Lecture 3 - Psychological Effects Of Trauma Flashcards
1
Q
Fear
A
- basic emotion accompanying stress
- powerful behavioral motivator
2
Q
Trauma and mamory (charcot)
A
- parasites of the mind
- memory of trauma not incorporated into memory as part of personal experience
3
Q
Freud: anxiety as a danger signal
A
- External threats: objective anxiety or fear. Uncomfortable emotional state in the case of threat anticipation. Intensity is proportional to danger
- Own internal drives - unacceptable unconscious wishes and impulses trying to breakthrough into consciousness (neurotics)
4
Q
Neurosis
A
- existence of defense mechanisms that block unacceptable unconscious wishes and impulses. Over time the ego is strengthened, defense mechanisms are fixed and previous conflicts are transformed into stable forms of automatic operation separate from the content of the infantile conflict
5
Q
Psychotraumatized persons
A
- develop defense mechanisms to protect themselves from the intrusive elemets related to trauma
6
Q
Preva;emce
A
- exposure to traumatic event: 40-80%
- lifetime prevalence of PTSD: 7.8%
- Australian 12-months prevalence of PTSD: 6.4%
7
Q
Criterion A for PTSD - Traumatic event
A
- Trauma survivors must have been exposed to actual or threatened death, serious injury or sexual violence
- exposure can be direct, witnessed, indirect
- non-professional esposure by media does NOT count
8
Q
Criterion B: Intrusion or re-experiencing
A
- 1 or more symptoms
- intrusive thourhgts or memories
- Nightmares related to traumatic event
- Flashbacks, feeling like the event is happening again
- Psychological and physical reactivity to reminders of the traumatic event
9
Q
Criterion C - Avoidant symptoms
A
- avoinding thoughts or feelings connected to the traumatic event
- avoiding people or situations connected to the traumatic event
10
Q
Criterion D: Negative alterations in mood or cognitions
A
- a decline in someones mood or thought patterns
- 2 or more
- Memory problems exclusive to the event
- Negative thoughts or beliefs about one’s seld or the world
- distorted sense of blame for one’s self or others, related to the event
- being stuck in severe emotions related to the trauma
- severly reduced interest in pre-trauma activities
- feeling detached, isolated or disconnected from other people
11
Q
Criterion E: increased arousal symptoms
A
- Increases 2+ arousal symptoms used to describe the ways that the brain remains “on edge”, wary and watchful of further threats
- Difficulty concentrating
- irritability, increased temper or anger
- Difficulty falling or staying asleep
- hypervigilance
- Being easily startled
12
Q
Duration
A
- 1 months +
- functional impairment significant
- Acute: duration of symptoms is
13
Q
Compulsive exposure
A
- aim is to obtain the control over traumatic experiences
1) Abuse of others
2) Self-destructiveness
3) Revictimization
14
Q
Diagnostic categories
A
- ASD
- PTSD
- Adjustment disorder
- Bereavement
- Enduring personality change after catastrophic experience
15
Q
Additional categories
A
- combat and operational stress reaction
- compassion fatigue
- DESNOS:
- complex PTSD
- Stockholm syndrome
- Lyma syndrome
- PTSD with secondary psychotic feature
16
Q
DESNOS
A
- lasting changes in identity, interpersonal relationships, sense of life’s meaning
17
Q
Complex PTSD
A
- prolonged repeated trauma
- somatisation, dissociation, affect deregulation, poor impulse control, self-destructive behavior, pathological pattern of relationships
18
Q
Stockholm syndrome
A
- form of traumatic bonding
- strong emotional ties that develop between two persons where one person intermittently harrasses beats, threatens, abuses or intimidates other
19
Q
Lyma syndrome
A
- reverse stockholm syndrome
20
Q
PTSD with secondary psychotic features
A
- hallucinations and delusions are not confined to episodes of re-experiencing - they are pervasive, but content are traumatic event specific
21
Q
Diagnostic criteria for ASD
A
- stressor
dissociative symptoms 3+
- subjective sense of numbing, detachment or absence of emotional responsiveness
- reduction in awareness of his/her surroundings
- derealization
- depersonalization
- dissociative amnesia
22
Q
How predictive of PTSD is ASD
A
- 78-83% victims who have ASD met criteria for PTSD at a 6 months follow up
- Sub threshold ASD ( ASD without dissociative symptoms) is also a good predictor of PTSD
23
Q
Comorbidity
A
- 2/3 at least another disorder
- depressive disorder, anxiety, OCD, BD, suicide
24
Q
Enduring personality change after catastrophic experience
A
- present for at least 2 years, following exposire to catastrophic stress
- stress must be so extreme that personal vulnerability is not considered
- hostile or distrustful attitude toward the world, social withdrawal, feelings of emptiness or hopelessness, feeling of being on edge as if constantly threatened
- PTSD may precede personality change disorder
25
Q
Biology of stress related disorder
A
- Exaggerated ANS response - heart rate, BP
- Neuronal changes adversely affect learning, coping and discrimination of stimuli
- limbic hyperactivity, cortical hyporeactivity
- hippocampus, VMPFC and amygdala complete the neural circuitry of stress
- evoked potential
- response is immedite
26
Q
Suite
A
- serotonergic system decreases - modultes noradrenergic responses to stress
- plasma and urine adrenaline and noradrenaline: normal or elevated levels in rest phase, higher rise on reexposure to stress
- no overlap in the altered serotonin or catecholamine system response
- low b-endorphin: trauma addiction
27
Q
PTSD: neuroendocrine characteristics
A
- low cortisol
- high adrenaline, noradrenaline
- loe levels of corticosteroids causes maladaptive behavioral coping styles and makes individuals more prone to develop PTSD
- increased T3 and total T4 but no increase in TSH and free T4
28
Q
Treatment: pharmacoherapy
A
- TCS and MAOI
- SSRI and SNRI
- target: core symptoms, quality of life, comorbidity
- SSRI mixed results about efficacy
- antivonvulsants
- monotherapy with quietiapine
- omega 3 fatty acids
- rTMS
- benziodiazepines, b-blockers
29
Q
Psychotherapy
A
- no debriefing
- practical assistance
- social support
- CBT: psycho education/ imagined exposure/ writing trauma narrative/ in vivo exposure
30
Q
Cognitive processing therapy for PTSD
A
- breack the stuck points
- break vvicious ccyle of thoughts
31
Q
Cognitive restructuring
A
- trauma itself
- predictability of trauma
- causes leading to the traumatic event
- possibility to change the course of events
- personal responsibility
- system of values, attitude to life
- self esteem and self evaluation
- life after trauma
32
Q
Systemic desensitization
A
- in vitro/vivo
- behavioral analysis
- relaxation techniques
- fears hierarchy
- sessions of systematic desensitization
