Post-Traumatic Stress Disorder (PTSD)

Question 1

______ is “the complex somatic, cognitive, affective, and behavioral effects of psychological trauma”

Answer 1

PTSD

Question 2

Types of Trauma for PTSD

Answer 2

(1) Sexual Trauma
(2) Trauma to someone in close interpersonal network
(3) Interpersonal violence
(4) Participation in organized violence
(5) Other types of violent events such as (MVA) or Natural disasters

Question 3

What are some specific considerations regarding armed conflict for PTSD?

Answer 3

Correlation seen with presence of and extent of injuries, such as TBI

Question 4

Specific considerations regarding armed conflict and combat
(1) Correlation seen with presence of and extent of injuries
–(a) Strong correlation with ____
(2) Develops over _____ length of time:
–(a) One study of hospitalized soldiers showed increased prevalence of 4.2% at one month versus 12.2% at 4 months of exposure
(3) Another study of US 1,648 US Marines showed that experiencing a TBI during deployment was a strong predictor of _______

Answer 4

(a) TBI
2) Several Months
3) PTSD symptom development

Question 5

Pathophysiology of PTSD development is unknown
(1) Studies using MRI have shown decreased volume in several areas of the brain
–(a) __________ (fear center)
–(b) __________ (memories)
–(c) __________ cortex
(2) Other reported findings in studies include increased central _________ levels

Answer 5

a) Left amygdala
b) Hippocampus
c) Anterior cingulate
2) norepinephrine

Question 6

Clinical Manifestations of what disorder?
(1) Some response to trauma is considered to be normal but in patients with this issue the symptoms go beyond the realm of normal with multiple impairments:
-(a) Affective dysregulation (anger common)
-(b) Cognitive impairment
-(c) Several behavior responses in response to regular stimuli:
–1) Flashbacks
–2) Severe anxiety symptoms
–3) Fleeing
–4) Combative behaviors
(2) These symptoms lead to compensatory behaviors by the individual
-(a) We call this an avoidance of triggering experiences
–1) Avoidance leads to furthering of symptoms such as emotional

Answer 6

Post-Traumatic Stress Disorder (PTSD)

Question 7

Common screening questions employed by primary care providers for PTSD include…..

Answer 7

(a) How do you feel when you recall the event?
(b) Do you experience dreams or flashbacks about it?
(c) Do you find yourself avoiding people or activities you associate with the event?
(d) Do you find yourself forgetting things from that period?
(e) Do you find yourself carefully looking around when you are in a public place?
(f) Do you have nightmares about the event?
(g) Do you try hard to not think about the event?
(h) Do you ever feel numb or detached from people around you?
(i) Do you feel guilty or unable to stop blaming yourself or others about the event?

Question 8

What is the focus of the Independent Duty Corpsman is screening for PTSD?

Answer 8

Symptoms must be present for at least four weeks following trauma for psychiatry to make the diagnosis

Question 9

Treatment for PTSD

Answer 9

1) Therapy and medication are both useful and can be used either alone or in combination
(a) Psychotherapy
(b) Since marital problems and substance abuse are commonly seen with PTSD, consider referral sources for counseling
(d) Medications
–1) Antidepressant medications (SSRIs) are the first line therapy of choice
-2) Other adjuncts may be used based on symptoms
–a) Prazosin for nightmares
–b) Beta blockers for tremors and sympathetic responses
–c) Antipsychotics for comorbid psychosis if needed

Question 10

Medications used in PTSD
1) __________ are the first line therapy of choice
2) Other adjuncts may be used based on symptoms
-a) ______ for nightmares
-b) ______ for tremors and sympathetic responses
-c) ______ for comorbid psychosis if needed

Answer 10

1) Antidepressant medications (SSRIs)
a) Prazosin
b) Beta blockers
c) Antipsychotics

Question 11

When treating PTSD what medication should be avoided due to safety and dependency issues?

Answer 11

benzodiazepines

Question 12

Since marital problems and substance abuse are commonly seen in patients with PTSD should also consider referral sources for _______

Answer 12

counseling

Question 13

Prognosis PTSD
(1) _______ leads to better prognosis
(2) Do not wait to ____
(3) Be aware that the treatment course will likely be long, no quick fixes here

Answer 13

1) Sooner therapy
2) refer

Question 14

Psychotherapy options for PTSD

Answer 14

1) Exposure therapy
2) CBT (Cognitive Behavioral Therapy)
3) EMDR (Eye Movement Desensitization and Reprocessing

Question 15

How does psychotherapy work? What is the goal?

Answer 15

Helps the patient integrate the events in an adaptive way