowed down."
8. Thoughts of ending one's own life.
9. To be w/ a major depressive episode, a person must experience 5 of these all within the same 2 week period or longer.

PTSD comes from a traumatic event that has happened, it’s a mental injury not mental illness, the highlighting characteristic of PTSD is flashbacks to the traumatic event, it’s more anxiety than depression but curable. Depression can be caused by hormonal imbalances which affect the chemistry of the brain.

Depression和PTSD的Overgeneral Autobiographical Memory (OGM) 的病理机制是完全不同的, Depression的OGM是因为执行功能受到损害而PTSD是情绪调节的影响而产生, PTSD的OGM和其他认知困难有重要的关连, 包括问题解决的能力受损, etc.

Depression的人多数都曾经有过traumatic experiences, 这是因为PTSD的各种symptoms出现会让当事人的身体变的很弱, 心理也很容易和家人和朋友detached or disconnected, 这样就很容易会发展到depression….

PTSD是面对死亡威胁, 人脑的自我保护和抵制机能失败后的延迟性压力反应, 跟个人的体能和个性无关. 因为任何人在经历traumatic event后都会出现或强或弱的PTSD, 参加过战争的veteran的体能和心理素质都是经过专业的高强度训练, 比多数的人更强, 但为什么还是会出现PTSD呢? 那是因为直到今天, “死亡”仍然是人类无法承受的最大恐惧点!