109b - Trauma and PTSD

Question 1

How does regulation of the hypothalamic-pituitary-adrenal axis change in PTSD?

Answer 1

There is excess regulation

• PTSD patients have abnormally low plasma cortisol levels
  
  • Increased cortisol suppression during a dexamethasone suppression test

Question 2

What defines acute stress disorder?

Answer 2

• Onset in the first month following trauma
• Predicts later development of PTSD
• Diagnosis requires symptoms of
  
  • Distressing memories, dreams, reactions, phsyiological response
  • Efforts to avoid ^
  • Inability to experience positive emotions
  • Altered sense of reality
  • Sleep disturbance, hypervigilence, problems concentrating

(Many listed to define diagnosis, these are general patterns - not diagnostic)

Question 3

How is PTSD treated?

Answer 3

• Psychotherapy
  
  • Cognitive processing
  • Prolonged exposure
• Medications
  
  • SSRI, SNRI, or TCA
  • Prazosin
    
    • Can help with nightmares
  • Do not give benzos

Question 4

What is the treatment for acute stress disorder?

Answer 4

Cognitive behavioral therapy

• Decrease symptom severity
• Decrease rates of conversion to PTSD

Question 5

What is the role of benzodiazepines in the treatment of PTSD?

Answer 5

There is none!

Don’t give them!!

Question 6

What is psychogenic amnesia?

Answer 6

• Retrograde amnesia
  
  • Cannot recall own identity - “fugue state”
• Prognosis is good
  
  • If the individual manages to avoid being framed for crimes he did’t commit

Question 7

List 3 neurobiologic changes of PTSD

Answer 7

• 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

Question 8

What syptom differentates acute stress disorder from PTSD?

Answer 8

People with ASD may experience an altered sense of reality of ones surroundings or self

Question 9

How can PTSD be prevented?

Answer 9

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

Question 10

Describe the natural course of PTSD

Answer 10

• Onset may be delayed by deckads
• Prognossis is good for may patients
  
  • Only 10% experience no change or worsening