Behavioral Science Flashcards
What is the time frame for which acute stress disorder takes place?
during the first month after a traumatic event.
It cannot be diagnosed after a month has passed since traumatic event
~50% develop into PTSD
What is the time frame for which PTSD takes place?
After the first month following a traumatic event.
Cannot be diagnosed during the first month after traumatic event.
What are the clinical symptoms of Acute stress disorder and in PTSD?
What is different between the two?
Acute Stress Disorder:
- Reliving: flashbacks, nightmares, intrusive memories
- Avoidance of reminders
- Negative mood, cognition
- Dissociative: depersonalization/derealization/dissociative amnesia of part or all of event
- Hyperarousal: decreased sleep, aggression-overreacts to perceived threat, hypervigilant
In PTSD, all the same clinical symptoms EXCEPT for the dissociative symptoms and it lasts longer than 1mo
What term describes the persistent feelings of detachment or estrangement from ones own body, thoughts, perceptions, and actions or environment?
Depersonalization/derealization disorder
This is seen in acute stress disorder but NOT PTSD
Which of the following meet the “relieving” critera in the DSM-5 for PTSD in adults?
- Repeatedly talking about the trauma
- Intrusive memories
- Nightmares specifically of the trauma
- Nightmares without a necessarily specific theme
- Flashbacks
- Intrusive memories
- Nightmares specifically of the trauma
- Flashbacks
Which of the following symptom clusters would allow you to diagnose post traumatic stress disorder in a patient who is recovering from a near fatal accident at work?
a. Repeatedly speaking about the accident, Pessimistic thoughts, Sadness
b. Flashbacks of the accident, Avoidance of feelings related to the accident, Leaden paralysis
c. Nightmares of the accident, not going to work (to avoid reminders of the accident), depression, easily angered and aroused
C. Nightmares of the accident, not going to work (to avoid reminders of the accident), depression, easily angered and aroused
PTSD criteria: Reliving (nightmares), avoidance of reminders (not going to work), negative mood (depression), and hyperarousal (easily angered and aroused)
What are the three steps to coping after trauma?
- Stabilize, deal with immediate needs – distress after trauma is normal
- Grief – feel and process feelings that could not be felt at the time
- Integration, make meaning of experience new sense of self, world
T/F: Psychological debriefing after trauma (forcing people to talk about traumatic event) ultimately is a good way to helps people cope
FALSE
Note: stabilizing is an important step, AVOID “psychological debriefing”
“Psychological debriefing” after trauma (people were asked to talk about trauma to counselors for a single session) increased the likelihood of acute stress disorder/PTSD!
Tx for acute stress disorder?
Can treating acute stress disorder prevent PTSD?
cognitive behavioral therapy (CBT) with psychoeducation to normalize the distress after trauma
SSRIs are reasonable and even low dose benzodiazepines can be given for sleep but limit to short-term <2weeks
None of the Rx shown to prevent PTSD
Tx for PTSD?
CBT, mindfulness-based stress reduction, psychodynamic psychotheramy
SSRI are first line tx
Rx nightmares/flashbacks by reducing noradrenergic activity with prazosin, clonidine
Avoid long benzos
When treating PTSD, what is the Rx used for symptims of nightmares/flashbacks
Done by reducing noradrenergic activity with
- prazosin (alpha 1 blocker)
- clonidine (alpha 2 agonist)
Beta blockers do not help
Which of the following is/are an evidence-based first line treatment for acute stress disorder or PTSD?
a. Cognitive behavioral therapy
b. Sertraline
c. Debriefing therapy right after the trauma
d. Psychodynamic Psychotherapy
e. Bupropion
f. Propranolol
g. Mindfulness meditation
h. Clonidine
a. Cognitive behavioral therapy
b. Sertraline (=SSRI)
d. Psychodynamic Psychotherapy
g. Mindfulness meditation
h. Clonidine
What part of the brain does extinction learning during reconsoldation of memories depend on?
The idea is to get the Fear cue no longer associated with harm, this leads to extinction
Extinction depends on medial PFC (mPFC), ACC (ant cingulate cx)
mPFC, ACC damaged after child abuse.
Long Term Depression means
increase/decrease of synaptic weight
increase/decrease of threshold for action potential
Long Term Depression underlies extinction: True/False
Long Term Depression means
decrease of synaptic weight
increase of threshold for action potential
Long Term Depression underlies extinction: True
Long Term Potentiation means
increase/decrease of synaptic weight?
increase/decrease of threshold for action potential?
Long Term Potentiation means
increase of synaptic weight
decrease of threshold for action potential
The subcortical fast pathway involves synapses between which two brain structures?
Thalamus directly to amygdala to trigger the fear response
Fear extinction involves the _______ inhibiting the excitaiton of the _______, therefore no action potential elicited, resulting in long-term depression (decreased synaptic weight)
vmPFC, Amygdala
The slow polysynaptic pathway involves synapses from where to where?
thalamus then up into cortex then to amygdala to reduce output (output of amygdala is fear response)
T/F: an impaired fear extinction process is seen in many anxiety disorders (PTSD, panic, OCD, etc.)
True
What are the 4 symptom clusters of PTSD?
To diagnose, need traumatic experience
PLUS 4 symptom clusters
1. Reliving (Intrusive memories/re-experiencing) the trauma
2. Avoidance of reminders
3. Negative cognitions/negative mood/emotional numbing
4. Hyperarousal
Which of the following is/are likely to be true regarding psychotherapy for acute stress disorder or post-traumatic stress disorder?
a. Psychotherapy involves retrieving and then modifying the memory of the trauma during reconsolidation
b. Memories are most easily modified while stored without directly retrieving them
c. Regarding the fear response, psychotherapy promotes the “fast subcortical pathway” over the “slow cortical pathway”
d. Psychotherapy reduces fear by helping to bypass the amygdala
e. A large hippocampus is likely to interfere with the efficacy of psychotherapy.
f. Extinction of the fear response is believed to be from prefrontal inhibition of the activity of the amygdala, leading to long term depression of the synapse mediating the fear response.
a&f are correct
a. Psychotherapy involves retrieving and then reconsolidating the memory of the trauma.
f. Extinction of the fear response is believed to be from prefrontal inhibition of the activity of the amygdala, leading to long term depression of the synapse mediating the fear response.
Brain fear pathways for exam:
- The amygdala mediates what emotion?
- what area in the brain causes extinction?
- Fear
2. medial prefrontal cortex (PFC)
T/F: Memories are most easily modified while stored without directly retrieving them
False
memories are modified after retrieval during reconsolidation.
Psychotherapy involves retrieving and then reconsolidating the memory of the trauma.
T/F: Psychotherapy reduces fear by helping to bypass the amygdala
False.
Psychotherapy promotes nuanced response from slow polysynaptic cortical path to amygdala, but does not bypass the amygdala