Clinical Approach to Trauma and Stress Disorders Flashcards
What is posttraumatic stress disorder?
- Person exposed to a traumatic event in which both were present:
1. Person experienced/witnessed actual or threatened death/injury/integrity of self or others - Persistently re-experience traumatic event
- Persistent avoidance of stimuli associated with trauma
- Persistent symptoms of increased arousal such as difficulty sleeping, irritability, difficulty concentrating, hypervigilance
What are some negative cognitions with posttraumatic stress disorder?
- Persistent and distorted sense of blame of self or others
- Estrangement from others
- Markedly diminished interest in activities
- Inability to remember key aspects of the event
How long is the duration of disturbance and symptoms in PTSD?
- More than 1 month
- will have clinically significant distress and impairs function
What are some neurobiological abnormalities seen in PTSD?
- HPA axis (hyperactive or increased autonomic nervous system response)
- Brain imaging (amygdala, prefrontal cortex, hippocampus)
- Neurotransmitters (NE, Dopamine, and endogenous opioids)
What are some treatment options for PTSD?
- SSRIs
- Cognitive processing therapy (support groups and EMDR)
- Increased risk of substance abuse (avoid addictive Rx such as benzodiazepines
What is acute stress disorder?
- Symptoms similar to PTSD
- Duration is different (3 days to 1 month after trauma exposure)
What are adjustment disorders?
- Development of emotional/behavioral symptoms in response to identifiable stressor; occurring within 3 months of stressor
- Not normal grief or bereavement
What do adjustment disorders result in?
- One or both:
1. Significant distress out of proportion to severity of stressor
2. Impairment in functioning
How long do adjustment disorders usually last?
- No longer than 6 months
What is seen in adjustment disorders with depressed mood?
- Low mood
- Tearfulness or feelings of hopelessness are predominant
What is seen in adjustment disorders with anxiety?
- Nervousness
- Worry
- Jitteriness
- Separation anxiety is predominant
What is seen in adjustment disorders with mixed anxiety and depressed mood?
- Combination of depression and anxiety is predominant
What is seen in adjustment disorders with disturbance of conduct?
- Disturbance of conduct is predominant
What is seen in adjustment disorders with mixed disturbance of emotions and conduct?
- Both emotional symptoms and a disturbance of conduct are predominant
What are some somatoform disorders?
- Somatic symptom disorder (pain disorder)
- Conversion disorder
- Illness anxiety disorder (hypochondriasis)
- Body dysmorphic disorder
- Somatoform disorder, NOS
What is a part of somatic symptom disorder?
- One or more somatic symptoms that are distressing or result in significant disruption of daily life
- Excessive thoughts, feelings, or behavioral related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms
2. Persistently high level of anxiety about health or symptoms
3. Excessive time and energy devoted to these symptoms or health concerns - Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)
What needs to be specified in somatic symptom disorder?
- With predominant pain
What is the treatment for somatoform disorder?
- Well established therapeutic relationship
- Team approach: pain management, neurology, psychiatry
- Cognitive behavioral therapy
- Hypnosis
- Anti-anxiety medications
What is the diagnostic criteria for conversion disorder?
A. One or more symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or other general medical condition
B. Psychological factors are judged to be associated with the symptom or deficit because the initiation or exacerbation of the symptom or deficit is preceded by conflicts
C. The symptom or deficit is not intentionally produced or feigned
D. Symptom or deficit cannot, after appropriate investigation, be fully explained by a general medical condition, or by the direct effects of a substance, or as culturally sanctioned behavior or experience
E. Symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation
F. Symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder
What are some symptoms of conversion disorder?
- Paresthesias and anesthesias
- Weakness
- Paralysis
- Pseudoseizures/psychogenic seizures
- Involuntary movements
- Sensory disturbances (blindness and mutism)
What is illness anxiety disorder?
- Preoccupation with having or acquiring a serious illness
What is the high level anxiety associated with in illness anxiety disorder?
- About health, and the individual is easily alarmed about personal health issues
Are somatic symptoms present in illness anxiety disorder?
- They may or may not be present. If present, they are mild in intensity
- If there is another medical condition is present or there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate
What does the individual do in illness anxiety disorder?
- They perform excessive health related behaviors or exhibits maladaptive avoidance
How long must illness preoccupation be present in illness anxiety disorder?
- For at least 6 months
What are the two types of illness anxiety disorder?
- Care seeking type: medical care is frequently used
- Care avoidant type: medical care is rarely used
What is factitious disorder?
- Voluntary control of symptoms
- Self-injected feces or saliva
- Bizarre or unusual symptoms
What are some factitious disorders?
- Munchausen’s
- Munchausen’s by proxy (the movie “the act”)
What is dissociative amnesia?
- Inability to recall important personal information
- Usually information regarding traumatic experience
What is dissociative fugue?
- Sudden, unexpected travel away from home
- Inability to recall one’s past/personal identity
What is dissociative identity disorder?
- Formerly known as “multiple personality disorder”
- Often survivors of sexual abuse
What are some impulse control disorders that are not otherwise classified?
- Intermittent explosive disorder
- Kleptomania
- Pyromania
- Pathological gambling
- Impulse control disorder, NOS
