Anxiety and Trauma Disorders Flashcards
How are reactions to major stressors similar?
Involve:
- emotional responses (threat => fear & loss => sadness)
- physical symptoms (autonomic arousal +/- fatigue)
- psychological responses conscious or unconscious (avoidance behavior v denial / dissociation)
What are abnormal stress reactions?
Exaggerated or maladaptive responses to stressor:
- acute (acute stress reactions)
- prolonged (PTSD, adjustment disorder, abnormal grief)
ICD 10 criteria of acute stress reactions?
Rapid onset (min-h) of extreme responses to sudden and severe stressful events
Symptoms of acute stress reactions?
Mixed and fluctuating picture:
- initial state: dazed and perplexed
- depression, anger, despair
- purposeless overactivity and withdrawal
- intense anxiety with autonomic arousal (sweating, dry mouth, tachy, vomiting)
- dissociative symptoms (inc wandering aimlessly)
- reduced sleep and nightmares
Initial management of acute stress reactions?
- helping reorient and ground individual
- practical support (temp housing after nat disaster)
- brief CBT (imp outcomes, reduce risk PTSD)
anxiolytics in acute stress reactions?
No evidence! Carry a risk of dependence
`When does acute stress reaction -> PTSD?
Persistence of symptoms >1month indicates development PTSD
What are the adjustment disorders?
Range of abnormal psychological responses to life adversity (job loss, move, divorce etc)
Onset and resolution adjustment disorders?
Onset: within weeks of stressful event
-Duration
Presentation of adjustment disorders?
Broad mix of Sx:
- anxiety (autonomic arousal, insomnia, irritability)
- depression (sadness, tearfulness, worry)
Initial Mx adjustment disorder?
- ventilate feelings (encourage)
- develop problem solving strategies
- sometimes formal CBT req’d
How may adjustment to chronic or terminal illness manifest?
Anxiety, depression, exaggerated disability. Sequence may be similar to bereavement of:
-shock and denial => anger => sadness => acceptance.
Onset PTSD?
Weeks, months or (rarely) years after severe stressful experience of exceptionally threatening or catastrophic nature
Duration of Sx for PTSD Dx?
At least one month
Characteristic features of PTSD?
- persistent intrusive thinking or re-experiencing of the trauma (memories, flashbacks, dreams)
- avoidance of reminders
- numbing, detachment and estrangement from others; loss of interest in significant activities
- foreshortened sense of future
- increased arosal (autonomic Sx, hypervigilance, sleep disturbance, irritability, poor concentration, exaggerated startle response)
What factors influence risk of PTSD development?
- Risk correlated with magnitude of event (although man made ?>natural; greater if stress continues)
- lack of social support
- presence of other adversities at time of trauma
- premorbid personality
Effective PTSD treatments?
- Trauma focussed CBT
- eye movement desensitization and reprocessing therapy
- antidepressants
What are the classic stages of grief?
- Shock and disbelief: autonomic arousal, paroxysms of weeping. D -> W
- Anger: at desertion by deceased
- Searching/pining: vivid dreams / pseudohallucinations of seeing or speaking to deceased
- Guilt and self blame
- Sadness and despair (many fx of depression_
- Acceptance: return of interests
What is abnormal grief?
Delayed onset, greater intensity/prolongation of reaction.
-suicidal ideas may be harboured during abnormal pining borne of wish to be reunited with deceased
When is abnormal grief more common?
- relationship with deceased was problematic
- grieving impeded by social constraints (e.g. putting on brave face for the children)
How may abnormal grief be managed?
- may respond to CBT
- encourage ventilation of feelings
- structured review of relationship
- treat depression
- hospitalise if significant suicidal ideation
