adult psych Flashcards
Criteria for PTSD
A: The person has been exposed to a traumatic event in which the person experienced, witnesses, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of others
B: The traumatic event is persistently reexperienced in one (or more) ways
- Recurrent and intrusive distressing recollections of the event
- Recurrent distressing dreams of event
- Acting or feeling as if the traumatic event were recurring: sense of reliving the experience
- Intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event.
- Physiological reactivity on exposure to internal/ external cues.
C: Persistent avoidence of stimuli associated with the trauma and numbing of general responsiveness (not present before trauma), as indicated by 3 or more of the following
- efforts to avoid thoughts, feelign, conversations about trauma
- efforts to avoid activies, places, or people that arouse memories of trauma
- Inability to recall an important aspect of trauma
- Diminished interest or participation in significant activities
- Feeling of detachment or estrangement from others
- Restriced affect
- Sense of a foreshorted future.
D: Persistent symptoms of increased arousal (>2)
- difficulty falling or staying asleep
- irritability or outbursts of anger
- difficulty concentrating
- hypervigilance
- exaggerated startle response
E: distubances duration >1month
F: Disturbance causes clinically significant distress or impairment in social, occupational or other important areas.
Risk factors for developing PTSD
PRE TRAUMA FACTORS gender ( female more @risk) <25yrs education (those with less formal education >risk) childhood trauma childhoood adversity adverse life events psychiatric disorders Genetics (eg fam hx of PTSD)
TRAUMA FACTORS Severity Type of trauma (eg: rape= more personal than accident) Betrayel Peritraumatic dissociation Participation in trauma
POST TRAUMA
poor social support
development of acute stress disorder (develops within one month after exposure)
Clinal features of PTSD
Reexperiencing the traumatic event
Physical or emotional avoidence of stimuli ass with the trauma, or an inability to remember traumatic details of the event
Negative alterations in cognitions & mood involving numbing of emotions and persistent distorted blame and negative emotional states.
Persitent symptoms of increased arousal, such as irritability, insomnia and increased startle responses.
Things to consider before/ with diagnosis of PTSD
Medical conditions:
head injury/ injuries during the traumatic event
epilepsy
alcohol use & substances
Differentiate PTSD from: adjustment disorder dissociative disorder borderline PD factitious disorder malingering
Treatment of PTSD
Prevention*: more of a theoretical thing
Psychotherapy:
Mainly CBT
Psychosocial therapies
exposure therapy (desensitise pt to anxiety caused be traums)
cogntive therapy (aims to correct irrational beliefs)
stress inoculation training (teaches a set of skills: relaxation, breathing, assertivness)
Pharmacotherapy
1. SSRIs (sertraline and paroxetine)..allow trial of 3 months before referring to psychiatrist.
The SNRI, Venlafaxine can be used as an alternative
if SSRIs not well tolerated, use TCA
- Atypical antipsychotics for treatment resistent PTSD.
- Alpha 1 adrenergic blocker Prazosin to reduce nightmares and insomnia
- Propranolol for decreasing the heightened reactivity in PTSD
How long do we treat for in PTSD
acute PTSD: 12months
chronic PTSD:: 24 months
Criteria for anorexia nervosa
A: Restriction of energy intake relative to requirements. Significantly low body weight (BMI >17 is mild, 15-16 is moderate & <15 extreme )
B: Fear of weight gain, and persistent behavior that interferes with weight gain.
-restrictive type and purging type
C: disturbed body image
Criteria for Bulimia nervosa
A: Repeated episodes of binge eating
episodes of excessive food intake AND loss of control during these episodes
B: Recurrent compensatory behavior
- vomiting
- Laxative
- self-administered enema
- diuretic abuse
- appetite suppresant abuse
- excessive exercise
- fasting
C: Binge eating episode frequency: once/week for 3 months
D: Self evaluation is influenced by body build or weight
E: not part of anorexia.
- specify severity (in terms of binge episodes)
- mild: 1-3
- moderate 4-7
- severe 8-13
- extreme >14
Clinical features of anorexia nervosa
onset 10-30
Reduction in food intake
obsessed with food and fear weight gain
Obsessive compulsive behabvior regarding food is common: calorie counting etc
Purging, appetite suppresants are common.
often have concomitant MDD; AND anxiety
Physical complications of anorexia
High mortality (5-18%)
LOW
Amenorrhoea
Bradycardia
hypotension
hypothermia
Downy lanugo hairs on skin
fractures…osteoporosis
Hypokalemia…cardiac arrythmias
Clincal features of bulimia nervosa
Uncontrolled binge eating
skip meals and binge later
Binge sessions are followed by feelings of guilt and patients then do compensatory behavior
do bulimia patients ever experience a state of starvation
yes…. often skip meals and then binge later in the day
Which other psychiatric conditions if bulimia associated with
MDD substance use disorder anxiety disorders impulse control disorders dissociate disorders personality disorders
Physical comlications of bulimia
electrolyte disturbances
gastric/ oesophageal tears
hypokalemia
tooth enamel erosion
Binge eating disorder
Epis of binging, at least one per week for 3 months
with No compensatory behavior
