PTSD can develop at any age, including in childhood, with About 20% of children developing PTSD after trauma. This can vary widely, with 2% after a natural disaster (tornado), 28% after an episode of terrorism, and 29% after a plane crash. About 71% of subjects diagnosed with Mental disorders had also received a diagnosis of PTSD, and 44% of those diagnosed with PTSD were also affected by Mental disorders. In Nigeria, the prevalence of PTSD was estimated to be 60% in communities with direct exposure to armed conflicts and 14.5% in a community with no direct exposure.

According to duration of symptoms after the trauma:

1. Peri-traumatic: symptoms lasting minutes or hours
2. Acute Stress Disorder (ASD): symptoms lasting 2/3 days to ≤1 month
3. Post-Traumatic Stress Disorder (PTSD): symptoms for more than 1 month

Neurobiologically, armed conflicts are existential threats that could lead to profound uncertainty and anxiety, forcing the brain to adapt. A survivor of trauma is physiologically not able to simply ignore emotions to increase logical thinking. A trauma survivor cannot be told how to think, behave, or feel when traumatic episodes take place. Physiology takes precedence. The brain structure tells us when to run and when to stay and fight, providing the necessary chemicals to ensure survival. The structural changes in the brain include overly reactive amygdala, reduced hippocampus size, and smaller and less responsive medial prefrontal cortex. Other affected areas of the brain are anterior cingulate and corpus collosum. Also, there is an alteration in the neurohormonal and neurotransmitters functoing e.g hypothalamic pituitary adrenal axis malfunctioning evidenced by demonstrable hyperactivity of the sympathetic branch of autonomic nervous system in in patients with PTSD, among others.

1. Trauma & stress-related: Depression, Adjustment disorder

1. Anxiety disorders: Panic, Phobia, Obsessive-Compulsive Disorder.
2. Somatic disorders: Dissociative disorders, Conversion disorder
3. Other disorders: Psychosis, Substance abuse
4. Other problems: Behavioural problems. Attention problems, Regression.

Exposure to death or threatened death, actual or threatened serious injury, actual or threatened sexual assault

1. ONE symptom of intrusion (flashbacks, nightmares etc.)
2. Persistent avoidance
3. TWO symptoms of alterations in arousal or reactivity (e.g., startle, irritability, sleep disturbance)
4. TWO symptoms of negative alterations in mood or cognition (e.g., blame, emotional numbing, withdrawal etc.)

• Present more than 1 month
• Clinically significant distress or impairment
• The disturbance is not due to physiologic effects of a substance or other medical condition

This is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). It is characterised by the core symptoms of PTSD; i.e, all diagnostic requirements for PTSD have been met at some point during the course of the disorder. It is also characterised by:

1. Severe and pervasive problems in affect regulation.
2. Persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event; and
3. Persistent difficulties in sustaining relationships and in feeling close to others. The disturbance causes significant impairment in personal, family, social, educational, occupational or other functioning areas

PTSD often improves during the first year after the event. Symptoms typically begin within 3 months of a traumatic event, although occasionally, they do not begin until years later. Once PTSD occurs, the severity and duration of the illness varies. Some people recover within 6 months, while others suffer much longer. When untreated, the course can be chronic and disabling.

The goals of managing PTSD are to reduce symptoms, reduce distress, and reduce impairment.

The important of detail history around trauma is very crucial and a couple of self-administered screening tools for PTSD come in handy (e.g PTSD Checklist for DSM-5, Trauma Symptoms Checklist 40, Distressing Event Questionnaire etc)

Secondary prevention of PTSD

1. Psychological first aid: Education, medical and safety needs, social support, referral if necessary
2. Exposure-based intervention

1. Critical Incident Debriefing: with potential for harmful consequences either as individual or group debriefings as it may cause flooding.
2. Brief cognitive behavioural therapy: This has been shown to be very helpful in decreaing the rate of subsequent PTSD

Treatment of PTSD

1. Psychotherapy e.g Trauma focused CBT and eye movement desensitization and reprocessing (EMDR)

.2.  Psychopharmacology:

1. Selective Serotonin Reuptake Inhibitors: Recommended by the APA as first line treatment however the WHO and NICE guidelines do not recommend medications as first line.
2. Mood stabilizers: sodium valproate in adolescents
3. Antipsychotics: some positive data from adults
4. Prazocin may be used for trauma related nightmare and insomnia according to APA
5. Evidence do not support the use of Benzodiazepines for trauma related insomnia or acute stress symptoms following a traumatic event as it may prolong the course of PTSD
6. Monitoring and follow up: there are need to constantly monitor victims and assess for emergent of suicidal ideation and or substance use problems during follow up

PTSD is a syndrome that develops following exposure to an extremely threatening or horrific event or series of events that is characterized by re-experiencing, avoidance and hypervigilance, persisting for at least a month and causing significant impairment in functioning. Complex PTSD is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most prolonged or repetitive events from which escape is difficult or impossible. There is need to assess for comorbidities in PTSD and effective collaborations with other clinicians where necessary is crucial for optimal recovery