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Brain and Behavior > Lectures 82, 83: PTSD and Anxiety > Flashcards

Lectures 82, 83: PTSD and Anxiety Flashcards

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1
Q

Define trauma

A

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

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2
Q

Four symptom classes required for PTSD

A

Intrusion symptoms, avoidance symptoms (+ general numbness), negative alterations in cognitions and mood, alterations in arousal or activity

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3
Q

Negative alterations in cognitions & mood includes what “classic” memory symptom

A

Not being able to recall important aspect of the trauma

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4
Q

How long must symptoms exist? What is the final criteria for a PTSD diagnosis?

A

1 month; impaired functioning

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5
Q

How is acute stress disorder different from PTSD? Can it become PTSD?

A

3 days - 1 month after a trauma; yes

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6
Q

About how common is trauma disorder(%)? About how common is PTSD (lifetime, %)?

A

~50% for 1 traumatic event; ~10%

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7
Q

What is a significant predictor of a worse outcome for PTSD? Describe

A

Childhood trauma; early trauma –> dysrupted limbic-HPA axis –> negative impact on development –> lifelong psych/behavioral, etc problems

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8
Q

What can keep a traumatized kid from developing LT psych/non-psych consequences?

A

Lifestyle factors: access to care, community support, etc.

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9
Q

Is PTSD the only disorder related to tramau exposure?

A

Nope: lots of psych problems are correlated

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10
Q

Risk factors for PTSD (3)

A
  1. Amount of trauma; 2. Type of trauma (rape is very high); 3. Lack of preparedness
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11
Q

Describe an example of differential trauma responses b/t women and men

A

Women are more likely to experience PTSD after threat/physical attack

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12
Q

T/F: Is it possible for a person to develop PTSD from stressors w/in range of usual human experiences?

A

Yes

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13
Q

Women/men more at risk for PTSD?

A

Women

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14
Q

One pathophysiological model of PTSD describes it as…How is this related to the stress response? Findings in ER?

A

A failure to recover; fundamentally different stress response to trauma that can be distinguished early; elevated HR in those who develop PTSD

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15
Q

What NT system is implicated in PTSD?

A

Noradrenergic: hyperactive sympathetic system

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16
Q

What evidence exists demonstrating abnormal noradrenergic system in PTSD? Test?

A

Increased plasma levels and urinary excretion of NE, elevated HR, BP; alpha-2 receptor antagonist –> flashbacks due to increased NE

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17
Q

What are a medication class effective at treating PTSD? Therefore…

A

SSRIs; serotonin likely involved in PTSD

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18
Q

What happens if you give dexamethasone to PTSD pt?

A

Hyper suppression of HPA axis due to excessive sensitivity of glucocorticoid receptors

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19
Q

PTSD patients have higher/lower cortisol levels. Comparison to MDD?

A

Lower; higher levels in MDD

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20
Q

If you have low cortisol you cannot…How could this effect memory? The final step in this pathway would be?

A

Shutdown fight/flight response (increased NE); “overconsolidation” of memories of distress –> state of perpetual fear

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21
Q

Research examining what related to the HPA axis?

A

Giving steroids (cortisol) at the time of trauma

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22
Q

Describe the cognitive model of PTSD and what are some negative ways of thinking?

A

People respond to traumatic events based on their interpretation; perceived controllability, feelings of shame/guilt, feeling that it could have been prevented

23
Q

How do we treat PTSD

A

Medications (SSRIs and adrenergic blockers) and psychotherapy (CBTs: exposure therapy, relaxation techniques, stress management)

24
Q

What is an important part of psychotherapy for PTSD?

A

Education!

25
Q

Anxiety disorders (general def, and prevalence [gender, %])

A

Excessive, severe, prolonged anxiety that compromises functioning; females > males; about ~30%

26
Q

Anxiety disorders share these features…(2 categories)

A

Subjective features: apprehension, worry, fear, hypervigilance; Physiological symptoms: tension, fatigue, GI, hyperventilation, palpitations

27
Q

Physiological symptoms of anxiety often lead to…

A

Presentation in medical settings

28
Q

Panic disorder (two major criteria). Can or cannot have what associated symptom?

A

Recurrent unexpected panic attacks and anticipatory anxiety (> 1 month); agoraphobia

29
Q

Describe a panic attack

A

Abrupt onset of fear (5 - 30 min), out of the blue, physical symptoms, emotional symptoms (fear of dying/losing control)

30
Q

Cardinal symptom of panic attacks

A

Hyperventilation

31
Q

Agoraphobia (def)

A

Fear/avoidance of situations from which escape might be difficult

32
Q

Is panic disorder common?

A

Fairly: ~5%

33
Q

The first panic attack might be…the subsequent ones are?

A

Triggered; “out of the blue”

34
Q

There is a strong association b/t panic disorder and…

A

Suicide

35
Q

Generalized Anxiety Disorder (def)

A

Excessive anxiety and worry, most days, for > 6 months that cannot be controlled with some other symptoms (mostly physical/mental), impairs function

36
Q

GAD tends to be.. (course of illness) and strongly co-morbid with what other anxiety disorder?

A

Chronic: once a worrier, always a worrier; panic disorder

37
Q

Social Phobia (def)

A

Fear of 1 or more social/performance situation

38
Q

Basis of fear in social phobia (two examples)…

A

Humiliation/embarrassment

39
Q

T/F: Gender difference in social phobia

A

False: men and women get it the same amount

40
Q

When does social phobia generally hit?

A

Late childhood/early adolescence

41
Q

What is the course of social phobia

A

Chronic

42
Q

How disabling is social phobia?

A

Depends on how many social fears someone has

43
Q

What are the cognitive-behavioral theories of anxiety? (3)

A

Learned response from parental behavior; classical conditioning; faulty (catastrophic) thinking patterns –> maladaptive behaviors

44
Q

Cognitive theory about panic disorder

A

Somatic sensation –> catastrophic thought about meaning –> autonomic arousal (cycle) –> PANIC

45
Q

Describe fear network’s role in anxiety disorders

A

“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)

46
Q

A person with anxiety might do what with sensory information?

A

Misperceive it! –> arousal

47
Q

Serotonergic dysfunction in panic disorder based mostly on the fact that…Might also be related to these sites of inhibition?

A

SSRIs treat panic disorder; 5-HT inhibits response at PAG, LC, and hypothalamus

48
Q

Describe noradrenergic dysregulation in panic disorder

A

Panic disorder associated with increased activity and sensitivity of noradrenergic system

49
Q

GABA’s relationship to anxiety

A

Lower GABA levels/lower number of GABA receptors possible

50
Q

T/F: Environmental contribution is more significant for anxiety disorders than others

A

True

51
Q

What heritable trait is related to anxiety disorders?

A

Behavioral inhibition

52
Q

What kids of environmental contributions are related to the development of anxiety disorders?

A

Disruptions of early attachment and childhood trauma

53
Q

Three classes of pharm treatment for anxiety

A

Antidepressants, benzos (short-term while SSRIs kick in), anticonvulsants

54
Q

What type of therapy is very effective for anxiety disorders? How might it work?

A

CBT; increases frontal inhibition over amygdala

Brain and Behavior (56 decks)

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