Nice attack: what is post-traumatic stress disorder?

in collaboration with

Dr Gérald Kierzek (Medical Director of Doctissimo)

The Nice attack, which took place on July 14, 2016, claimed many victims. Some of them suffer from post-traumatic stress syndrome.

Doctissimo: What is the definition of post traumatic stress syndrome? In what other case (other than an attack) can it occur?

Dr. Joachim Müllner: Post-traumatic stress disorder is a so-called “psychiatric” disorder, that is to say neurological, but which involves the processing of information by the brain, emotions, thoughts, and behaviors.

It can appear as a consequence of a psychic trauma, ie a particularly violent event which gives rise to a feeling of intense fear of dying or of harm to one’s physical integrity for oneself and/or those around them.

The more an event is brutal, unpredictable, unusual in relation to the context, the more it is experienced as immoral, the more the aggressor feels pleasure in hurting ourselves, the more we are in a position of impossibility to be able to react, the greater the risk post traumatic stress increases. It can therefore happen in various situations. The most typical are attacks, but also sexual assault, physical assault, death threats or attempted homicide. It can also happen in aggressions without intentionality such as road accidents, also railway accidents or natural disasters.

In the first month after the events, we speak of acute stress, then of Post Traumatic Stress State or PTSD (PTSD Post Traumatic Syndrom Disorder in English).

Dr Joachim Müllner: The 3 main syndromes of this disorder are:

• Hypervigilance: with increased mistrust, hypersensoriality (noises that weren’t scary before), startles, hyperemotivity, false recognition (the brain tells us “it’s him” when it’s not aggressor);
• Relives: the fact of reliving the scene as if one were there, with the emotions of terror of the moment, either during the day, we speak of “flashbacks”, or at night and these are then nightmares;
• Avoidance behaviors: of thought (the brain which tries not to think about what happened), of situation (the brain commands to avoid situations which recall the aggression), or of place (the brain order to avoid the place of the attack).

Post-traumatic stress syndrome is also accompanied by: – ​​disabling concentration and memory disorders on a daily basis

• sleep disturbances;
• appetite disorders;
• of a sadness of mood.

And can be complicated by:

• chronicization over time;
• a major depressive episode (depression);
• addictions;
• suicidal thoughts.

Doctissimo: What is its treatment and is it cured?

Dr Joachim Müllner: As with any physical or psychological injury, there is a part of spontaneous healing. But if not the most important from the moment when one feels that one’s emotional management capacities are exceeded and that one is not as usual one must consult so that the healing is accompanied / accelerated by a psychiatrist or specialized psychotherapist psychologist.

• Certain psychotherapies such as EMDR (Eye Movement Desensitization and Reprocessing) are particularly indicated and have demonstrated their effectiveness, in particular in reducing relivings, flashbacks, as well as cognitive-behavioral therapies (CBT).
• Often at the start of treatment, medication with anxiolytics is necessary, just as paracetamol can help with physiotherapy at the start, anxiolytics can help calm down, rest, and help the physiotherapy of the brain that is psychotherapy.

It is important to favor antihistamines such as hydroxyzine (Atarax) and avoid benzodiazepines (such as valium, xanax, lexomil, seresta, lysanxia, ​​temesta or tranxene).

And when the PTSD is particularly intense, invasive, or becomes chronic then there is an indication for antidepressant treatment which is increased to a dose higher than the doses usually used for antidepressant purposes.