6. Trauma and Stress Related Disorders Flashcards
What is the criteria for diagnosing PTSD?
PTSD is HARD
Exposure to a prior trauma (witness or actual exposure to death/injury or integrity to self/others), which causes:
- Hyperarousal: hard time sleeping/concentrating, irritable, hypervigilence
- Avoidance of stimuli associated with trauma
- Rexperiencing event (nightmares or flashbacks)
- Negative cognitions/distress: blame self/others, detached from others, ↓ interest in activities and cannot remember key aspects of events
That lasts >1 month with significant distress or impaired functioning
Treatment of PTSD
1st line:
- CBT/cognitive processing therapy: support groups and EMDR (eye movement desensitization and reprocessing)
- SSRIs
- Venlaxine
Patients with PTSD have an ↑ risk of:
- Substance abuse: benzos (xanex) and alcohol
What is the criteria for diagnosing [acute stress disorder]?
- Same criteria as PTSD, however the symptoms last 3 days => 1 month
What is the criteria for diagnosing [adjustment disorders]?
Emotional symptoms (anxiety/depression) that occurs within 3 months of an idenfiable stressor (divorce/illness) lasting less than 6 months. If symptoms las > 6 months => GAD.
- Cause significant stress that is out of proportion with stressor and causes impairment of stressor.
What types of adjustment disorders can occur?
- AD + depressed mood: low mood, tearful, feeling of hopeless
- AD + anxiety: nervous, worry, jittery, seperation anxiety
- AD + mixed anxiety and depressed mood
- AD + disturbance of conduct (acting out being an asshole)
- AD + mixed disturbance of emotions and conduct
What are the types of Somatoform Disorders?
- Somatic Symptom Disorder
- Illness Anxiety Disorder (Hypochondriasis)
- Conversion Disorder
- Pain Disorder
- Body Dysmorphic Disorder (now under OCD in DSM-V)
- Somatoform Disorder, NOS
In Somatoform Disorders,
- Symptoms and motivation are:
- Physical symptoms cause: ___________
- Symptoms are/are NOT intentionally produced or feigned.
- Symptoms and motivation are unconscious/ not done for desire
- Physical symptoms cause significant distress and impairment
- Symptoms are NOT intentionally produced or feigned.
What are the criteria for diagnosis of Somatic Symptom Disorder?
Somatic symptoms that last longer than > 6 months that cause distress, persistent thoughts and anxiety
Treatment for Somatic Symptom Disorder
Regular office visits with the same doctor + Psychotherapy
What are the criteria for diagnosis of Illness Anxiety Disorder/Hypochondriac?
- Preocupation with a undiagnosed illness, despite having mild – no somatic symptoms that lasts longer than > 6 months.
- Patient has repeated health related behavior: repeatedly checks signs of illness.
What are the criteria for diagnosis of Conversion Disorder/ Functional Neurological Symptom Disorder?
Sudden onset of voluntary sensory/motor dysfunction (neurological: mutism, blindness, seizures, paralysis), usually after a psychological stressor, however, neurological WU is NL.
- Sx are NOT intentionally produced
- Sx are NOT fully explained by general medical condition, substance, culturally behavior.
- Sx cause clinical significant distress/impairment
- Sx or deficit is not limited to pain or sexual dysfunction; does not occur during course of Somatization disorde
RF for Conversion Disorder
F, adolescent, young adults
What is a characteristic of patients with Conversion Disorder?
Patient shows La belle indifference: aware of, but lack of concern towards symptoms
What are the types of factitious disorders?
- Factitious Disorder on self (Munchausen syndrome)
- Factitious Disorder on others (Munchausen syndrome by-proxy)
Factitious disorders
- Symptoms are ______; Sx are done ______ out of desire for ____
- Patient ______ creates __________ and for _______ gain.
- Patient feels better in sick role or it resolves internal conflict: patient is afraid to go to work or afraid to be alone and loves the attention they get at hospital
- Patients are often willing to do what?
- Symptoms are intentional/falsified; Done consciously out of desire for attention
- Patient consciously creates physical and/or psychological sx (self-inject feces or saliva) /exaggerate a REAL illness to assume a sick role and for Primary / internal gain.
- Patient feels better in sick role or it resolves internal conflict: patient is afraid to go to work or afraid to be alone and loves the attention they get at hospital
- Patients are often willing to go in for tests and surgeries
What is the criteria for diagnosis of Munchausen syndrome?
Chronic factitious disorder where patient creates bizzare/unusual symptoms/illness for primary/internal gain.
Characterized by:
- hx of multiple hospital admissions
- willingness to undergo invasive procedures.
What is the criterai for diagnosis of Munchausen Syndrome by-proxy
Production of intentional symptoms in ANOTHER person so the other person assumes a sick role.
RF for Munchausen Syndrome
- F, unmarried and healthcare workers
What is the motivation in Munchausen by-proxy?
Assume a sick role by-proxy
What is the treatment in Somatoform Disorders?
- Well-established therapetuic relationship
- Team based approach: pain management, neuro and psych
- CBT
- Hypnosis
- Anti-anxiety meds (clonazapam)
What medication is best for somatoform disorders?
Anti-anxiety (clonazapam)
What is malingering?
- Patient consciously fakes/exaggerates or claims disorder for secondary/external gain (avoid work, obtain compensation), and stop after gain (vs factitious disorder)
- Patient has poor compliance with treatment and F/U
In malingering:
- Symptoms and motivation are: _______
- What is their compliance with treatment and F/U?
- Symptoms and motivation are: intentional
- Compliance with treatment and F/U: Poor
What is the difference between malingering vs facittious disorders?
-
Factitious disorders:
- Done for primary/internal gain: attention/sympathy;
- Sx do not stop after gain
- Undergo treatments and surgeries
-
Malingering:
- Done for secondary/external gain: avoid work, obtain compensation.
- Sx stop after gain
- Poor F/U and treatment
What are the dissociative disorders?
- Dissociative Identity Disorder
- Depersonalization/derelealization disorder
- Dissociative Amnesia
- Dissociative Fugue
Generally, what are dissociative disorders and how is it different from psychosis?
- Dissociative disorders: Detachment from reality (feel abnormal stimuli/sensation, but know that sensation and stimuli are not real. Thus, still know what reality is), causing them to feel like theyre outside own body or become another person.
- Psychosis, which is the loss of reality = hear voices/ see things
What is criteria for diagnosing Dissociative Identity Disorder (Multiple personality Disorder)?
2 or more distinct personalities with their own behavior, memory and thinking that are observed by others or reported by patient, often occuring after childhood trauma/abuse (especially sexual abuse before 6 YO).
- Gaps in memory about events
- Sx cause distress/problem functioning
Dissociative Identitiy Disorder
- More common in:
- Most commonly occurs after:
- DID is has a HIGH RATE OF what co-morbid disorders?
- Women
- Childhood trauma (***sexual abuse BEFORE 6YO)
- High rate of co-morbid disorders with:
- PTSD (up to 100%);
- Depression and substance abuse (96%);
- Avoidant and borderline personality disorder
What is the criteria for diagnosis of
Depersonalization/ derealization disorder?
Depersonalization = Persistent feeling of detachment from self (“Like I was in a dream”/ “Like I am watching myself”), which may cause them to lose control over actions
Derealization = detachment from world (patients are not detached from body, but world around them seems strange: unreal, foggy, visually distorted)
- Often triggered by trauma
- Sx must cause significant distress/impairment
- In both, reality it intact (unlike psychosis) = patients know that sensations are NOT real.
What is the criteria for diagnosis of
Dissociative Amnesia/ psychogenic amnesia?
Inability to recall important personal information/autobiographical memory (past events, job, where they live), after a traumatic event.
- Memories can come back
- Patient often not bothered by lack of memory
- Amnesia not explained by other cause
How is dissociative amnesia different from simple amnesia?
- Includes large groups of memories: name, job and home
- Due to stress/ trauma
How is dissociative amnesia different from repression?
- Repression = repress a certain event (abuse);
- DA = loss of autobiographical memory (name, job, home), after trauma
What is dissociative fugue?
Patient who has dissociative amnesia develops dissociative fugue = sudden wandering/traveling in that dissociated state.
What is Trichotillomania?
- Presents as:
- MC in:
- Treatment:
- Compulsive pulling out of ones own hair, causing distress and persists even though patient tries to stop.
- Presents with: thinning of hair/baldness in any are of the body, MC in scalp.
- MC in: childhood, but spans all ages
- Tx: Psychotherapy is 1st line; meds (clomipramine) can be considered.
