125. Trauma & PTSD

Question 1

PTSD

• prevalence
• Risk Factors
• Genetics
• Comorbidity
• Neurobiology

Answer 1

8-9% general population affected - COMMON!
RF: Women, recent alcohol use, other psych disorders, Hx childhood trauma
Genes: 30% Heritable, FKBP5/COMT mutations increases risk
CoM: 80% have at least one other psych dx (MDD!!!, Alcohol use disorder, substance use disorder, anxiety disorder), Medical Conditions (Vascular - DM, Heard Disease, Ulcer, HTN)
TBI: prior TBI predisposes to PTSD (during trauma is NOT protective)
NBio:
- HPA access: EXCESS regulation (LOW cortisol)
- Decreased activity in anterior cingulate and prefrontal cortex = AMYGDALA dysregulation
- Decreased hippocampal volume (also RISK FACTOR)

Question 2

DSM 5 Dx of PTSD

Answer 2

1. Trauma: exposure to death, threatened death, actual/threatened serious injury, actual/threatened sexual violence (directly, witnessing, indirectly)
2. 1+ of: intrusive thoughts, nightmares, flashbacks, emotional distress after traumatic reminder, physical reaction to traumatic reminder
3. 1+ of: avoidance of trauma-related thoughts/feelings OR reminders
4. 2+ mood sx: cant recall features of trauma, overly negative thoughts about self/world, exaggerated blame, negative affect, decreased interest in activities, feeling isolated
5. 2+: irritability/aggression, risky/destructive behavior, hypervigilance, heightened startle, difficulty concentrating, sleeping problems

Question 3

Natural Course of PTSD

Prevention of PTSD

Tx of PTSD (What DON’T YOU GIVE??)

Answer 3

• onset delayed by DECADES
• good prognoses (30% asx, 40% minor sx, 10% unchanged/worsen)
• INCREASES risk of suicide/SI - major predictor: guilt regarding combat (survivor’s guilt)

No Prevention: Do NOT do psych debriefing (worsens conversion to PTSD)

TX: PSYCHOTHERAPY (Cog processing therapy, prolonged exposure, EMDR - all help recount trauma)
Meds: Antidepressants (SSRIs 1st), Prazosin for nightmares

NOOOO BENZOS! (increase development, prolong course, worsen outcomes, cause aggression)

Question 4

Acute Stress Disorder

• onset
• DSM 5 DX

Answer 4

Onset in first month after trauma (not up to decades)
Predicts later development of PTSD
DSM5: needs 9 sx of PTSD, no categories
- distressing memories of trauma
- recurrent nightmares with feelings of trauma
- flashbacks
- marked physiologic/psych reactions to symbolic cues of trauma
- inability to experience positive emotions
- DEREALIZATION AND DEPERSONALIZATION (key difference from PTSD - altered sense of the reality of one’s surroundings/self)
- inability to remember aspects of traumatic event
- efforts to avoid distressing memories/thoughts/feelings
- efforts to avoid external reminders of trauma
- sleep disturbance
- irritability/angry outbursts
- hypervigilance
- concentration problems
- exaggerated startle

Question 5

Treatment of Acute Stress Disorder

Answer 5

BEST: BRIEF CBT

Question 6

Describe:

• Psychogenic Amnesia
• Fugue State
• Transient Global Amnesia
• Transient Epileptic Amnesia

Prognosis of Psychogenic Amnesia

Answer 6

Psychogenic Amnesia: retrograde amnesia (esp autobiographical info) without anterograde amnesia (can make new memories)

Fugue State: severe psychogenic amnesia, pt cannot recall own identity due to trauma

Transient Global Amnesia: anterograde amnesia with retained identity (asks repeated questions)

Transient Epileptic Amnesia: neurological cause of memory loss (due to seizure)

Prognosis: often GOOD :)