Lecture 3 - Psychological Effects Of Trauma

Question 1

Fear

Answer 1

• basic emotion accompanying stress

- powerful behavioral motivator

Question 2

Trauma and mamory (charcot)

Answer 2

• parasites of the mind

- memory of trauma not incorporated into memory as part of personal experience

Question 3

Freud: anxiety as a danger signal

Answer 3

• 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)

Question 4

Neurosis

Answer 4

• 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

Question 5

Psychotraumatized persons

Answer 5

• develop defense mechanisms to protect themselves from the intrusive elemets related to trauma

Question 6

Preva;emce

Answer 6

• exposure to traumatic event: 40-80%
• lifetime prevalence of PTSD: 7.8%
• Australian 12-months prevalence of PTSD: 6.4%

Question 7

Criterion A for PTSD - Traumatic event

Answer 7

• 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

Question 8

Criterion B: Intrusion or re-experiencing

Answer 8

• 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

Question 9

Criterion C - Avoidant symptoms

Answer 9

• avoinding thoughts or feelings connected to the traumatic event
• avoiding people or situations connected to the traumatic event

Question 10

Criterion D: Negative alterations in mood or cognitions

Answer 10

• 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

Question 11

Criterion E: increased arousal symptoms

Answer 11

• 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

Question 12

Duration

Answer 12

• 1 months +
• functional impairment significant
• Acute: duration of symptoms is

Question 13

Compulsive exposure

Answer 13

• aim is to obtain the control over traumatic experiences
  1) Abuse of others
  2) Self-destructiveness
  3) Revictimization

Question 14

Diagnostic categories

Answer 14

• ASD
• PTSD
• Adjustment disorder
• Bereavement
• Enduring personality change after catastrophic experience

Question 15

Additional categories

Answer 15

• combat and operational stress reaction
• compassion fatigue
• DESNOS:
• complex PTSD
• Stockholm syndrome
• Lyma syndrome
• PTSD with secondary psychotic feature

Question 16

DESNOS

Answer 16

• lasting changes in identity, interpersonal relationships, sense of life’s meaning

Question 17

Complex PTSD

Answer 17

• prolonged repeated trauma
• somatisation, dissociation, affect deregulation, poor impulse control, self-destructive behavior, pathological pattern of relationships

Question 18

Stockholm syndrome

Answer 18

• form of traumatic bonding
• strong emotional ties that develop between two persons where one person intermittently harrasses beats, threatens, abuses or intimidates other

Question 19

Lyma syndrome

Answer 19

• reverse stockholm syndrome

Question 20

PTSD with secondary psychotic features

Answer 20

• hallucinations and delusions are not confined to episodes of re-experiencing - they are pervasive, but content are traumatic event specific

Question 21

Diagnostic criteria for ASD

Answer 21

• 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

Question 22

How predictive of PTSD is ASD

Answer 22

• 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

Question 23

Comorbidity

Answer 23

• 2/3 at least another disorder

- depressive disorder, anxiety, OCD, BD, suicide

Question 24

Enduring personality change after catastrophic experience

Answer 24

• 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

Question 25

Biology of stress related disorder

Answer 25

• 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

Question 26

Suite

Answer 26

• 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

Question 27

PTSD: neuroendocrine characteristics

Answer 27

• 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

Question 28

Treatment: pharmacoherapy

Answer 28

• 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

Question 29

Psychotherapy

Answer 29

• no debriefing
• practical assistance
• social support
• CBT: psycho education/ imagined exposure/ writing trauma narrative/ in vivo exposure

Question 30

Cognitive processing therapy for PTSD

Answer 30

• breack the stuck points

- break vvicious ccyle of thoughts

Question 31

Cognitive restructuring

Answer 31

• 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

Question 32

Systemic desensitization

Answer 32

• in vitro/vivo
• behavioral analysis
• relaxation techniques
• fears hierarchy
• sessions of systematic desensitization