Post-Traumatic Stress Disorder Flashcards
Learn about current diagnostic classification of PTSD Understand the complex relationship between psychological trauma and mental health, including complex PTSD Learn about management and treatment options for PTSD, and its prognosis
Name the 3 main symptom clusters of PTSD
Re-experiencing, hyperarousal, avoidance
State some PTSD symptoms in the hyperarousal cluster
Difficulty falling asleep, irritability, angry outbursts, difficulty concentrating, exaggerated startle response
State some PTSD symptoms in the avoidance cluster
Avoiding thoughts and feelings associated with the trauma; avoiding activities, places, and people which produce recollection of the trauma; feeling detached from others; reduced interest and participation in activities
Describe the difference between type I and type II trauma
Type I is a single traumatic event, whereas type II is prolonged and repeated trauma
What percentage of PTSD susceptibility is heritable? (Goldberg et al, 1990)
30%
State some brain changes associated with PTSD susceptibility
Impaired HPA axis sensitivity and reduced hippocampal volume
What is the lifetime prevalence of PTSD in the general population? (Kessler et al, 1995)
8%
State some differential diagnoses for PTSD
Depression, borderline personality disorder, substance abuse
State the most common comorbidities of PTSD
Alcohol misuse, drug misuse, major depressive disorder, stomach ulcers
What is the first-line treatment for severe PTSD?
Pharmacotherapy - SSRIs, mirtazapine, or antipsychotics (olanzapine)
Name some psychological interventions for PTSD
Trauma-focused CBT, eye movement desensitisation and reprocessing (EMDR)
Describe the evidence for single session debriefing after a traumatic event
There is no evidence of benefit and it may even be harmful
What percentage of patients no longer meet the diagnostic criteria for PTSD after psychotherapy?
56%
Describe the main features of ‘enduring personality change after catastrophic experience’ (EPCACE) in ICD-10
Permanent hostile and distrustful attitude, social withdrawal, constant feelings of emptiness or hopelessness, feeling on-edge or threatened, permanent feeling of being changed, feeling different to others
According to Munjiza et al’s 2017 case-control study, what percentage of patients with personality change meet criteria for EPCACE?
35.7%
What were the problems with the EPCACE diagnosis? (Munijza et al, 2019)
More than 50% of patients who met the diagnostic criteria described symptoms not included in the ICD-10 criteria, including frequent mood changes, anger control problems, persistent feelings of eccentricity, over-sensitivity to criticism, loss of libido, perfectionsism, and suicidal ideation or self-harm
Define complex PTSD, as introduced in ICD-11
Meeting the criteria for PTSD, with the addition of severe and persistent problems with affect regulation, feelings of worthlessness, shame, and guilt, and difficulties with sustaining relationships
State some problems with the ICD-11 criteria for complex PTSD
Significant overlap with personality disorder (diagnostic confusion), significant overlap with personality disorder risk factors, stigma attached to personality disorder leading to preference for complex PTSD, treatment for personality disorder and PTSD being very different (unclear which would be more efficacious)