2- PTSD Flashcards
What is psychological trauma?
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
What determines if acute stress will become an acute stress disorder?
Risk/protective factors
If acute stress disorder persists for 1 month what does it become?
Acute PTSD
If acute PTSD persists for 3 months what does it become?
Chronic PTSD
What is the physiological response to long term trauma?
Body sensitized to threat (flight or fight trigged unnecessarily)
heightened physical responses to triggers/cures
What is the emotional response to long term trauma?
Intense feelings that are difficult to contain (numbing of emotions)
Tendency towards all or nothing reactions
What is the cognitive response to long term trauma?
Disrupts what we previously thought to be true about ourselves, others, and the world
Memory and cognitive impairments
Tendency towards all or nothing thinking
What 5 areas are commonly disrupted by trauma?
- Safety
- Trust
- Power and control
- Esteem
- Intimacy
Sexual trauma is considered what kind of trauma?
Interpersonal
- Frequently perpetrated by trusted individual
- Violation of boundaries/integrity
Sexual trauma (experience) can result in what dx?
PTSD Depression Substance abuse/dependence Eating d/o Physical health manifestations
What are protective factors against PTDS? (6)
Close relationships (family, school, community, peers/social)
Emotional regulation skills/amount of positive emotions
Spirituality/religion
Achievement/self-regard
Cognitive strategies
Mobilization after threat
What are risk factors for PTSD? (9)
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
What area of the brain encodes fear w/ trauma and pairs stress w/ sensory cues?
Amygdala
*Scan the environment for threats
What area of the brain learns fear environment/context?
Hippocampus
What area of the brain will release NE during trauma?
LC
What area of the brain associates visceral/autonomic sensation w/ fear?
Insula/anterior cingulate cortex
*I feel afraid
What area of the brain controls the amygdala and regulates emotion?
Pre-frontal cortex
What assessment can be used in PCP setting to evaluate PTSD?
PC-PTSD
What is the DSM5 criteria for PTSD? (7)
- Exposure to traumatic stressor
- Re-experiencing sx
- Avoidance of memories or external reminders
- Negative alteration in cognition/mood
- Alteration in arousal, reactivity (irritable, reckless, sleep problems)
- Duration for ≥ 1 month
- Cause impairment, not due to substance or GMC
What is the DREAMS mnemonic for PTDS?
Detachment Re-experiencing the event Event had emotional effects Avoidance Month in duration Sympathetic hyperactivity/hypervigilance
What is Criteria A for PTSD?
Direct exposure to actual or threatened death, injury, sexual violence
What is Criteria B for PTSD?
1+ intrusive sx (nightmares, flashbacks, strong emotions or physical reactions when reminded of event)
What is Criteria C for PTSD?
Avoidance sx (avoiding memories, thoughts, or feelings OR external reminders of event)
What is Criteria D for PTSD?
2+ Cognitions or moods (negative beliefs about self/world, self blame, feeling numb/disconnected, difficult w/ positive feelings)
What is Criteria E for PTSD?
2+ Arousal/Reactivity (irritable, aggressive, trouble concentrating, easily startled, sleep troubles)
When evaluating pt w/ PTSD. What 2 questions should you ask to assess psych comorbidities?
- Did you experience these sx PRIOR TO your traumatic incident?
- Do you ever experience these sx separate from a trauma trigger or cure?
What screening tools can you use to assess psych comorbidities?
PHQ9 - Depression
GAD7 - Generalized anxiety
MDQ - Bipolar
What are common clinical comorbidities associated w/ PTSD?
Heart disease AI disease Hyperlipidemia Interstitial cystitis Dementia Fibro Chronic pain
How might sx of pts w/ PTSD present in clinical setting?
Avoidance (no showing appointments, not completing therapy assignment)
“Forgetting” medication regimen or refusing to take meds
Resistance to therapy/change
Labile mood
As a PR how should you approach your pts w/ PTSD?
- Validate sx
- Ask permission before touching
- DON’T ask for trauma details
- Know community resources
What are the tx steps for pt w/ PTSD?
- Education
- Tx options
- Develop common goals/rapport
- Develop tx plan
What are the tx goals for pt w/ PTSD? (6)
- Reduce severity of sx
- Prevent or tx trauma-related comorbid conditions
- Improve adaptive functions (social, occupational)
- Restore sense of safety/trust
- Prevent relapse
- Limit generalization of danger experienced
What are the tx options for PTSD? (6)
- Trauma focused CBT (or regular CBT if not ready for trauma based work)
- EMDR
- Stress management
- Group therapy
- Sleep hygiene
- Anger management training
Are antipsychotics and BZs recommended for pts w/ PTSD?
NO
What meds are FDA approved for PTSD?
Sertraline
Paroxetine
*SSRI/SNRIs, Trazodone and mood stabilizers also given
What med can be given if nightmares?
Prazosin (a-blocker)
What med can be given for hyperarousal?
B-blocker
What must a pt have if you are going to refer them for trauma therapy?
Appropriate coping skills (therapy w/ exacerbate intrusive sx)
Should you increase a pt’s meds w/ PTSD during trauma therapy?
No, unless clinically necessary (can make therapy less effective)
What do you need to tx before a pt is eligible for trauma therapy? (3)
Substance abuse
Cognitive impairment (TBI)
Intrusive/untx psychosis
