Lectures 82, 83: PTSD and Anxiety Flashcards
Define trauma
Exposure to actual or threatened death, serious injury, or sexual violence in 1+ these ways… 1) direct experiencing the traumatic event; 2) Witnessing the event as it occurred to others; 3) Learning the traumatic event occurred to close family member or friend; 4) Experiencing repeated or extreme exposure to aversive details of the event
Four symptom classes required for PTSD
Intrusion symptoms, avoidance symptoms (+ general numbness), negative alterations in cognitions and mood, alterations in arousal or activity
Negative alterations in cognitions & mood includes what “classic” memory symptom
Not being able to recall important aspect of the trauma
How long must symptoms exist? What is the final criteria for a PTSD diagnosis?
1 month; impaired functioning
How is acute stress disorder different from PTSD? Can it become PTSD?
3 days - 1 month after a trauma; yes
About how common is trauma disorder(%)? About how common is PTSD (lifetime, %)?
~50% for 1 traumatic event; ~10%
What is a significant predictor of a worse outcome for PTSD? Describe
Childhood trauma; early trauma –> dysrupted limbic-HPA axis –> negative impact on development –> lifelong psych/behavioral, etc problems
What can keep a traumatized kid from developing LT psych/non-psych consequences?
Lifestyle factors: access to care, community support, etc.
Is PTSD the only disorder related to tramau exposure?
Nope: lots of psych problems are correlated
Risk factors for PTSD (3)
- Amount of trauma; 2. Type of trauma (rape is very high); 3. Lack of preparedness
Describe an example of differential trauma responses b/t women and men
Women are more likely to experience PTSD after threat/physical attack
T/F: Is it possible for a person to develop PTSD from stressors w/in range of usual human experiences?
Yes
Women/men more at risk for PTSD?
Women
One pathophysiological model of PTSD describes it as…How is this related to the stress response? Findings in ER?
A failure to recover; fundamentally different stress response to trauma that can be distinguished early; elevated HR in those who develop PTSD
What NT system is implicated in PTSD?
Noradrenergic: hyperactive sympathetic system
What evidence exists demonstrating abnormal noradrenergic system in PTSD? Test?
Increased plasma levels and urinary excretion of NE, elevated HR, BP; alpha-2 receptor antagonist –> flashbacks due to increased NE
What are a medication class effective at treating PTSD? Therefore…
SSRIs; serotonin likely involved in PTSD
What happens if you give dexamethasone to PTSD pt?
Hyper suppression of HPA axis due to excessive sensitivity of glucocorticoid receptors
PTSD patients have higher/lower cortisol levels. Comparison to MDD?
Lower; higher levels in MDD
If you have low cortisol you cannot…How could this effect memory? The final step in this pathway would be?
Shutdown fight/flight response (increased NE); “overconsolidation” of memories of distress –> state of perpetual fear
Research examining what related to the HPA axis?
Giving steroids (cortisol) at the time of trauma
Describe the cognitive model of PTSD and what are some negative ways of thinking?
People respond to traumatic events based on their interpretation; perceived controllability, feelings of shame/guilt, feeling that it could have been prevented
How do we treat PTSD
Medications (SSRIs and adrenergic blockers) and psychotherapy (CBTs: exposure therapy, relaxation techniques, stress management)
What is an important part of psychotherapy for PTSD?
Education!
Anxiety disorders (general def, and prevalence [gender, %])
Excessive, severe, prolonged anxiety that compromises functioning; females > males; about ~30%
Anxiety disorders share these features…(2 categories)
Subjective features: apprehension, worry, fear, hypervigilance; Physiological symptoms: tension, fatigue, GI, hyperventilation, palpitations
Physiological symptoms of anxiety often lead to…
Presentation in medical settings
Panic disorder (two major criteria). Can or cannot have what associated symptom?
Recurrent unexpected panic attacks and anticipatory anxiety (> 1 month); agoraphobia
Describe a panic attack
Abrupt onset of fear (5 - 30 min), out of the blue, physical symptoms, emotional symptoms (fear of dying/losing control)
Cardinal symptom of panic attacks
Hyperventilation
Agoraphobia (def)
Fear/avoidance of situations from which escape might be difficult
Is panic disorder common?
Fairly: ~5%
The first panic attack might be…the subsequent ones are?
Triggered; “out of the blue”
There is a strong association b/t panic disorder and…
Suicide
Generalized Anxiety Disorder (def)
Excessive anxiety and worry, most days, for > 6 months that cannot be controlled with some other symptoms (mostly physical/mental), impairs function
GAD tends to be.. (course of illness) and strongly co-morbid with what other anxiety disorder?
Chronic: once a worrier, always a worrier; panic disorder
Social Phobia (def)
Fear of 1 or more social/performance situation
Basis of fear in social phobia (two examples)…
Humiliation/embarrassment
T/F: Gender difference in social phobia
False: men and women get it the same amount
When does social phobia generally hit?
Late childhood/early adolescence
What is the course of social phobia
Chronic
How disabling is social phobia?
Depends on how many social fears someone has
What are the cognitive-behavioral theories of anxiety? (3)
Learned response from parental behavior; classical conditioning; faulty (catastrophic) thinking patterns –> maladaptive behaviors
Cognitive theory about panic disorder
Somatic sensation –> catastrophic thought about meaning –> autonomic arousal (cycle) –> PANIC
Describe fear network’s role in anxiety disorders
“Short route” of senosry thalamus to amygdala that does NOT involve inhibitory control of frontal regions sends; amygdala signals to lower brain regions that causes physiological changes (e.g. hypothalamus –> sympa NS and cortisol)
A person with anxiety might do what with sensory information?
Misperceive it! –> arousal
Serotonergic dysfunction in panic disorder based mostly on the fact that…Might also be related to these sites of inhibition?
SSRIs treat panic disorder; 5-HT inhibits response at PAG, LC, and hypothalamus
Describe noradrenergic dysregulation in panic disorder
Panic disorder associated with increased activity and sensitivity of noradrenergic system
GABA’s relationship to anxiety
Lower GABA levels/lower number of GABA receptors possible
T/F: Environmental contribution is more significant for anxiety disorders than others
True
What heritable trait is related to anxiety disorders?
Behavioral inhibition
What kids of environmental contributions are related to the development of anxiety disorders?
Disruptions of early attachment and childhood trauma
Three classes of pharm treatment for anxiety
Antidepressants, benzos (short-term while SSRIs kick in), anticonvulsants
What type of therapy is very effective for anxiety disorders? How might it work?
CBT; increases frontal inhibition over amygdala
