Prevention of PTSD Flashcards
What is the definition of trauma?
Literal: “Wound”
emotional shock following a stressful event or a physical injury, which may lead to long-term neurosis
A deeply distressing or distrubing experience
So not only the traumatic event, but also the aftermath (consequences).
What are the DSM-5 criteria for PTSD?
- traumatic event involves exposure to actual or threatened death, serous injury, or sexual violence
* direct exposure (self, important other)
* indirect exposure (repeated confrontation, witnessing) - re-experiences/intrusive symptoms
- avoidance
- negative alterations in mood and cognition
- alterations in arousal and reactivity
- social/occupational impairment.
Last at least 1 month
Is now categorized as a trauma and stressor related disorder.
What is the prevalence of PTSD between genders? And what kind of trauma are most prevalent for each gender?
There is no gender difference. However, after a traumatic event, there is gender difference: 20% women, 8.5% men. This is influenced by: * type of exposure * biological differences * appraisal / coping * stigma
Men experience more: physical violence, accidents, disasters, combat, rescue
Women experience more: sexual violence, illness that threaten life, loss of a child.
What happens after a threat? And what determines the course of action?
- Biological consequences: fight or flight response.
- Freezing is a possibility as well and is part of dissociation.
- Appraisal of the threat determines the course of action.
- acute stress reactions are normal.
Explain the fight or flight response and the two systems included.
SAM (sympatho-adrenomedullary pathway) * activated within seconds * Stimulates the adrenal glands to produce adrenaline to activate fight or flight reaction.
HPA - hypothalamus-pituitary-adrenal axis)
* activated after minutes
* stimulates production of cortisol to suppress immune system to prolong stress response.
* Sufficient cortisol levels then
provide negative feedback to the
pituitary to decrease cortisol
production and restore balance
What can acute stress reactions be?
- Recurrent images
- urge to avoid reminders
- Heightened emotional state
- numbness
- watchfulness
- irritability
- anger
Body and mind need to recover.
Within first month of trauma. After that month, they will naturally decrease. Not always back to the same extent as before but not high enough for PTSD.
(they are symptoms of PTSD as well, when it lasts over a month.
What are the four trajectories in PTSD?
See slide for picture.
Chronic stays high after trauma, delayed is first low after trauma than rises. Recovery is first high, then lowers. Resilience stays low.
- Chronic ~10-12%
- Delayed ~8% (longer period of low symptomatic/symptom free and then developing disorder at later stage. Diagnosed like rest of ptsd)
- Recovery ~12-20%
- resilience ~60-75%
Is PTSD the only mental disorder that starts after a trauma?
No. Other mental health outcomes are just as prevalent as PTSD after trauma.
Think about anxiety, depression, substance abuse disorders.
What are pretrauma risk factors of PTSD
Pretrauma
- genetic vulnerability
- female sex
- low age
- lower intelligence
- low SES
- prior trauma
- prior psychiatric symptoms
What are universal preventive interventions for universal prevention?
Guidelines for psychological first aid are:
* psycho education
* material and practical support
* emphasis on distraction, relaxation, rest
* involvement of social network.
–> highly early stress symptom group benefited
most.
psychological debriefing (surviver talks about traumatic experience) is not effective, sometimes even harmful.
What are the steps for targeted prevention of PTSD?
- screening for ptsd
* known risk factors
* early symptoms - early intervention
* psychotherapy in within first month
* self-guided e-health
Eg. app SAM for screening (quick en easy, low response and use, might be cost effective)
Other interventions: games, memory training
What falls beneath a dissociative reaction?
- Normal integrated functions of consciousness, memory, identity and perception are disrupted;
- Fragmentation or disconnection of the emotional content and memory of the trauma;
- Leading to absence or decreased awareness of emotion
- risk factor for post trauma psychopathology.
What are peritrauma risk factors for PTSD?
Peritrauma (during event)
- perceived threat
- negative interpretation of event
- physiological arousal
- anger and shame
- dissociation during event
What are post trauma risk factors for PTSD?
Post trauma
- social support
- coping
- Shame
- negative interpretation of consequences of event
- new life events
Why offers PTSD unique points for prevention?
• Distinct stressor, clear onset point
• Early symptoms (mostly) develop within days of
trauma exposure
• Organized professional response
