2- PTSD Flashcards

1
Q

What is psychological trauma?

A

Injury or shock to body, mind spirit to which the brain creates coping mechanism to avoid future trauma
Results in emotional, psychological and social consequences

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2
Q

What determines if acute stress will become an acute stress disorder?

A

Risk/protective factors

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3
Q

If acute stress disorder persists for 1 month what does it become?

A

Acute PTSD

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4
Q

If acute PTSD persists for 3 months what does it become?

A

Chronic PTSD

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5
Q

What is the physiological response to long term trauma?

A

Body sensitized to threat (flight or fight trigged unnecessarily)

heightened physical responses to triggers/cures

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6
Q

What is the emotional response to long term trauma?

A

Intense feelings that are difficult to contain (numbing of emotions)

Tendency towards all or nothing reactions

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7
Q

What is the cognitive response to long term trauma?

A

Disrupts what we previously thought to be true about ourselves, others, and the world

Memory and cognitive impairments

Tendency towards all or nothing thinking

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8
Q

What 5 areas are commonly disrupted by trauma?

A
  1. Safety
  2. Trust
  3. Power and control
  4. Esteem
  5. Intimacy
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9
Q

Sexual trauma is considered what kind of trauma?

A

Interpersonal

  • Frequently perpetrated by trusted individual
  • Violation of boundaries/integrity
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10
Q

Sexual trauma (experience) can result in what dx?

A
PTSD
Depression
Substance abuse/dependence
Eating d/o
Physical health manifestations
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11
Q

What are protective factors against PTDS? (6)

A

Close relationships (family, school, community, peers/social)
Emotional regulation skills/amount of positive emotions
Spirituality/religion
Achievement/self-regard
Cognitive strategies
Mobilization after threat

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12
Q

What are risk factors for PTSD? (9)

A
Severe trauma/injury
Chronic life stress
Lack of social support
Young age/F gender
Psych comorbidities (anxiety, mood d/o)
Low SES/edu
Bereavement/grief
Poor coping skills
Shame/blaming
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13
Q

What area of the brain encodes fear w/ trauma and pairs stress w/ sensory cues?

A

Amygdala

*Scan the environment for threats

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14
Q

What area of the brain learns fear environment/context?

A

Hippocampus

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15
Q

What area of the brain will release NE during trauma?

A

LC

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16
Q

What area of the brain associates visceral/autonomic sensation w/ fear?

A

Insula/anterior cingulate cortex

*I feel afraid

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17
Q

What area of the brain controls the amygdala and regulates emotion?

A

Pre-frontal cortex

18
Q

What assessment can be used in PCP setting to evaluate PTSD?

A

PC-PTSD

19
Q

What is the DSM5 criteria for PTSD? (7)

A
  1. Exposure to traumatic stressor
  2. Re-experiencing sx
  3. Avoidance of memories or external reminders
  4. Negative alteration in cognition/mood
  5. Alteration in arousal, reactivity (irritable, reckless, sleep problems)
  6. Duration for ≥ 1 month
  7. Cause impairment, not due to substance or GMC
20
Q

What is the DREAMS mnemonic for PTDS?

A
Detachment
Re-experiencing the event
Event had emotional effects
Avoidance
Month in duration
Sympathetic hyperactivity/hypervigilance
21
Q

What is Criteria A for PTSD?

A

Direct exposure to actual or threatened death, injury, sexual violence

22
Q

What is Criteria B for PTSD?

A

1+ intrusive sx (nightmares, flashbacks, strong emotions or physical reactions when reminded of event)

23
Q

What is Criteria C for PTSD?

A

Avoidance sx (avoiding memories, thoughts, or feelings OR external reminders of event)

24
Q

What is Criteria D for PTSD?

A

2+ Cognitions or moods (negative beliefs about self/world, self blame, feeling numb/disconnected, difficult w/ positive feelings)

25
Q

What is Criteria E for PTSD?

A

2+ Arousal/Reactivity (irritable, aggressive, trouble concentrating, easily startled, sleep troubles)

26
Q

When evaluating pt w/ PTSD. What 2 questions should you ask to assess psych comorbidities?

A
  1. Did you experience these sx PRIOR TO your traumatic incident?
  2. Do you ever experience these sx separate from a trauma trigger or cure?
27
Q

What screening tools can you use to assess psych comorbidities?

A

PHQ9 - Depression
GAD7 - Generalized anxiety
MDQ - Bipolar

28
Q

What are common clinical comorbidities associated w/ PTSD?

A
Heart disease
AI disease
Hyperlipidemia
Interstitial cystitis
Dementia
Fibro
Chronic pain
29
Q

How might sx of pts w/ PTSD present in clinical setting?

A

Avoidance (no showing appointments, not completing therapy assignment)

“Forgetting” medication regimen or refusing to take meds

Resistance to therapy/change

Labile mood

30
Q

As a PR how should you approach your pts w/ PTSD?

A
  1. Validate sx
  2. Ask permission before touching
  3. DON’T ask for trauma details
  4. Know community resources
31
Q

What are the tx steps for pt w/ PTSD?

A
  1. Education
  2. Tx options
  3. Develop common goals/rapport
  4. Develop tx plan
32
Q

What are the tx goals for pt w/ PTSD? (6)

A
  1. Reduce severity of sx
  2. Prevent or tx trauma-related comorbid conditions
  3. Improve adaptive functions (social, occupational)
  4. Restore sense of safety/trust
  5. Prevent relapse
  6. Limit generalization of danger experienced
33
Q

What are the tx options for PTSD? (6)

A
  1. Trauma focused CBT (or regular CBT if not ready for trauma based work)
  2. EMDR
  3. Stress management
  4. Group therapy
  5. Sleep hygiene
  6. Anger management training
34
Q

Are antipsychotics and BZs recommended for pts w/ PTSD?

A

NO

35
Q

What meds are FDA approved for PTSD?

A

Sertraline
Paroxetine

*SSRI/SNRIs, Trazodone and mood stabilizers also given

36
Q

What med can be given if nightmares?

A

Prazosin (a-blocker)

37
Q

What med can be given for hyperarousal?

A

B-blocker

38
Q

What must a pt have if you are going to refer them for trauma therapy?

A

Appropriate coping skills (therapy w/ exacerbate intrusive sx)

39
Q

Should you increase a pt’s meds w/ PTSD during trauma therapy?

A

No, unless clinically necessary (can make therapy less effective)

40
Q

What do you need to tx before a pt is eligible for trauma therapy? (3)

A

Substance abuse
Cognitive impairment (TBI)
Intrusive/untx psychosis