Anxiety disorders: PTSD

Question 1

Define PTSD

Answer 1

Intense delayed prolonged reaction following exposure to an exceptionally traumatic event

occurs 4 weeks post event

Question 2

Define Abnormal Bereavement

Answer 2

Delayed onset, more intense and prolonged (>6m)

Impact of their loss overwhelms the individuals coping capacity

Question 3

Define Acute Stress Reaction

Answer 3

Abnormal reaction to a sudden stressful event

up to 4 weeks following trauma

Question 4

Define Adjustment Disorder

Answer 4

Normal adjustment refers to psychological reactions involved in adapting to new circumstances.

Adjustment disorder is when there is significant distress (greater than expected), accompanied by an impairment in social functioning

Question 5

What are the 5 stages of grief

Answer 5

Denial
Anger
Bargaining
Depression
Acceptance

Question 6

The aetiology of PTSD is thought to be a combination of a severe traumatic event and an element of pre existing vulnerability, describe the cognitive theory.

Answer 6

Failure to process emotionally charged events causes memories to persist in an unprocessed form

Question 7

Give three Pre Trauma risk factors for PTSD

Answer 7

previous trauma

history of mental illness

females

low-socioeconomic background

childhood abuse

Question 8

PTSD must occur within 6 months of the event, describe the four categories

Answer 8

• *Reliving the situation** - flashbacks, vivid memories, nightmares, distress when exposed to similar circumstances as the stressor
• *Avoidance** - avoiding the reminders of trauma, excessive rumination about trauma, inability to recall aspects of trauma
• *Hyperarousal** - irritability or outbursts, difficulty concentrating, difficulty with sleep, hypervigilance, exaggerated startle response
• *Emotional Numbing** - negative thoughts about oneself, difficulty experiencing emotions, feeling of detachment from others, giving up previously enjoyed activities

Question 9

What happens in ‘Reliving the Situation’ in PTSD?

Answer 9

Flashbacks
Vivid Memories
Nightmares

Question 10

What happens in ‘Avoidance’ in PTSD?

Answer 10

Avoiding reminders of trauma
Excess rumination
Inability to recall

Question 11

What happens in ‘Hyperarousal’ in PTSD?

Answer 11

Irritability or outbursts
Difficulty concentrating
Difficulty sleeping

Question 12

What happens in ‘Emotional Numbing’ in PTSD?

Answer 12

Negative thoughts about oneself
Detachment from others

Question 13

Describe the ICD10 criteria for PTSD

Answer 13

A - Exposure to stressful event
B - Persistent remembering
C - Actual/Preferred avoidance of stimulus
D - Inability to recall important aspects, increased psychological sensitivity and arousal

Question 14

Describe the expected Appearance, Behaviour, Speech and Mood of someone with PTSD

Answer 14

A and B - Hypervigilant, Startled Response
Speech - Slow and Trembling
Mood - Anxious
Thought - Pessimistic/Reliving event

Question 15

Describe the expected Perception,Cognition and Insight of a PTSD patient

Answer 15

Perception - No hallucinations, may have illusions
Cognition - Poor attention and Concentration
Insight - Good

Question 16

Describe two questionnaires to give a patient with suspected PTSD

Answer 16

Trauma Screening
Post Trauma Diagnostic Scale

Question 17

Describe the management of PTSD where symptoms are present within THREE MONTHS of trauma

Answer 17

• Watchful waiting - mild symptoms lasting <4 weeks
• Trauma focussed CBT
• Short term drugs for sleep management (eg Zopiclone)
• Risk assessment

Question 18

Describe the management of PTSD where symptoms have been present >3 months after a trauma

Answer 18

Trauma focussed psychological intervention (such as CBT or EMDR)

Consider drug treatment such as Paroxetine or Mirtazepine or amitriptyline or phenelzine if little benefit to psych therapy/patient doesn’t want to engage/comorbid depression