2.2 Responses to Stress (PTSD) Flashcards
What is type 1 trauma?
This is trauma that is a single incident, and is unexpected.
What is type 2 trauma?
This is complex trauma, that may be:
- repetitive
- ongoing abuse, hostake taking, genocide
- may affect 1/10 to 1/7 children
- potential betrayal of trust in a primary relationship
- developmental trauma
- attachment/attunement
What is the definition of a major incident?
“Any situation associated with multiple casualties and fatalities, and damage to property, due to natural or unnatural causes, that is beyond what can be coped with ordinarily by the deployment of the emergency services”
True or false:
Trauma is equal opportunity
False.
Poor and marginalised more likely to be victims and die.
True or false:
Panic is a common response to a traumatic event or disaster?
False.
Most people behave rationally.
What is the origin of activating defence mechanisms in the brain?
Defence has a midbrain origin ?PAG
There is top-down control from the ventromedial prefrontal cortex
What is tonic immobility?
The “freeze” response occurs in an ‘inescapable threat’
It is a state of involuntary profound reversible motor inhibition
It occurs when in direct physical contact with predator/aggressor.
-occurs in 1/3 to 1/2 of sexual assault cases
Features:
- decreased vocalisation
- intermittent EC
- rigidity, paralysis
- muscle tremors in extremities
- chills
- unresponsiveness to pain
What is the orienting response?
Sequence of:
- arousal
- arrest
- alert
- musclar change
- orient/scan
- locate
- identify
- evaluate
- take action
- re-organise
What is the neurobiology of threat in increased proximity to a predator?
There is a shift in brain activation from prefrontal cortex to midbrain:
- superior colliculi
- Periaqueductal grey
these regions responsible for active and passive defence responses
-shift from cortical to sub-cortical activation
What is a theory of PTSD neurobiology?
PTSD is associated with deficiency in top down modulation of amygdala activation by the pre-frontal cortex.
What is the role of cortisol in the stress response?
Cortisol mediates and shuts down the stress response.
It acts through negative feedback on the pituitary, hypothalamus, hippocampus, and amygdala.
Acute stress increases cortisol levels.
What are the levels of cortisol in PTSD? Low or high?
LOW cortisol levels.
What are the definitions of a traumatic event? ICD/DSM?
DSM
experienced, witnessed or confronted
threat of death or serious injury (self or others)
[intense fear, helplessness or horror]
ICD
delayed &/or protracted response
exceptionally threatening or catastrophic
likely to cause pervasive distress in almost anyone For both the TE is the primary and overriding causal factor
What are the DSM IV criteria for PTSD?
Traumatic events
Intrusive symptoms- 1 or more
Avoidance symptoms- 3 or more
Increased arousal- 2 or more
Duration - 1 month
Distress and impairment in social or occupational functioning
May be acute/chronic/delayed onset
What are intrusive phenomena in PTSD?
Intrusive symptoms- 1 or more
Avoidance symptoms- 3 or more
Increased arousal- 2 or more
recurrent distressing recollections nightmares flashbacks, in any modality distress accompanies reminders physiological reactions (fight or flight)
What are aboidant and emotional numbing symptoms in PTSD?
Intrusive symptoms- 1 or more
Avoidance symptoms- 3 or more
Increased arousal- 2 or more
avoidance of thinking or talking about the event
avoidance of reminders such as activities, places or people
amnesia for important aspect of trauma
loss of interest in activities
detachment
emotional numbing
sense of foreshortened future
What are hyperarousal symptoms in PTSD?
Intrusive symptoms- 1 or more
Avoidance symptoms- 3 or more
Increased arousal- 2 or more
sleep disturbance irritability / anger concentration difficulties hypervigilance exaggerated startle response
What are the characteristics of complex PTSD?
PTSD symptoms Cognitive disturbances- low self-esteem, self-blame, hopelessness, helplessness, pre-occupation with threat Mood disturbances Somatisation Identity disturbance Emotional dysregulation Chronic interpersonal difficulties Dissociation Tension reduction activities - binge-purging, self mutilation, substance misuse etc)
What is one possible explanation for the biological paradox of low cortisol in those with PTSD?
Receptors for cortisol are more sensitive in people with PTSD at the level of the pituitary gland.
High cortisol levels damage the hippocampus.
Hippocampal observations in PTSD?
Current PTSD symptom severity explains hippocampal size
Hippocampal size correlated with current severity of PTSD
What medications may a non-specialist prescribe for PTSD
Paroxetine
Mirtazapine
What medications may specialists prescribe for PTSD?
Amitriptyline Phenelzine Prazosin Atypical antipsychotics Mood stabilisers- Carbamazepine
