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Somatoforme symptomen bij PTSS Dr. Geert Smid, psychiater Studiedag iMMO 15 maart 2014.

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Presentatie over: "Somatoforme symptomen bij PTSS Dr. Geert Smid, psychiater Studiedag iMMO 15 maart 2014."— Transcript van de presentatie:

1 Somatoforme symptomen bij PTSS Dr. Geert Smid, psychiater Studiedag iMMO 15 maart 2014

2 © G.E. Smid2 Overzicht Diagnostiek van PTSS volgens DSM-5 Beloop van stressgerelateerde klachten na trauma bij migranten Psychoneuroimmunologische aspecten van PTSS Somatoforme symptomen bij PTSS Casus

3 © G.E. Smid333 Trauma- and Stressor-Related Disorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder Acute Stress Disorder Posttraumatic Stress Disorder Adjustment Disorders Other Specified Trauma- or Stressor- Related Disorder Unspecified Trauma- or Stressor- Related Disorder

4 © G.E. Smid444 Trauma exposure criterion The person was exposed to one or more of the following event(s): death or threatened death serious injury or sexual violence In one (or more) of the following ways: 1.Directly experiencing the traumatic event(s) 2.Witnessing, in person, the event(s) as they occurred to others 3.Learning that the event(s) occurred to a close relative or close friend; in such cases, the actual or threatened death must have been violent or accidental 4.Experiencing repeated or extreme exposure to aversive details of the event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse)

5 © G.E. Smid555 PTSD Symptoms 1.Intrusion symptoms (1) 1.Recurrent, involuntary, and intrusive distressing memories 2.Recurrent distressing dreams related to the event(s). 3.Dissociative reactions in which the individual feels or acts as if the event(s) were recurring 4.Intense or prolonged psychological distress to cues 5.Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s) 2.Persistent avoidance of stimuli (1) 1.Avoids internal reminders (thoughts, feelings, or physical sensations) 2.Avoids external reminders (people, places, conversations, activities, objects, situations) 3.Negative alterations in cognitions and mood (2) 1.Inability to remember an important aspect of the event(s) 2.Exaggerated negative expectations about one’s self, others, or the world 3.Distorted blame of self or others about the cause or consequences of the event(s) 4.Pervasive negative emotional state - e.g., fear, horror, anger, guilt, or shame 5.Markedly diminished interest or participation in significant activities 6.Feeling of detachment or estrangement from others 7.Persistent inability to experience positive emotions 4.Alterations in arousal and reactivity (2) 1.Irritable or aggressive behavior 2.Reckless or self-destructive behavior 3.Hypervigilance 4.Exaggerated startle response 5.Problems with concentration 6.Sleep disturbance

6 © G.E. Smid666 Time criteria Duration more than 1 month Specify if: With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate)

7 Distress Over Time After a Disaster By Damage to Home and Minority Status Smid, Drogendijk & Kleber, in prep.

8 Stress Generation; Impairment Secondary/ Distal Effects Stress Sensitization Cognitive Sensitization: Negative/Threat Appraisal, Memory Intrusion Interpersonal Sensitization: Mistrust, Anger, Irritability, Detachment/Estrangement, Identity Disruption Neurobiological Sensitization: SNS Hyperreactivity, HPA-Axis Dysregulation, Immune Activation Trauma/ Loss PTSD, Depression, Traumatic Grief, Dissociation, Personality Change, etc. Stressor/ Resource Loss Other outcomes (e.g. Substance Abuse, Somatic Disease, Severe Mental Illness) Personal, Social, & Cultural Factors (e.g. Genetically Increased Stress Reactivity) Smid et al Direct effect Indirect effect Contextual effect

9 Yirmiya & Goshen (2011) Immuun-stress model

10 © G.E. Smid10 Somatoforme symptomen na trauma (Sack e.a. 2007) Abdominal pain Rectal pain Regurgitation of food Intolerance of food Excessive menstrual bleeding Unusual or copious vaginal discharge Difficulty swallowing or lump in throat Loss of voice Loss of touch or pain sensations Double vision Seizures Amnesia (loss of memory) N=892 poliklinische patienten in GGz-instelling (Duitsland)

11 © G.E. Smid11 Casus man In het medisch dossier van het GCA maakt hij melding van zijn seksuele marteling in de vorm van gedwongen orale seks, waarbij hij meldt dat hij vaak nog de geur van de penis ruikt. Bij veel spanning en stress krijgt betrokkene braakneigingen en moet dan ook vaak daadwerkelijk braken. Dit lucht dan even op. Hieraan gekoppeld zijn maagpijnen en misselijkheid, hetgeen hij meer heeft in de nacht dan overdag. Hij krijgt hiervoor een maagtablet.

12 © G.E. Smid12 Casus vrouw Betrokkene vertelt dat de onwillekeurige inhalaties die ze ook nu nog heeft, in de gevangenis zijn begonnen. Sindsdien wordt zij geplaagd door allerlei herinneringsbeelden waaronder die van het schreeuwende meisje dat betrokkene doodgemaakt zag worden, en die betrokkene aankijkt, vlak voor ze de zak over haar hoofd krijgt Opvallend zijn de om de paar minuten optredende spontane en diepe inhalaties, een soort spasmen waarvan zij verklaart dat het vanzelf gebeurt en dat ze dan achter adem is

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