Anxiety Disorder: Post-Traumatic Stress Disorder

Question 1

What is post traumatic stress disorder (PTSD)?

1 - an abnormal fear of a specific event
2 - disorder developed from an exceptionally threatening or horrifying event
3 - exceptional fear of every day objects
4 - compulsive fear of other people

Answer 1

2 - disorder developed from an exceptionally threatening or horrifying event

• patients experience or witness an event
• involved actual or threatened death or serious injury
• response involved is intense fear, helplessness or horror

Question 2

To be diagnosed with PTSD, according to the ICD-11, the stressor must have been markedly distressing to almost everyone. Which of the following are the main features of PTSD?

1 - delayed response to stressor
2 - re-experiencing the traumatic event
3 - dissociative symptoms (numbness, depersonalisation, derealisation)
4 - avoidance of thoughts /memories of stressor
5 - persistent heightened fear of threat
6 - depression
7 - increased arousal
8 - all of the above

Answer 2

8 - all of the above

• symptoms must last for at least several weeks

Question 3

Post traumatic stress disorder is a response to exceptionally threatening or catastrophic event. How long must a patient present with symptoms, since being exposed to the stressor before a diagnosis can be made according to the ICD-11?

1 - 1 week
2 - >1 month
3 - >6 months
4 - >12 months

Answer 3

2 - >1 month

Question 4

Which of the following must be present for a diagnosis of PTSD to be made?

1 - others must have experienced the stressor
2 - patient has physical symptoms
3 - patient had a significant impairment in functioning

Answer 4

3 - patient had a significant impairment in functioning

Question 5

In PTSD, how soon can symptoms present?

1 - within days of the event
2 - within weeks of the event
3 - within 6 months of the event
4 - >12 months from the event

Answer 5

1 - within days of the event

• BUT goes undiagnosed for prolonged periods

Question 6

In accordance with the ICD-11 diagnostic criteria, from the onset of symptoms, how long before a patient with PTSD symptoms go away?

1 - 6 days
2 - 6 weeks
3 - 6 months
4 - 6 years

Answer 6

3 - 6 months

Question 7

Are patients with PTSD at an increased or decreased risk of other psychiatric conditions?

Answer 7

• increased risk

Question 8

In a patient with PTSD, which of the following are re-experiencing aspects of the PTSD?

1 - flashbacks
2 - nightmares
3 - intrusive images and memories
4 - all of the above

Answer 8

4 - all of the above

Question 9

In a patient with PTSD, which of the following are examples of avoidance of the PTSD?

1 - reminders of trauma external
2 - thoughts and memories of trauma
3 - returning to location of trauma
4 - all of the above

Answer 9

4 - all of the above

Question 10

Patients with PTSD are at an increased risk of other co-morbidities, but it is often difficult to identify if these are primary or secondary. Which of the following are common co-morbidities in PTSD?

1 - depression
2 - anxiety
3 - substance misuse
4 - somatisation (physical symptoms caused by stressor)
5 - all of the above

Answer 10

5 - all of the above

Question 11

There are a variety of differentials that must be considered when trying to diagnose PTSD. Which of the following should be included in the most likely differentials?

1 - substance misuse
2 - acute stress reaction
3 - adjustment disorder
4 - depressive disorder
5 - anxiety disorder
6 - OCD
7 - dissociative disorders
8 - all of the above

Answer 11

8 - all of the above

Question 12

In PTSD, what % of patients recover and what % of patients become chronic?

1 - 10% recover and 10% become chronic
2 - 30% recover and 10% become chronic
3 - 30% become chronic and recover
4 - 10% recover and 40% become chronic

Answer 12

3 - 30% become chronic and recover

• 30% recover within 3 months, but most in a year
• 30% become chronic

Question 13

What is the 1st line therapy for PTSD?

1 - medication
2 - psychological treatment
3 - electroconvulsive therapy
4 - hospitalisation for intense therapy

Answer 13

2 - psychological treatment

• trauma focused CBT
• eye movement desensitisation and reprocessing

Question 14

If the first line treatment for PTSD fails or is not possible, which involves:

• trauma focused CBT
• eye movement desensitisation and reprocessing

What is the second line treatment approach?

1 - antipsychotics
2 - anti-depressants
3 - electroconvulsive therapy
4 - hospitalisation for intense therapy

Answer 14

2 - anti-depressants

• SSRIs = Venlafaxine has the best evidence base

Question 15

If the first and 2nd line treatment for PTSD fails, what is the final treatment option?

1 - antipsychotics with anti-depressants
2 - anti-depressants with electroconvulsive therapy
3 - electroconvulsive therapy
4 - therapy with antipsychotics and with anti-depressants

Answer 15

4 - therapy with antipsychotics and with anti-depressants

• SSRIs = Venlafaxine has the best evidence base
• antipsychotics = Olanzapine has best evidence base

Question 16

What % of patients who have experienced sexual assault (a form of PTSD) will experience long term psychological symptoms?

1 - 0.3%
2 - 3.3%
3 - 33.3%
4 - 66.6%

Answer 16

3 - 33.3%

Question 17

In a patient who has experienced sexual assault (a form of PTSD), which of the following psychological reactions are common?

1 - feeling of being humiliated and ashamed
2 - blaming themselves for event
3 - low confidence and self-esteem
4 - trust issues
5 - feeling of vulnerability
6 - all of the above

Answer 17

6 - all of the above

• these should be included in any psychiatric history
• same approach should be used in any instances of child abuse