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Adult psychiatry 2 > Post-traumatic stress disorder > Flashcards

Post-traumatic stress disorder Flashcards

1
Q

DSM-5

A
  • now in a new class of ‘trauma and stressor related disorders’ rather than anxiety disorders
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2
Q

PTSD

A

-a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of the 4 symptoms clusters:
1/ intrusion
2. avoidance
3. negative alterations in cognitions and mood (includes self-blame and blame of others)
4. alterations in arousal and reactivity (includes reckless and destructive behaviour)

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3
Q

Point prevalence

A

1%

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4
Q

Lifetime prevalence

A
  1. 8%

- in men 3.6%, in women 9.7%

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5
Q

Exposure to traumatic events

A
  • Males are more likely to be exposed to traumatic events (60%vs 50%)
  • but females develop PTSD 2x more frequently
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6
Q

Trauma and PTSD

A

-up to 30% of people exposed to trauma may develop PTSD

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7
Q

Most common traumas

A
  • witnessing someone being badly injured or killed
  • exposure to fire, flood or natural disaster
  • molestation and mugging are more common in females- more likely to develop PTSD
  • men develop more PTSD after rape
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8
Q

Age

A

-PTSD is more common in younger than older individuals

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9
Q

Pretraumatic factors in PTSD

A
  • previous psychiatric disorder
  • female
  • personality (external locus of control is greater than internal locus of control)
  • lower socioeconomic and educational status
  • ethnic minority status
  • personality disorder (Cluster B)
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10
Q

Peritraumatic factors

A
  • perceived threat to life
  • high severity of trauma
  • pertitraumatic dissociation
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11
Q

Post-traumatic factors

A
  • perceived lack of social support
  • subsequent life stress
  • physical illness
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12
Q

Protective factors

A
  • high IQ
  • higher social class
  • getting an opportunity to grieve for the loss
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13
Q

Neuroimaging

A

-hippocampus and amygdala show neuroimaging abnormalities

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14
Q

Cortisol

A

-high in PTSD

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15
Q

Beneficial interventions

A

-multiple session CBT to prevent PTSD in people with acute stress disorder

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16
Q

Initial management in primary care

A
  • watchful waiting in mild symptoms present for less than 4 weeks
  • non-benzo sleeping tablet after 4 consecutive nights sleep disturbance is recommended
17
Q

Psychological treatment

A
  • regular, weekly and single person

- trauma focused CBT should be offered in first month in severe PTSD or PTSD within 3 months of the event

18
Q

If symptoms present for more than 3 months after trauma

A
  • trauma focused CBT or eye movement desensitization and reprocessing (EMDR)
  • if no improvement then paroxetine, mirtazapine, amitriptyline or phenelzine
19
Q

Paroxetine

A
  • good RCT evidence
  • NICE second line
  • licensed for PTSD
20
Q

Sertraline

A
  • RCT evidence but NICE not approved

- licensed for females but not males in UK

21
Q

Fluoxetine

A

1 RCT

Not significant

22
Q

Imiprazmine and Amitriptyline

A

-poor quality of evidence but statistically significant

23
Q

Phenelzine

A

poor quality of evidence but statistically significant

24
Q

Mirtazapine

A
  • one small strongly positive RCT

- NICE second line

25
Q

Venlafaxine

A

-one large RCT but no benefit

26
Q

Olanzapine

A

-no good for monotherapy but good for augmentation of SSRIs

27
Q

Risperidone

A

Tested only as an adjunct-no effect

28
Q

Trauma focused CBT

A
  • similar efficacy to EMDR
  • uses exposure therapy and cognitions
  • 8-12 sessions
29
Q

Eye Movement desensitisation and reprocessing

A
  • discovered by a psychologist accidentally (Shapiro)
  • bilateral stimulation in the form of eye movements allows the processing of traumatic memories
  • individual focuses on specific images, negative sensations and associated cognitons and bilateral stimulation is applied
  • 50% remission at 2 years
30
Q

Acute stress disorder

A
  • must be an immediate and clear temporal connection between the impact of an exceptional stressor and the onset of symptoms
  • symptoms usually appear within minutes of the impact of the event and disappear within 2-3 days
  • partial or complete amnesia for the episode may be present
31
Q

Symptoms of acute stress disorder

A
  • mixed and usually changing picture

- resolves rapidly

Adult psychiatry 2 (8 decks)

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