PTSD Flashcards
What is EMDR?
Eye movement desensitisation and reprocessing
What psychotherapy is used for PTSD?
eye movement desensitisation and reprocessing
Stress related disorders ICD 11
6B40 Post Traumatic Disorder
6B41 Complex Post Traumatic Stress Disorder
6B42 Prolonged Grief Disorder
6B43 Adjustment Disorder
6B44 Reactive Attachment Disorder
6B45 Disinhibited Reactive Attachment Disorder
What is PTSD?
Severe psychological distress following a traumatic event
Event exceptionally threatening or catastrophic in nature
How long after traumatic event can symptoms of PTSD arise?
up to 6 months
Normally within a month - acute stress reaction to PTSD after a week to a month
Symptoms of PTSD
Poor sleep
Irritability/outbursts of anger
Poor concentration
Hypervigilance
Exagerated startle response
Flashbacks, vivid memories, recurrent dreams
Avoidance
Problem recalling events
Functional impairment required
What risk factors increase chance getting PTSD>
Women
Low education
low SE status
Psychiatric problems
Prev traumatic events - vulnerability factors
Comorbidities with PTSD?
Depressive disorders, other anxiety disorders, alcohol and substance misuse disorders
Biological management PTSD?
Antidepressants - SSRIs, TCAs
Anti-psyhcotics
Pscyhological management PTSD?
Cognitive Processing Therapy
Cognitive Behavioural Therapy for PTSD
Narrative Exposure Therapy
Prolonged Exposure Therapy
Social management of PTSD
Involve the family, friends, carers, or others
Ensure occupational therapy input
Prevetntion of PTSD
Traumatic event in last month - monitor for acute stress reaction or sympotms of PTSD
Trauma focused CBT intervention - reduce sympotms and chance of PTSD
Trauma focused CBT interventions
Cognitive Processing Therapy
Cognitive Therapy for PTSD
Narrative exposure therapy
Prolonged exposure therapy
Cognitive processing therapy aims
Eduation around: PTSD, thoughts, emotions
Build on: Safety, Trust, Power, Control , Esteem
What risks to consider PTSD
To slef
Withdrawal
Neglect
What happens in cognitive processing therapy?
Write a statment about why event occured
- identifies automatic thoughts, increases awareness between thoughts and feelings
Complete a detailed written account
Challenge beliefs re event
Dichotomous thinking
Black and white - arrive at conclusions based on inadequate evidence eg one traumatic event defining personaluty
When offer EMDR therapy? When cant offer
If symptoms clinically important and presentation
-Within 1-3 months of non combat can consider
Over 3 months should offer
ONly offer if:
they do not have severe PTSD symptoms, in particular dissociative symptoms and
they are not at risk of harm to themselves or others
When are risperidone or similar antipsychotics used in PTSD?
Severe hyperarousal
Severe psychosis
Other drug treatments failed
What meds can offere in PTSD
Venlafaxine
SSRI
Antipsychotics if severe and refractory
EMDR aims
Psychoeducation about reactions to trauma; managing distressing memories and situations;
Identifying and treating target memories (often visual images);
Promoting alternative positive beliefs about the self
repeated in-session bilateral stimulation (normally with eye movements[1]) for specific target memories until the memories are no longer distressing
Include the teaching of self-calming techniques and techniques for managing falshbacks, iwthin and between sessions
What is an acute stress reaction?
Innaporpriately exaggerated stress reaction to a trigger
When is CBT for sleep or anger offered in PTSD?
More than 3 motnhs after traumatic event
If patient unable or unwilling to engage in trauma focused intervention or has residual symptoms after trauma focused intervention
What is complex PTSD?
Severe and pervasive problems in affect regulation
Persistent negative beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event
Persistent difficulties in sustaining relationships and in feeling close to others.
Causing significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
What to do after traumatic event has occured?
Therapy - talk about traumatic event
What is ACE?
adverse childhood experience
What information to give to PTSD patients
their aim, content, duration and mode of delivery
the likelihood of improvement and recovery
what to expect during the intervention, including that symptoms can seem to get worse temporarily
that recovery is more likely if they stay engaged with treatment
Difficulties with PTSD treatment
Be aware that people with PTSD may be apprehensive, anxious, or ashamed. They may avoid treatment, believe that PTSD is untreatable, or have difficulty developing trust. Engagement strategies could include following up when people miss appointments and allowing flexibility in service attendance policies
How to manage subthreshold symptoms of PTSD within 1 month of a traumatic event?
Active monitoring within 1 month, arrange follow up after 1 month.
What should group trauma focused interventions do? When are tehy used?
Used when exposed to large scale shared trauma
be based on a validated manual
typically be provided over 5 to 15 sessions
be delivered by trained practitioners with ongoing supervision
include psychoeducation about reactions to trauma, strategies for managing arousal and flashbacks, and safety planning
involve elaboration and processing of the trauma memories
involve restructuring trauma-related meanings for the individual
provide help to overcome avoidance
When do you offer individual trauma focised CBT intervention?
adults who have acute stress disorder or clinically important symptoms of PTSD and have been exposed to 1 or more traumatic events within the last month
individual trauma-focused CBT interventio
cognitive processing therapy
cognitive therapy for PTSD
narrative exposure therapy
prolonged exposure therapy
When consider EMDR therapy?
or adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented between 1 and 3 months after a non-combat-related trauma if the person has a preference for EMDR.
OR
Offer EMDR to adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 3 months after a non-combat-related trauma
When offer trauma focused computerised CBT for adults?
Diagnosis PTSD
Clinically imiportant symptoms PTSD presentred more than 3 months after a traumatic event if prefer to EMDR as long as
-No severe PTSD symptoms,
-No risk of harm to self or others
What offer when still have vivid reaction to trauma?
CBT interventions targeted at specific symptoms such as sleep disturbance or anger, for adults with a diagnosis of PTSD or clinically important symptoms of PTSD who have presented more than 3 months after a traumatic event only if the perso
When offer CBT interventions targeted at specific symptoms?
is unable or unwilling to engage in a trauma-focused intervention or
has residual symptoms after a trauma-focused intervention
What drugs use to treat PTSD?
Venlafaxine, SSRI
Antipsychotics if disabling symptoms and behaviours, for example severe hyperarousal or psychotic symptoms, symptoms not reponded to other drug pr psychological treatments
What to do if people present with PTSD and depression?
usually treat the PTSD first because the depression will often improve with successful PTSD treatment
treat the depression first if it is severe enough to make psychological treatment of the PTSD difficult, or there is a risk of the person harming themselves or other
