Post Traumatic Stress Disorder (PTSD) Flashcards
Define post-traumatic stress disorder (PTSD)
Briefly describe ‘acute stress reaction’
Exposure to an exceptional physical or mental stressor (e.g. physical assault, road traffic accident) followed by an immediate onset of symptoms (within one hour).
Divided into mild, moderate or severe based on extent of symptoms.
Possible symptoms include anxiety symptoms, narrowing of attention, apparent disorientation, anger or verbal aggression, despair or hopelessness, uncontrollable or excessive grief.
Symptoms must begin to diminish within 8 hours (for transient stressors) or 48 hours (for continued stressors).
Briefly describe ‘adjustment disorder’
Identifiable (non-catastrophic ) psychosocial stressor (e.g. redundancy, divorce) within one month of onset of symptoms.
Symptoms are variable but can be of the types found in the affective disorders or the neurotic disorders (but not severe enough to be classed as a specific psychiatric disorder).
The symptoms must be present for less than 6 months .
Briefly describe ‘abnormal bereavement’
Normal bereavement goes through a number of stages in response to loss of a loved one.
Abnormal bereavement has a delayed onset , is more intense and prolonged ( >6 months ).
The impact of their loss overwhelms the individual’s coping capacity.
Briefly describe the aetiology of PTSD
The most important component of aetiology is an exceptionally stressful event in which the individual was involved directly or as a witness.
Not all individuals who experience the same traumatic experience go on to develop PTSD, thus suggesting a pre-existing vulnerability. Twin studies of Vietnam War veterans suggest that part of the vulnerability may be genetic.
Cognitive theories suggest that failure to process emotionally charged events causes memories to persist in an unprocessed form which can intrude into conscious awareness.
Give examples of traumatic events
- Severe assault (e.g. physical or sexual abuse, robbery, mugging)
- Major natural disaster (e.g. earthquakes, floods)
- Serious road traffic accident
- Observer/survivor of civilian disaster (e.g. acts of terrorism, the Holocaust)
- Involvement in wars (e.g. World War II, Vietnam War)
- Freak occurrences (e.g. near drowning when on holiday)
- Physical torture
- Prisoner of war or hostage situation
- Hearing about unexpected injury or violent death of a family member or friend
In the UK, what % of the population have PTSD?
Approximately 3% of adults in England suffer from PTSD.
What % of individuals who suffer a traumatic event go on to develop PTSD?
25– 30% of individuals experiencing a traumatic event may go on to develop PTSD.
What is the male to female ratio of PTSD?
It can affect people of all ages, but is more common in ♀ (♀:♂ratio is 2:1).
What are the risk factors for PTSD?
- Exposure to a major event
- Professions at risk (armed forces, police, fire services, journalists, traumatic event doctors) and groups at risk (refugees, asylum seekers)
- Pre-trauma
- Previous trauma, history of mental illness, females, low socio economic background and childhood abuse
- Peri-trauma
- Severity of trauma, perceived threat to life, adverse emotional reaction during or immediately after event.
- Post-trauma
- Concurrent life stressors and absence of social support
What are the clinical features of PTSD?
PTSD symptoms must occur within 6 months of the event and can be divided into four categories:
- Reliving the situation (persistent, intrusive, involuntary): Flashbacks, vivid memories, nightmares, distress when exposed to similar circumstances as the stressor.
- Avoidance: Avoiding reminders of trauma (e.g. associated people or locations), excessive rumination about the trauma, inability to recall aspects of the trauma.
- Hyperarousal: Irritability or outbursts, difficulty with concentration, difficulty with sleep, hypervigilance, exaggerated startle response.
- Emotional numbing: Negative thoughts about oneself, difficulty experiencing emotions, feeling of detachment from others, giving up previously enjoyed activities.
Briefly describe the ICD-10 Classification of PTSD
A. Exposure to a stressful event or situation of extremely threatening or catastrophic nature (would likely cause distress in almost anyone).
B. Persistent remembering (‘reliving’) of the stressful situation.
C. Actual or preferred avoidance of similar situations resembling or associated with the stressor.
D. Either (1) or (2)
- Inability to recall some important aspects of the period of exposure to the stressor.
- Persistent symptoms of increased psychological sensitivity and arousal.
E. Criteria B, C & D all occur within 6 months of the stressful event, or the end of a period of stress.
Briefly describe the MSE for PTSD
Appearance and behaviour: hypervigilance (‘on edge’), exaggerated startle reaction, may have features of anxiety or depression, e.g. poor eye contact.
Speech: slow rate, trembling and non-spontaneous.
Mood: anxious.
Thought: pessimistic and reliving or remembering of the event.
Perception: no hallucinations but may have illusions.
Cognition: poor attention and concentration.
Insight: good.
What are the investigations for PSTD?
Questionnaires: Trauma Screening Questionnaire (TSQ), Post-traumatic diagnostic scale.
CT head: if head injury suspected.
Briefly describe the Kübler– Ross stages of grief
Denial: temporary denial of reality as emotionally overwhelmed.
Anger: intense emotions expressed as anger.
Bargaining: negotiating a compromise in order to reduce grief.
Depression: depressed mood.
Acceptance: acceptance and reorganisation of life.
