LOS ANGELES – Adolescents who have experienced a significant, life-threatening illness can develop posttraumatic stress disorder, according to a study of 104 transplant patients.
The study found that 1 year after a transplant procedure, 16% of the patients met all criteria for a posttraumatic stress disorder (PTSD) diagnosis, and 14% met two of the three criteria, said Margaret L. Stuber, M.D., at the annual meeting of the Society for Adolescent Medicine.
Other studies have documented PTSD responses to childhood cancer, diabetes, and burns, said Dr. Stuber, professor of psychiatry at the University of California, Los Angeles.
The purpose of the current study was to try to tease out what specific factors lead to PTSD. Hence, the study included and compared kidney, heart, and liver transplant patients–that is, patients with conditions with very different courses and prognoses.
The study found the patients had similar risk factors for PTSD, regardless of the type of transplant the patients had had. The factors associated with an adolescent developing PTSD were medical complications and the experience of an acute illness (rather than a chronic one), meaning it is uncertainty, anxiety, and what Dr. Stuber called “disruption of expectations” that triggers the PTSD reaction.
Demographics did not seem to play a significant role in determining risk for PTSD, he noted.
Other studies have found that PTSD can have a negative impact on a patient's compliance with his or her medical regimen. One report describing six noncompliant patients with PTSD indicated that treating them for PTSD improved their adherence to medical therapy.
Overall, the work in this field also suggests general anxiety level is an important predictor of the risk that an adolescent will develop PTSD. Dr. Stuber thus recommended focusing on general anxiety level as a risk factor for PTSD. “[It] is essential we find out what the patient's subjective experience is,” he said. “I would screen for anxiety.”
Symptoms of PTSD include recurrent and distressing recollections of the traumatic event, avoidance, and increased arousal.
Avoidance may entail efforts to stay away from reminders of the event but can also manifest as an inability to recall important aspects of the event, diminished interest in activities, feelings of detachment from others, and a restricted range of affect. Features of increased arousal can be sleep problems, irritability, a lack of concentration, hypervigilance, and an exaggerated startle response.