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PSYCHIATRY > 1. Trauma and Stress > Flashcards

1. Trauma and Stress Flashcards

1
Q

Definition: complex gene-environment interaction in which the individual is genetically predisposed to certain precipitating stressor conditions that, over time, effect changes in gene expression through a variety of epigenetic alterations

A

Stress response

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2
Q

According to the General Adaptation Syndrome model, what determines the effects of stress?

A

stress effects depend on both nature and intensity of the stressor as well as the duration

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3
Q

What are the 3 stages of the General Adaptation Syndrome model?

A
  • Alarm stage
  • Resistance stage
  • Exhaustion stage
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4
Q

What occurs during the alarm stage of the GAS model?

A

body’s adaptive defenses are mobilized

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5
Q

What occurs during the resistance stage of the GAS model?

A

organism attempts to cope and adapt utilizing available resources

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6
Q

What occurs during the exhaustion stage of the GAS model?

A

demand exceeds available resources and defensive efforts fail, leaving the individual increasingly susceptible

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7
Q

In what stage of the GAS model do diseases of adaptation occur?

A

resistance stage

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8
Q

What is Selye’s term for healthy stress?

A

eustress

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9
Q

What is Selye’s term for unhealthy stress?

A

distress

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10
Q

Stress information sensed by the thalamus is forwarded to what brain areas?

A

amygdala, hipocampus, and cortical association areas

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11
Q

What brain area is responsible for activation of the H-P-A axis?

A

amygdala

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12
Q

Amygdala activation of the HPA axis triggers release of what?

A

catecholamines (EPI and NOREPI)

glucocorticoids

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13
Q

Which brain areas judge the importance of incoming information?

A

hippocampus and prefrontal cortex

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14
Q

What happens if the hippocampus and prefrontal cortex judge information to be unimportant?

A

amygdala’s response is altered or terminated

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15
Q

What happens if the hippocampus and prefrontal cortex judge information to be important?

A

amygdala continues the emergent response

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16
Q

How does arousal get “turned off” after acute stress?

A

Hypothalamus (parasympathetic pathways) activate glutocorticoid, cholinergic and other inhibitory system receptor neurons

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17
Q

What happens in most people with chronic stress?

A

as stress becomes chronic, glucocorticoid receptor response can become impaired and secretion does not return to normal (glucocorticoid “flood”)

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18
Q

What are the physical consequences of the “glucocorticoid flood” in chronic stress?

A
  • Inhibition of protein synthesis and accelerated protein catabolism with lipolysis and decreased peripheral glucose utilization
  • Muscle wasting, bone loss, metabolic syndrome, immune system suppression, impaired neurogenesis in hippocampus
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19
Q

What is the consequence of impaired neurogenesis in the hippocampus due to chronic stress?

A

inability to modulate amygdala in HPA activated stress response

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20
Q

What affects do glucocorticoids of chronic stress have on insulin?

A

impair the insulin response (increase blood glucose, fat, and insulin)–> T2DM devleopment

21
Q

What are the acute metabolic effects of stress?

A

shunting stored nutrients to muscles and vital organs (and shut down digestion and non-emergent functions)

22
Q

How does chronic stress affect growth?

A

impairs normal growth (no GH hormone released)

23
Q

How does chronic stress affect fertility?

A

glucocorticoids impair release of LH and FSH and also can impede parasympathetic activation resulting in impotence or premature ejaculation

24
Q

How does chronic stress affect estrogen production?

A

induced fat cell ocnsumption can impede estrogen production and lower progesterone (osteoporosis, atherosclerosis, and impaired uterine wall nutrition, so increased miscarriage and pre-term labor)

25
Q

What affect does chronic stress have on the immune system?

A

impairs B and T cell production and the formation of antibodies

26
Q

How are chronic stress and cancer connected?

A
  • Chronic stress can impair apoptosis (accumulation of abnormal cells)
  • Chronic stress can decrease body’s defenses against tumors
27
Q

What is anticipatory anxiety?

A

dread that pending situations will trigger a fear response

28
Q

What is the name of the scale that weighs severity of life stressors?

A

Holmes Rahe Life Events scale

29
Q

According to the Holmes Rahe Life Events scale, what is the most stressful event that can happen to a person?

A

Death of spouse > divorce > marital separation >death of close family member > jail term

30
Q

How do you use the Holmes Rahe Life Events scale?

A

you calculate the total number of “life change units” that are matched to how stressful life events were in a 6-12 month period which coorelates with the estimated impact of the stress on the individual’s health (like 80% illness with 300+ life change units)

31
Q

Definition: emotional or behavioral symptoms in response to an identifiable stressor that exceeds a normally expected response (NOT due to another mental disorder or normal bereavement)

A

adjustment disorder

32
Q

What are the time restraints on adjustment disorder diagnosis?

A

Occur within 3 months of the onset of the stressors and NOT LINGERING past 6 months after the stressor is removed

33
Q

What types of events are most commonly associated with adjustment disorder?

A

events that are negative and NOT under a person’s control

34
Q

How do you treat adjustment disorder?

A

psychotherapy (encouragement of more adaptive coping)

35
Q

Definition: acute stress or trauma that leads to intrusive thoughts, intense anxiety or other emotional response (including angry outburst)

A

acute stress disorder

36
Q

What are the time restraints on acute stress disorder diagnosis?

A

Starts no later than 3 days after trauma, lasts up to 1 month and causes significant distress and impairment

37
Q

How do the symptoms of adjustment disorder and acute stress disorder differ?

A
  • Adjustment disorder presents with sleep problems, GI symptoms and pain
  • Acute stress disorder presents with nightmares, flashbacks, re-living event, guilt, panic attacks, and impaired memory
38
Q

Who is likely to get acute stress disorder?

A

first responders

victims of disaster

39
Q

True or false: you have to be the victim of a traumatic event to have acute stress disorder

A

FALSE: it can be direct or vicarious (but cannot be related to seeing something on TV)

40
Q

What is the underlying pathophysiology of PTSD?

A

stress response is so severe that the emergency function of the amygdala overwhelms the ability of the hippocampus to act as a modulator (and the emotional responses of the stressor event cannot be anchored in by any identifiable contextual memory)

41
Q

True or false: invasive medical procedures can exascerbate PTSD

A

true

42
Q

What are the 4 questions asked in the PTSD screen?

A

In your life have you had an experience that was so horrible or upsetting that in the past MONTH you:

1) Have had nightmares about it?
2) Tried hard not to think about it or go out of your way to avoid situations that remind you of it?
3) Were constantly on guard, watchful or easily startled?
4) Felt numb or detached from others, activities or your surroundings?

43
Q

What are the 3 major symptoms of PTSD?

A

arousal
intrusion
avoidance

44
Q

What are some negative emotional and cognitive changes that occur in PTSD patients?

A 
amnesia
negative beliefs
guild, fear, anger, shame
loss of interest
detachment/estrangement
lack of positive emotion
45
Q

What are some examples of PTSD arousal?

A

sleep problems, startle, hypervigalence, irritability

46
Q

What is required for the management of PTSD patients?

A

TRAUMA INFORMED CARE

47
Q

What are the 4 major tenants of trauma informed care?

A
  • The survivor needs to be respected, informed, connected and hopeful.
  • Stay calm and do not get upset with patient
  • Relate trauma and symptoms (ex. anxiety, depression, etc.)
  • Work in a collaborative way with survivors
48
Q

What are the 3 tenants of empathy?

A
  • Perspective taking
  • Staying out of judgment
  • Recognize emotion and communicating that
49
Q

What are common mistakes made with sympathetic people?

A
  • “at least” statements

- try to silver line a bad situation

PSYCHIATRY (9 decks)

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