Class 11: Trauma and Related Disorders Flashcards
Name 3 disorders in the subclass of trauma and stressor-related disorders.
- Childhood attachment disorder
- Acute stress disorder
- PTSD
Name 3 examples of Childhood attachment disorders
- Adjustment disorder
- Disinhibited social engagement disorder
- Reactive attachment disorder
What criteria must be met to be diagnosed with a trauma and stressor-related disorder according to the DSM-5?
Exposure to a traumatic or stressful event MUST occur
Define Trauma
Actual or threatened death, serious injury, or sexual violence
Why would job loss not be trauma?
Trauma needs to involve an immediate threat to life or physical injury
What are the 4 types of symptoms of Psychological Trauma?
- Intrusion symptoms
- Avoidance
- Negative Alterations in Cognitions and Mood
- Hyperarousal
What are 3 intrusion symptoms?
Flashbacks, Nightmares, and Intrusive thoughts
What is the Avoidance Symptom of Trauma?
Avoidance of stimuli associated with trauma
What are two examples of negative alterations in cognition and mood in trauma?
- Difficulty recalling important aspects of trauma
2. Emotional detachment
What are 6 examples of hyperarousal symptoms of trauma?
- Hypervigilance
- Insomnia
- Agitation
- Irritability
- Impulsivity
- Anger
What percentage of Canadian meet the criteria for PTSD?
8%
Define PTSD
Post-traumatic stress disorder is when trauma symptoms persist
Are men or women more likely to have PTSD?
Women due to sexual assault
What are the 5 PTSD’s Criterion Categories and for how long are they required to be?
- Stressor
- Intrusion Symptom
- Avoidance
- Negative Alterations in Cognition and Mood
- Alteration in Arousal and Reactivity
for more than 1 month
What two criteria must be met otherwise it is NOT PTSD?
- Must have Functional Significance
- Cannot be due to medication, substance use or other illness
What are the 5 events that typically cause PTSD?
- Experiencing or witnessing a traumatic event
- Physical assault
- Threat of death, sexual violence or serious injury
- Learning about a violent death of a loved one
- Job exposure in jobs relating to trauma
Name 5 intrusive symptoms of PTSD.
- Unwanted upsetting memories
- Nightmares
- Flashbacks
- Emotional distress after triggers
- Physical reactivity after triggers
What are 2 ways that Criterion C: Avoidance symptoms of PTSD can be met?
- Avoidance of trauma-related thoughts or feelings
2. Avoidance of trauma-related external reminders
What are 7 ways that Criterion D: Negative Alterations in Cognition and Mood symptoms of PTSD can be met?
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling Isolated
- Difficulty experiencing positive affect
What are 6 ways that Criterion E: Alterations in Arousal and Reactivity symptoms of PTSD can be met?
- Irritability or aggression
- Risky or destructive behaviour
- Hypervigilance
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
What are 6 risk factors of PTSD?
- History of substance abuse
- Inadequate coping skills
- Lack of social support
- Childhood trauma
- Sex
- Genetics
What three brain systems experience alterations in PTSD?
1 Neuroendocrine (Hormones)
2. Neurochemical (NTs)
3. Neuroanatomical (Structures)
What is the endocrine reaction in PTSD?
Dysregulation in glucocorticoid signaling
In PTSD what is the effect ‘from normal’ of the CRH and cortisol level?
CRH increases, but cortisol is reduced.
Given the HPA axis, how can an increase of CRH AND decrease of cortisol happen?
The Anterior Pituitary will decrease the CRH receptors when CRH is too high which in turn results in less ACTH then less cortisol
Define Hypocortisolaemia and what could it predict
Low cortisol levels perhaps due to a dysfunction in the adrenal glands or simply not being stressed.
If this is found at time of trauma exposure it may predict PTSD.
What is one preventative measure to PTSD?
a high dose of hydrocortisone IV within 24 hours of trauma
What two parts of the PFC are involved in PTSD?
Medial PFC (mPFC) and the Anterior Cingulate Cortex (ACC)
What happens to the mPFC and ACC in PTSD?
They both reduce in volume which correlates with the increase in amygdala activity
What do the mPFC and ACC help mediate?
They both mediate fear extinction
What 4 things happen when PFC activity is reduced (and hypersensitive amygdala)?
- Hypervigilance
- Intrusion symptoms
- Avoidance of stimuli associated with trauma
- Cognitive Symptoms
What is fear conditioning?
fear conditioning is when the circuit occurs so dramatically it cements this circuit into place
How do you ‘forget’ a fear?
You do not forget fear you can just learn that the fearful thing is not fearful. This occurs in the 3 synaptic system of the amygdala take over the fear from the 2 synaptic system
How does the 3 synaptic circuitry in the amygdala stop the 2 synaptic circuitry?
The 3 synaptic circuitry release GABA which inhibits the 2 synaptic circuitry neurons from firing
NE Neurons originate where?
Locus coeruleus of the brainstem
What happens in to the amygdala if NE is blocked from the 2-synapse circuit immediately after trauma?
The fear response/conditioning does not become permanent since the NE does not activate and solidify the 2-synapse circuit.
Define unconditioned stimulus and unconditioned response
A stimulus that invokes a fear response for the stimulus itself. (Electric shock causes fear)
Defined conditioned stimulus and conditioned response.
A stimulus that has become associated with the original unconditioned stimulus that originally caused the fear now causing it without the unconditioned stimulus. (A noise is played at the same time as a shock, the noise now causes fear (as a conditioned response)
How does fear extinction occur?
Recondition the amygdala to realize that the conditioned stimulus is not harmful
What part of the brain “remembers” the context of a event?
The hippocampus (which can in turn relay the info to the amygdala to initiate fear response)
How is the volume of the left hippocampus related to the level of PTSD?
The smaller the left hippocampus volume the higher the level of PTSD
What are the 6 physiological steps of PTSD?
- There is an enhanced NE activity
- Leading to synaptic changes in amygdala leading to the fear response
- The surrounding neutral stimuli becomes associated with the trauma (as triggers)
- The fear response is difficult to turn off due to less hippocampal neuronal input signaling safety
- Circuits become increasingly activated
- A lot of stimuli triggers can result in PTSD
What PTSD symptom is represented within these brain areas?
Altered arousal and reactivity
What PTSD symptom is represented within these brain areas?
Altered Cognition and Mood
What PTSD symptom is represented within these brain areas?
Intrusions
What PTSD symptom is represented within these brain areas?
Avoidance
What is the first line of treatment for PTSD?
SSRI’s
What PTSD Treatment helps with night-time symptoms?
Anti-adrenergic drugs
Name 3 examples of non-pharmacological approaches to PTSD Treatment
- Prolonged Exposure Therapy
- Cognitive Processing Therapy
- Virtual Reality
Why are people with PTSD at increased odds of using cannabis?
PTSD patients have higher number of cannabinoid receptors (CB1 and CB2) and a lower level of endocannabinoid (AEA, 2-AG, etc).
What are the effects on the PTSD symptoms when THC or CBD is used?
THC makes the symptoms worse
CBD reduces the symptoms
