Post-Traumatic-Stress-Disorder (PTSD) Flashcards
What is the criterion A for PTSD?
Criterion A: Trauma
The person was exposed to (one required)…
…death
…actual or threatened serious injury
…actual or threatened sexual violence
-> direct exposure
-> witnessing in person
-> Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental
-> Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (eg.: first responders, collecting body parts, professionals repeatedly exposed to details of child abuse)
What are examples for traumatic events?
- accidents
- natural disaster
- physical or sexual assault
- witnessing homocide
- sudden death
- human suffering
- exposure to war
- etc.
What are demographic vulnerability factors to develop PTSD?
- females have a higher risk than males
- young people have a higher risk
What is included in the Criterion B for PTSD according to the DSM-V?
Criterion B: Intrusive symptoms
The traumatic event is persistently re-experienced as (one required)…
…recurrent, involuntarily and intrusive memories
…traumatic nightmares
…dissociative reactions (flashbacks) -> can even lead to complete unconsciousness of a situation
…intense or prolonged stress when confronted with trauma reminders (eg.: sounds, smells,…)
…marked physiological reaction due to trauma-related stimuli
What is included in Criterion C for PTSD according to the DSM-V?
Criterion C: Avoidance
avoiding trauma-related stimuli in daily life:
- trauma-related thoughts or feelings
- trauma-related external reminders (eg.: places, conversations, objects, crowded places)
Criterion D for PTSD?
Criterion D: Negative alterations in cognitions and mood
- persistent negative trauma related emtions (eg. fear, horror)
- diminished interest in various activities
- feeling alienated from others (eg.: detachment)
- constricted affect: inability to experience positive emotions
Criterion E for PTSD?
Criterion E: alterations in arousal and reactivity that began or worsened after event
- aggressive behavior
- reckless or self-destructive behavior
- hypervigilance
-exagerated in startle response
- problems in concentration
- sleep disturbances
-
What is the time criterion for PTSD (criterion F)?
at least 1 month
What is the problem about trauma-focused psychotherapy such as EMDR or CBT in veterans with PTSD?
40% of veterans with PTSD tried at least one of the trauma-focus treatments but are still experiencing their symptoms. Thus, they chronically affected by their symptoms.
How do high doses of cortisol impact the brain (rat study)?
Exposing high doses of cortisol to pyramidal cells is leading to necrosis and shrinking of the brain.
Why were neuro studies mostly focused on hippocampal differences?
Previous studies showed that glucocorticoids (eg.: cortisol) has a huge influence on the hippocampus.
What neuroanatomic differences were found in PTSD patients?
- thinner pre-frontal cortex
- smaller hippocampus
What showed the twin-study by Gilbertson et al. (2002)?
The twin-study showed evidence that a smaller hippocampus is a vulnerability factor to develop PTSD. (trait effect)
Is the left or right hippocampus volume more reduced in PTSD patients?
The left hippocampus is often significantly more reduced than the right one.
What was found in the PTSD group that did not recover after treatment compared to the other groups?
- In the PTSD patients that recovered (due to treatment) showed a very similar hippocampal volume as compared to the combat controls (without PTSD)
- BUT: The PTSD group that did not recover (these 40% mentioned before), are the ones who actually have a significantly smaller hippocampal volume
Summarize the findings about hippocampal volume in PTSD patients.
- smaller hippocampal volume is not a result of stress exposure
- a smaller hippocampal volume is not compulsory to develop PTSD
- hippocampal volume does not increase after treatment
=> BUT: patients with a taller hippocampal volume have a better prognosis and (early) recovery from PTSD
What happens in the amygdala when a PTSD patient is exposed to emotional faces, trauma-related smells and sounds, or traumatic words?
The amygdala becomes hyperactive.
Explain and describe the study conducted by van Roij et al. (2014) and its findings.
Participants (HC, PTSD, combat controls) were exposed to emotional processing task with neutral stimuli and trauma-unrelated negative pictures (not war).
-> no difference in amygdala activation was found, thus, it implies that the amygdala becomes only hyperactive in PTSD patients when exposed to trauma-related stimuli
-> BUT: PTSD patients and the combat controls showed increase in the medial superior frontal gyrus (highly relevant for cognitive controls)
-> increased activity in dACC in PTSD participants (this are is important for emotional and cognitive processing) => increased activity in dACC very specific for PTSD compared to other anxiety disorders
After treatment:
- the non-recovered PTSD patients showed pre-and post treatment increased activity in the insula and the dACC (compared to recovered PTSD and HC) -> at least amygdala does decrease (probably also due to habituation to the stimuli)
Summarize the findings of the emotional processing task (Roij et al., 2014).
- Increased amygdala activity occurs only when exposed to trauma-related stimuli
- Dorsal ACC activity may indicate increased attention (bias) for negative stimuli in PTSD compared to other anxiety disorders
- Patients who do not recover after treatment show increased activity in salience network (dACC, insula, amygdala) prior to treatment
- Increased amygdala, dACC and insula activity is predictive of treatment persistence
-> even when controlling for education and PTSD severity
What was found in the PRISMO scan study?
What was found in the PRISMO scan study?
This study assessed soldiers before deployment, 1 month after coming back and 1,5 years later, compared to soldiers who were never deployed.
Results:
- deployed soldiers showed increased amygdala activation at the 1 month follow up -> Amygdala was much more sensitive to negative stimuli compared to HC
- BUT: 1,5 years later normalized the amygdala activity if the soldier that home (in The Netherlands)
What did the longitudinal study (Eckhout et al., 2016) on biomarkers for PTSD find?
Results:
- huge group does not develop PTSD -> resilient (85%)
- some develop quite late symptoms of PTSD (ca. 2years) -> 9%)
- some develop immediately after coming back PTSD and recover (mostly due to treatment) -> 5%
What was found to be predictors for PTSD (Eckhout et al., 2015)
- young age (<21) increased risk for PTSD symptoms 5 years after deployment
- lower ranks increased risk for PTSD symptoms 5 years after deployment
- early life trauma does increase the risk for PTSD at baseline but not at later time points
- Veterans with a more active role during deployment showed a greater increase in PTSD symptoms
What were found to be biomarkers for PTSD?
Individuals with a Higher number of GR prior to deployment are the ones who develop PTSD
-> GR (Glucocorticoid receptors) are receptors that are on the white blood cells
What personality traits are leading to a higher risk of developing PTSD?
Individuals who are…
… more hostile, harm avoiding
… scoring lower on self-directedness
show a higher chance to develop PTSD
How are GR (glucocorticoid receptors associated with the amygdala in individuals?
Individuals with high amount of glucocorticoid receptors showed also an increase in amygdala activity after deployment
What was investigated by ALTO neuroscience (Amit Etkin) regarding EG measures?
He has shown that a small EG measurement (approx. 5-6 min) prior to treatment is sufficient to predict who will benefit from SSRIs, Psychotherapy, or tDCS
