PTSD Flashcards
1
Q
Post-Traumatic Stress Disorder (PTSD)
A
- known “presumed aetiology” (ie. direct/indirect traumatic experience w/actual/threatened death/injury/threat to self/other)
- response involves fear/helplessness/horror
- FOA, KEANE & FRIEDMAN (2000); trauma links w/other disorders but unclearly
2
Q
PTSD: Trauma Examples
A
- short-term (ie. assault; road accident)
- continuous (ie. abuse; combat; persecution; domestic violence)
3
Q
PTSD: Symptoms of Coexisting “Bimodal Reactions”
A
- FIGHT/FLIGHT: flashbacks; nightmares; hyper-arousal to cues; hypervigilance of danger
- FREEZE: avoidance; amnesia; derealisation; disassociation; numbness
4
Q
PTSD: Previous Labels
A
- shell shock; war neurosis; soldier’s heart; gross stress reaction; combat stress/fatigue; post-Vietnam syndrome; traumatic neurosis
- rape trauma syndrome; child abuse syndrome; battered wife syndrome
5
Q
PTSD: Prevalence Rates
A
- 8% UN peacekeepers; 30% civilians in war zones; 90% Zeebrugge ferry disaster survivors
- 5% men; 10.4% women
- TOLIN et al (2006); women x4 more likely than men
6
Q
PTSD: Biological Mechanisms
A
- evolutionary preparedness for things to be quickly avoided
- FIGHT VS FLIGHT VS FREEZE response; evolutionary mechanism w/primitive brain/decision areas (right limbic/frontal lobes)
- to cope w/fighting/fleeing; short-term; noradrenaline released afterwards caused exhaustion; sometimes misfires (non-physical reaction needed)
1. Transmitted adrenaline surge.
2. Heart races; blood away from stomach.
3. Muscles tense; pupils dilate.
7
Q
PTSD: Biological Mechanisms (EG)
A
- HAWK et al (2000); stress hormone elevated hours after “common civilian trauma”; remains altered in readiness cycle
- PTSD makes more natural opiates; blunt pain but increase apathy
8
Q
PTSD: Autonomic Nervous System
A
- adrenaline increases heart rate/blood pressure/energy supplies
- cortisol; primary stress hormone increases sugar/glucose in blood/brain and availability of tissue-repairing substances
9
Q
PTSD: Parasympathetic and Sympathetic Systems
A
- PARASYMPATHETIC (rest/digest); pupils constrict/saliva made/heartbeat slowed/airways constricted/stomach activated/glucose released in gallbladder/stimulates intestines/promotes erection
- SYMPATHETIC (flight/fight); pupils dilate/saliva inhibited/heartbeat increased/airways relaxed/stomach inhibited/gallbladder inhibited/epinephrine and norepinephrine secreted/bladder relaxed/ejaculation promoted
10
Q
PTSD: Psychological Mechanisms
A
- COGNITIVE-BEH: fear conditioning & avoidance learning; fear (CS) associated w/UCS = negative reinforcement; reduced fear = fuelled avoidance
- COGNITIVE: self-efficacy (concept of control) shift/loss of predictability (ie. assault survivor hears thunder and believes family is being shot); hypervigilance/overgeneralisation of danger
11
Q
PTSD: Contributing Factors
A
- PRE-MORBID HISTORY: early separation; family history (ie. anxiety/PTSD/schema style)
- FEMALE SEX: requires more reporting; social power/abuse impact; under-reporting by men masked by alcoholism; increased exposure to sexual trauma creates biological/environmental/coping factors; minimisation in family/social group/government/news/organisations seriously harms female mental health
- NATURE OF EVENT: severity; exposure; control (ie. discrepancy over one off RTA VS systematic abuse); “it shouldn’t happen but it did”; para-diagmatic uncontrollable event
12
Q
PTSD: Course and Duration
A
- most trauma causes anxiety/stress symptoms
- diagnosis when symptoms last 1 month; days duration = Acute Stress Disorder (ASD)
- symptoms begin within 3 months of event; severity/duration usually varies
- some people recover within 6 months; some suffer decades
13
Q
PTSD: Co-Morbid Problems
A
- sleep disturbances; depression; anxiety; irritability/anger outbursts; substance misuse; impairment in socio-occupational functioning
14
Q
PTSD: Civilians in Warfare
A
- INVISIBLE WOUNDS OF WAR (2008); warfare/torture spreads death/disability; Amnesty International (1997) shows in 150+ countries civilian affect is rising compared to personnel
- trauma includes: constant endangerment of one’s life; extreme violence witnesses; familial separation; concentration camp detention; torture
15
Q
PTSD: Migration Hazards in Refugee Children
A
- FAZEL (2014); 7.6m displaced in 2012; half children; regions prone to conflict often have high child rates; run w/w/o families; children vulnerable in insecure situations
- increased abuse/exploitation/sexual violence/forced labour/trafficking/voluntary starvation/depression/sleep difficulty/somatic complaints/anxiety/PTSD/bedwetting/social withdrawal; broad functioning affected (ie. physical/academic)
- some countries use immigration detention as step to repatriation; concerns about the quality of care there
16
Q
PTSD-T: Cognitive Behavioural Therapy (CBT)
A
- CBT: manages NATs/beliefs; relaxation; exposure/desensitisation (ie. asked to relive frightening experience under controlled conditions to process trauma); ROTHBAUM et al (2000); most effective treatment
- DEBRIEFING: 12,000 schoolchildren experienced hurricane; better after 2 years; other equivocal studies
- EYE MOVEMENT DESENSITISATION (EMD): effects of desensitisation but not clearly linked to eye movement; better for one-offs rather than continuous PTSD
- PSYCHOSOCIAL REHABILITATION
- GROUP THERAPY
- MEDICATION: eases associated symptoms of depression/anxiety/insomnia
17
Q
PTSD: Phobias
A
- MICHELLE: attacked/stabbed in nightclub after protecting someone
- 2 years later; only leaves house for doctors; lost business; severely depressed; 20 fortnightly CBT sessions targeting: avoidance/agoraphobia/intrusive thoughts/anti-coping/developing stress management skills (SMS)
- “fear of fear”; not wanting to embarrass herself so avoids everything
- “avoidance loop” = reward for avoidance; NO tangible reward for overcoming fear
18
Q
PTSD-P: Phobias
A
- MICHELLE: SMS skills helped talk through events w/o severe emotions; systematic desensitisation hierarchy (aka. shop w/friend; alone quiet; bus quiet)
- random event “scanner” (going to “your place” to relax ie. beach)
- OUTCOME: managed agoraphobia; PTSD support group; further progress; part-time work; went on holiday
19
Q
PTSD: Traumatic Brain Injuries (TBI)
A
- “fast-stops” (ie. contusions/lacerations/diffuse axonal shearing); localised neuro-trauma; haemorrhages/infections/anoxia
- closed (within brain) or penetration (from outside)
- JOHN: 12h coma; 2y post injury (car collision; killed GF); “island of memory” (cut of hyperdetailed memory)
- SYMPTOMS: grief/survivors guilt; hyper nightmares/flashbacks; avoidance of driving/crowds; anger w/self/others; aggressive in new relationship
- (UNHEALTHY) COPING: shutting down; alcoholism for nightmares; smoking; aggression; embarrassment of facial scars
20
Q
PTSD-TBI: Treatments
A
- (JOHN) “GROUNDING”: skills to explore guilt/grief; managing irritability (relaxation/”breathe or leave”)
- DESENSITISATION FOR COHERENT STORY: monitoring intrusions (panic attacks at watching car accident movies); detailed reporting (ie. remembering that he couldn’t breathe w/steering wheel against chest, and panic attacks trigger this memory further); calming breaths to orientate surroundings
- OUTCOME: DIY part time work; shares tasks w/kid; no anger episodes; less nightmares; alcohol reduced by 50%; not STATSIG though
21
Q
PTSD-T: 3MDR
A
- overcoming avoidance in veterans via VR experience (ie. walking towards pic on treadmill); 37% improvement of symptoms; new method; widening to more PTSD sufferers as next step
22
Q
PTSD-T: Outreach & Screening
A
- BREWIN et al (2010); London terrorist bombing victims; Trauma Screening Questionnaire (TSQ) completed by 596; clinical assessments given; 217 given personalised CBT/EMD; depression/PTSD found
- OUTCOME: outreach w/screening linked w/evidence from treatments helps identify mental health disorders
23
Q
SUMMARY
A
- major issue; individual risks but severe event is more important; co-existing conditions common; highly effective treatments
- co-morbidity w/depression; coping can be unhealthy (ie. drugs/alcohol); parenting/schemas are possible risk factors; issue of controlling life events
