2.2 Responses to Stress (PTSD)

Question 1

What is type 1 trauma?

Answer 1

This is trauma that is a single incident, and is unexpected.

Question 2

What is type 2 trauma?

Answer 2

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

Question 3

What is the definition of a major incident?

Answer 3

“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”

Question 4

True or false:

Trauma is equal opportunity

Answer 4

False.

Poor and marginalised more likely to be victims and die.

Question 5

True or false:

Panic is a common response to a traumatic event or disaster?

Answer 5

False.

Most people behave rationally.

Question 6

What is the origin of activating defence mechanisms in the brain?

Answer 6

Defence has a midbrain origin ?PAG

There is top-down control from the ventromedial prefrontal cortex

Question 7

What is tonic immobility?

Answer 7

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

Question 8

What is the orienting response?

Answer 8

Sequence of:

• arousal
• arrest
• alert
• musclar change
• orient/scan
• locate
• identify
• evaluate
• take action
• re-organise

Question 9

What is the neurobiology of threat in increased proximity to a predator?

Answer 9

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

Question 10

What is a theory of PTSD neurobiology?

Answer 10

PTSD is associated with deficiency in top down modulation of amygdala activation by the pre-frontal cortex.

Question 11

What is the role of cortisol in the stress response?

Answer 11

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.

Question 12

What are the levels of cortisol in PTSD? Low or high?

Answer 12

LOW cortisol levels.

Question 13

What are the definitions of a traumatic event? ICD/DSM?

Answer 13

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

Question 14

What are the DSM IV criteria for PTSD?

Answer 14

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

Question 15

What are intrusive phenomena in PTSD?
Intrusive symptoms- 1 or more
Avoidance symptoms- 3 or more
Increased arousal- 2 or more

Answer 15

recurrent distressing recollections
nightmares
flashbacks, in any modality
distress accompanies reminders
physiological reactions (fight or flight)

Question 16

What are aboidant and emotional numbing symptoms in PTSD?
Intrusive symptoms- 1 or more
Avoidance symptoms- 3 or more
Increased arousal- 2 or more

Answer 16

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

Question 17

What are hyperarousal symptoms in PTSD?
Intrusive symptoms- 1 or more
Avoidance symptoms- 3 or more
Increased arousal- 2 or more

Answer 17

sleep disturbance
irritability / anger
concentration difficulties
hypervigilance
exaggerated startle response

Question 18

What are the characteristics of complex PTSD?

Answer 18

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)

Question 19

What is one possible explanation for the biological paradox of low cortisol in those with PTSD?

Answer 19

Receptors for cortisol are more sensitive in people with PTSD at the level of the pituitary gland.
High cortisol levels damage the hippocampus.

Question 20

Hippocampal observations in PTSD?

Answer 20

Current PTSD symptom severity explains hippocampal size

Hippocampal size correlated with current severity of PTSD

Question 21

What medications may a non-specialist prescribe for PTSD

Answer 21

Paroxetine

Mirtazapine

Question 22

What medications may specialists prescribe for PTSD?

Answer 22

Amitriptyline
Phenelzine
Prazosin
Atypical antipsychotics
Mood stabilisers- Carbamazepine