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Psychiatry > Psychological Effects of Trauma > Flashcards

Psychological Effects of Trauma Flashcards

1
Q

What is a traumatic event?

What is the effect on the brain?

A

Traumatic event is bodily or metal injury caused by an external agent. This elicits stress response in the brain.

Prefrontal cortex interacts with limbic system–> signals to:

  1. HPA axis –> releases cortisol via ACTH
  2. locus ceruleus–> release NE and DA–> increased sympathetics

Effect: increased HR, sweating, alertness, “fight, flight, freeze”

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2
Q

What are the 2 main “trauma and stressor-related disorders as classified by DSM5?

A
  1. Acute stress disorder [ASD]

2. Post traumatic stress disorder [PTSD]

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3
Q

What is criterion A for ASD and PTSD?

A

Exposure to actual or threatened death, serious injury, or sexual violation:

  1. directly
  2. witnessing in person as it occurs to others
  3. learning of the event occurring to a family member or close friend [violent or accidental]
  4. experiencing repeat or extreme exposure to aversive details of a traumatic event [first responders, police officers, etc]
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4
Q

What are the 5 categories of symptoms for acute stress disorder?
How many criteria must be met to classify the disease that way?

A
  1. intrusion
  2. negative mood
  3. avoidance
  4. arousal
  5. dissociation
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5
Q

What is intrusion?

A
  1. recurrent, involuntary distressing memories
  2. recurrent distressing dreams
  3. dissociative reactions [flashbacks] where they feel that they are back at the traumatic event
  4. intense psychological distress or physiological reactions to internal/external cues that symbolize the aspect of trauma
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6
Q

What are dissociative symptoms?

A
  1. altered sense of reality about oneself [depersonalization] or one’s surroundings [derealization]
  2. dissociative amnesia- inability to remember aspects of the traumatic event
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7
Q

What are avoidance symptoms of acute stress disorder?

A
  1. efforts to avoid distressing memories, thoughts, feelings,
  2. efforts to avoid external reminders that arouse memories, thoughts, feelings
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7
Q

What are avoidance symptoms of acute stress disorder?

A
  1. efforts to avoid distressing memories, thoughts, feelings,
  2. efforts to avoid external reminders that arouse memories, thoughts, feelings
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7
Q

What are avoidance symptoms of acute stress disorder?

A
  1. efforts to avoid distressing memories, thoughts, feelings,
  2. efforts to avoid external reminders that arouse memories, thoughts, feelings
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7
Q

What are avoidance symptoms of acute stress disorder?

A
  1. efforts to avoid distressing memories, thoughts, feelings,
  2. efforts to avoid external reminders that arouse memories, thoughts, feelings
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8
Q

What are the arousal symptoms associated with acute stress disorder and PTSD?

A
  1. sleep disturbance [difficulty falling or staying asleep]
  2. irritable with angry outbursts with no provocation
  3. hypervigilance [always looking around]
  4. problems with concentration
  5. exaggerated startle response
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8
Q

What are the arousal symptoms associated with acute stress disorder and PTSD?

A
  1. sleep disturbance [difficulty falling or staying asleep]
  2. irritable with angry outbursts with no provocation
  3. hypervigilance [always looking around]
  4. problems with concentration
  5. exaggerated startle response
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8
Q

What are the arousal symptoms associated with acute stress disorder and PTSD?

A
  1. sleep disturbance [difficulty falling or staying asleep]
  2. irritable with angry outbursts with no provocation
  3. hypervigilance [always looking around]
  4. problems with concentration
  5. exaggerated startle response
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8
Q

What are the arousal symptoms associated with acute stress disorder and PTSD?

A
  1. sleep disturbance [difficulty falling or staying asleep]
  2. irritable with angry outbursts with no provocation
  3. hypervigilance [always looking around]
  4. problems with concentration
  5. exaggerated startle response
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9
Q

What is the duration of disturbance for ASD?

A

It starts 3 days to one month after the trauma

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9
Q

What is the duration of disturbance for ASD?

A

It starts 3 days to one month after the trauma

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9
Q

What is the duration of disturbance for ASD?

A

It starts 3 days to one month after the trauma

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9
Q

What is the duration of disturbance for ASD?

A

It starts 3 days to one month after the trauma

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10
Q

How do intrusion symptoms for acute stress disorder and PSTD differ for adults and children?

A

Adults will have distressing memories of the traumatic event while children over 6 will have repetitive play where themes or aspects of the trauma are expressed.

Adults will have recurrent dreams where the content is related to the event. Children will have frightening dreams w/o recognizable content

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10
Q

How do intrusion symptoms for acute stress disorder and PSTD differ for adults and children?

A

Adults will have distressing memories of the traumatic event while children over 6 will have repetitive play where themes or aspects of the trauma are expressed.

Adults will have recurrent dreams where the content is related to the event. Children will have frightening dreams w/o recognizable content

10
Q

How do intrusion symptoms for acute stress disorder and PSTD differ for adults and children?

A

Adults will have distressing memories of the traumatic event while children over 6 will have repetitive play where themes or aspects of the trauma are expressed.

Adults will have recurrent dreams where the content is related to the event. Children will have frightening dreams w/o recognizable content

10
Q

How do intrusion symptoms for acute stress disorder and PSTD differ for adults and children?

A

Adults will have distressing memories of the traumatic event while children over 6 will have repetitive play where themes or aspects of the trauma are expressed.

Adults will have recurrent dreams where the content is related to the event. Children will have frightening dreams w/o recognizable content

11
Q

What is the only factor that differentiates intrusion symptoms from ASD and PTSD?

A

PTSD will have marked physiologic reactions to internal or external cuses that symbolize or resemble aspects of the trauma

11
Q

What is the only factor that differentiates intrusion symptoms from ASD and PTSD?

A

PTSD will have marked physiologic reactions to internal or external cuses that symbolize or resemble aspects of the trauma

11
Q

What is the only factor that differentiates intrusion symptoms from ASD and PTSD?

A

PTSD will have marked physiologic reactions to internal or external cuses that symbolize or resemble aspects of the trauma

11
Q

What is the only factor that differentiates intrusion symptoms from ASD and PTSD?

A

PTSD will have marked physiologic reactions to internal or external cuses that symbolize or resemble aspects of the trauma

12
Q

What negative alterations in cognitions are associated with PTSD?

A
  1. dissociative amnesia
  2. persistent and exaggerated negative beliefs or expectations of oneself, others, world [i am bad, the whole world is dangerous, no one can be trusted]
  3. blame of himself/herself for the traumatic event
  4. negative emotional state [fear, horror, guilt, shame]
  5. diminished interest in participation in activities
  6. detachment/estrangement from others
  7. inability to feel positive emotions
12
Q

What negative alterations in cognitions are associated with PTSD?

A
  1. dissociative amnesia
  2. persistent and exaggerated negative beliefs or expectations of oneself, others, world [i am bad, the whole world is dangerous, no one can be trusted]
  3. blame of himself/herself for the traumatic event
  4. negative emotional state [fear, horror, guilt, shame]
  5. diminished interest in participation in activities
  6. detachment/estrangement from others
  7. inability to feel positive emotions
12
Q

What negative alterations in cognitions are associated with PTSD?

A
  1. dissociative amnesia
  2. persistent and exaggerated negative beliefs or expectations of oneself, others, world [i am bad, the whole world is dangerous, no one can be trusted]
  3. blame of himself/herself for the traumatic event
  4. negative emotional state [fear, horror, guilt, shame]
  5. diminished interest in participation in activities
  6. detachment/estrangement from others
  7. inability to feel positive emotions
12
Q

What negative alterations in cognitions are associated with PTSD?

A
  1. dissociative amnesia
  2. persistent and exaggerated negative beliefs or expectations of oneself, others, world [i am bad, the whole world is dangerous, no one can be trusted]
  3. blame of himself/herself for the traumatic event
  4. negative emotional state [fear, horror, guilt, shame]
  5. diminished interest in participation in activities
  6. detachment/estrangement from others
  7. inability to feel positive emotions
13
Q

What alterations in arousal are associated with PTSD?

A
  1. irritable with angry outbursts
  2. reckless/self-destructive behavior
  3. hypervigilance
  4. exaggerated startle response
  5. problems with concentration
  6. sleep disturbance
13
Q

What alterations in arousal are associated with PTSD?

A
  1. irritable with angry outbursts
  2. reckless/self-destructive behavior
  3. hypervigilance
  4. exaggerated startle response
  5. problems with concentration
  6. sleep disturbance
13
Q

What alterations in arousal are associated with PTSD?

A
  1. irritable with angry outbursts
  2. reckless/self-destructive behavior
  3. hypervigilance
  4. exaggerated startle response
  5. problems with concentration
  6. sleep disturbance
13
Q

What alterations in arousal are associated with PTSD?

A
  1. irritable with angry outbursts
  2. reckless/self-destructive behavior
  3. hypervigilance
  4. exaggerated startle response
  5. problems with concentration
  6. sleep disturbance
14
Q

How does the duration of PTSD differ from ASD?

A

PTSD is over 1 month

ASD is less than 1 month [but atleast 3 days]

14
Q

How does the duration of PTSD differ from ASD?

A

PTSD is over 1 month

ASD is less than 1 month [but atleast 3 days]

14
Q

How does the duration of PTSD differ from ASD?

A

PTSD is over 1 month

ASD is less than 1 month [but atleast 3 days]

14
Q

How does the duration of PTSD differ from ASD?

A

PTSD is over 1 month

ASD is less than 1 month [but atleast 3 days]

15
Q

If a person has PTSD with dissociative symptoms, what are they demonstrating?>

A
  1. depersonalization - persistent or recurrent feeling that they are detached from themselves [an outside observer of their life, feeling as though they are in a dream, or time is moving slowly]
  2. derealization - unreality of the surroundings

This cannot be due to physio effects of substance or medical condition [seizures or blackouts from alcohol/drugs]

15
Q

If a person has PTSD with dissociative symptoms, what are they demonstrating?>

A
  1. depersonalization - persistent or recurrent feeling that they are detached from themselves [an outside observer of their life, feeling as though they are in a dream, or time is moving slowly]
  2. derealization - unreality of the surroundings

This cannot be due to physio effects of substance or medical condition [seizures or blackouts from alcohol/drugs]

15
Q

If a person has PTSD with dissociative symptoms, what are they demonstrating?>

A
  1. depersonalization - persistent or recurrent feeling that they are detached from themselves [an outside observer of their life, feeling as though they are in a dream, or time is moving slowly]
  2. derealization - unreality of the surroundings

This cannot be due to physio effects of substance or medical condition [seizures or blackouts from alcohol/drugs]

15
Q

If a person has PTSD with dissociative symptoms, what are they demonstrating?>

A
  1. depersonalization - persistent or recurrent feeling that they are detached from themselves [an outside observer of their life, feeling as though they are in a dream, or time is moving slowly]
  2. derealization - unreality of the surroundings

This cannot be due to physio effects of substance or medical condition [seizures or blackouts from alcohol/drugs]

16
Q

If a person has PTSD with delayed expression, what does this mean?

A

They did not meet the full criteria until at least 6 months after the traumatic event

17
Q

What is psychological first aid?

A

In the immediate aftermath of a trauma:

  1. provide safety and support
  2. gather info about the persons current needs
18
Q

What are the most common pharmacological treatments of PTSD?

A
  1. SSRI- sertraline, paroxetine [paxil] are FDA approved
  2. buproprion
  3. venlafaxine
  4. prazosin [a1 blocker] to treat nightmares
19
Q

What is trauma focused therapy for PTSD?

A
  1. exposure - have the person recount the event in a safe setting
  2. cognitive restructuring - have them challenge their beliefs about why the event happened
20
Q

In children, how does trauma most frequently occur?
What are the effects on neurology/neurobiology?
What are the children more susceptible to?

A

Trauma in childhood is often chronic with little or no time to recover in between events

Neuro:

  1. smaller intracranial, cerebral, cerebellar volumes
  2. larger ventricles
  3. smaller corpus callosum

Susceptible to:

  1. distractions, impulsivity
  2. poor problem solving
  3. poor coping skills
  4. increased substance abuse
21
Q

What is resilience?

A

50-60% of the population has experienced a traumatic event but PTSD prevalence is 8%.

Resilience is successful adaptive coping that is due to gene expression modulated by environmental exposures.
When a person is exposed to moderate stressors, they achieve a sense of mastery and this enhances personal control that helps them better cope with larger traumas.

Psychiatry (18 decks)

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