Anxiety disorder: post-traumatic stress disorder

Question 1

What is the triad of PTSD?

Answer 1

1. Reliving (flashbacks or recurrent nightmares)
2. Hyperarousal/vigilance
3. Avoidance due to perceived fear of re-exposure

Question 2

Define PTSD.

Answer 2

“An event of exceptionally threatening or catastrophic nature likely to cause pervasive distress in anyone: - ICD-10

E.g. sexual assault, war, natural disasters, accidents, torture, terrorism

Question 3

How common is PTSD? Who is most affected?

Answer 3

Prevalence: One year = 1-3 %. Lifetime = 6.8%

F>M

Question 4

What is the aetiology of PTSD?

Answer 4

• 10% who have experienced severe trauma
• Degree of exposure and proximity
• Genetics
• Predisposing traits e.g. neuroticism, FHx of psych disorders, childhood abuse, poor early attachment.
• Survivor guilt
• Continuous exposure to trauma or stressors
• Memory formation dysfunction

Question 5

What are the clinical features of PTSD? What may be comorbid?

Answer 5

• Reliving (flashbacks or recurrent nightmares)
• Hyperarousal/vigilance
• Avoidance due to perceived fear of re-exposure

Other:

• Comorbid Depression
• Comorbid substance misuse
• Suicidality

Question 6

What is the management of PTSD?

Answer 6

Psychological – CBT (Trauma focused) Or EMDR (eye movement desensitization and reprocessing)

Pharmacological

• Mirtazapine / SSRI / Venlafaxine
• MDMA trials = 80% cure rate at 12 weeks (MAPS)

Question 7

How does complex PTSD differ from PTSD?

Answer 7

Following exposure to an event/events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse).

May not be as intense a trigger but will have been prolonged.

MEETS ALL diagnostic requirements for PTSD

Question 8

What additional problems are present in complex PTSD?

Answer 8

In addition, severe and persistent

1. problems in affect regulation;
2. beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and
3. difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Question 9

What is the diagnosis and treatment?

Answer 9

Adjustment disorder - likely to go away once stressor disappears

Background of depression

Unlikely to by psychotic - more likely rumination

Question 10

Ameena undergoes a course of Trauma Focussed CBT to help her overcome her PTSD symptoms. Together with her therapist, they identify a negative thought about the trauma that she holds: ‘I am permanently broken’. This is best described as an example of which type of thinking error?

• A. All or nothing thinking
• B. Filtering
• C. Disqualifying the positive
• D. Mind reading
• E. “Shoulds” thinking

Answer 10

A

Question 11

Abeena is a 35 year old Ghanian A&E nurse. She was sexual assaulted by a stranger at a train station 5 months ago. She attend the psychiatry clinic after her GP referred her with flashbacks and nightmares about the incident. She had a panic attack when she tried to return to the train station to go to work a week ago and has not sued the train since.

Which of the following is not a symptom of the increased arousal seen in PTSD cases such as this:

• A. Difficulty falling asleep
• B. Irritability
• C. Difficulty concentrating
• D. Panic Attacks
• E. Exaggerated startle response