108/109b - Trauma and PTSD + Patient Flashcards
How does regulation of the hypothalamic-pituitary-adrenal axis change in PTSD?
There is excess regulation
- PTSD patients have abnormally low plasma cortisol levels
- Increased cortisol suppression during a dexamethasone suppression test
What defines acute stress disorder?
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Acute Stress Disorder = occurs in the first month following trauma, and predicts later development of PTSD
- not necessary to have ASD to develop PTSD later (only 50% of patients w/ PTSD had ASD)
- have to have 9 or more symptoms for diagnosis; some include distressing memories and dreams, dissociate reactions where individual feels/acts like the traumatic event is recurring, psychological reactions in response to cues/symbols of the traumatic event, inability to remember aspects of traumatic event, effort to avoid distressing memories and external reminders, sleep disturbance, hypervigilance
- big difference in the criteria for PTSD and ASD is that ASD includes dissociate reactions as a criteria and PTSD does not
How is PTSD treated?
- Treatment: Psychotherapy or medications
- SSRI’s are the first line medication.
- Prazosin (alpha 1 antagonist) improves nightmares, sleep quality, and hyperarousal symptoms of PTSD.
- NO BENZOS for PTSD unless there is another compelling reason.
- Some states have authorized use of marijuana for treatment, but evidence is not convincing
What is the treatment for acute stress disorder?
Cognitive behavioral therapy
- Decrease symptom severity
- Decrease rates of conversion to PTSD
What is the role of benzodiazepines in the treatment of PTSD?
- Benzos are prescribed to a large proportion of patients, but they shouldn’t be!
- they increase the likelihood of development of PTSD and prolong its course, worsens outcomes of psychotherapy, and can be disinhibiting and lead to aggression
- NO BENZOS for PTSD unless there is another compelling reason.
- they increase the likelihood of development of PTSD and prolong its course, worsens outcomes of psychotherapy, and can be disinhibiting and lead to aggression
What is psychogenic amnesia?
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Psychogenic Amnesia = retrograde amnesia (specifically autobiographical retrograde amnesia) w/o anterograde amnesia
- in severe cases, might have trouble recalling their own identity, called the “fugue state”
- needs to be separated from transient global amnesia, but transient global amnesia has anterograde amnesia
- prognosis is often good
List 3 neurobiologic changes of PTSD
- Excess regulation of the HPA axis -> low plasma cortisol
- Decreased activity in anterior cingulate, ventromedial prefontal cortex -> Dysregulation of amygdala (goes into overdrive)
- Decreased hippocampal volume
- An effect of PTSD and a factor that predisposes people to PTSD
What symptom differentates acute stress disorder from PTSD?
People with ASD may experience an altered sense of reality of ones surroundings or self (dissociation reactions where individual feels/acts like the traumatic event is reccuring)
How can PTSD be prevented?
By preventing trauma
(Unfortuantely, after the traumatic event no evidence-based treatment to prevent onset of PTSD)
But if a person has acute stress disorder after trauma, CBT can reduce rates of conversion to PTSD
Describe the natural course of PTSD
- Onset may be delayed by decades
- Prognossis is good for many patients
- Only 10% experience no change or worsening
Diagnostic criteria for PTSD:
- Diagnosis criteria:
- exposure to trauma (Criteria A)
- reexperiencing symptoms (Criterion B): intrusive thoughts, nightmares, etc.
- Avoidance symptoms (Criteria C): avoidance of thoughts/feelings or reminders of the trauma
- Mood-like Symptoms (Criteria D): can’t remember key details of trauma, self blame, negative affect, isolation, etc.
- Hypervigilance (Criteria E): constantly scanning environment for stress, easily startled, difficulty sleeping, etc.
What is the most comon psychiatric comorbidity of PTSD?
major depressive disorder
