PTSD Flashcards
Define PTSD.
Intense, delayed, prolonged reaction to stressful stimulus.
Event is likely to cause pervasive distress in anyone + usually involves threat to self.
Explain the aetiology/risk factors of PTSD.
Traumatic event (i.e. rape, death, war, torture). May be due to:
- Event challenges held beliefs, resulting in inability to cognitively rationalise
- Normal processing of emotionally charged info leading to overwhelming feeling + memories.
- Negative appraisal of intrusive thoughts, leading to lack of processing + therefore maintaining Sx over time.
Subjective meaning of event is one of the most important factors for development.
Summarise the epidemiology of PTSD.
Lifetime incidence 1-3%.
War veterans 30%.
Give 6 risk factors for PTSD
Younger age
Female
Low SES
Multiple major life stressors
Previous trauma
Past psych hx.
What are the 3 main elements which arise from PTSD?
Re-experiencing/ Intrusion
Avoidance
Hyperarousal
What are 6 signs of hyperarousal?
Hypervigilance
Poor concentration
Feeling tense/ on edge
Sleep disturbance- falling/ staying/ restless
Irritability + angry outbursts
Exaggerated startle response
What are 4 signs of intrusion?
FLASHBACKs: feel as if event recurring, may lose awareness of surroundings
Recurrent NIGHTMAREs with content related to event
Recurrent involuntary + INTRUSIVE distressing MEMORIES of event
Intense psychological distress +/- physiological reaction to internal/ external cues resembling event
What are 3 signs of avoidance?
Avoid memories, thoughts, feelings a/w event
Avoids external reminders
May change routine/ environment
What 6 mood and cognition symptoms may occur in PTSD?
Unable to recall details- dissociative amnesia
Persistent + exaggerated negative beliefs/ expectations about self + others
Persistent distorted cognitions about the cause/ consequences of the event
Diminished interest/ participation in activities
Emotional detachment
Persistent inability to experience positive emotions
For how long do symptoms have to be experienced for PTSD to be diagnosed?
> 1 month
Usually manifest within 6 months of event
How might a PTSD patient appear on examination?
Neglect
Depression
Anxiety
Hypervigilant
Poor eye contact
Tearful
Slow speech
Low mood
Poor concentration
How may PTSD present in children/ adolescents? (6)
Wetting the bed
Forgetting how to/ being unable to talk
Acting out the scary event during playtime
Being unusually clingy with a parent or other adult
Disruptive, disrespectful, destructive behaviour
Feelings of guilt
What screening assessment can be used for PTSD?
Trauma Screening-Questionnaire (TSQ)
What are 3 differentials for PTSD?
Depression: low mood, anhedonia, anergia
GAD: excessive anxiety, restlessness, difficulty concentrating
Adjustment disorder: low mood, anxiety, feeling of inability to cope
What is the short term management for PTSD?
Screen for comorbidities + other MH disorders
Risk assessment for suicide (admit/ CRHT)
What is the long term management of PTSD?
<4w: watchful waiting
Trauma focused CBT (12)
Eye movement desensitization + reprocessing (12)
Venlafaxine/ Sertraline if express preference/ decline therapy/ referral delayed
What is trauma focused CBT?
Exposure: confront traumatic memory (recall) + repeated exposure to situations have been avoiding
Cognitive: identifies + modifies misrepresentations of the trauma
What is EMDR?
Bilateral stimulation (eye movements, taps, + tones) while the person focuses on memories + associations.
Helps the brain process flashbacks + make sense of the traumatic experience.
What are the complications associated with PTSD? What is the prognosis of PTSD?
Social withdrawal
Suicide
Substance misuse
Half make good recovery in 1y, rest may have lifelong symptoms
