PTSD Flashcards
Define Trauma
An experience or witnessing ‘an event that involved actual or threatened death, serious injury, sexual violation, or threat to the physical integrity of self or others.
Outline the symptoms linked to PTSD
Re-experiencing
Avoidance
Negative mood and cognitions
Arousal
What are the symptoms of ASD
Dissociation
Intrusion
Avoidance
Negative mood
Arousal
What is the aetiology of PTSD
Biopsychosocial
Traumatic event primary (severity,onset,type)
Biological factors
-Genetics
-Neurochemistry- Serotonin(low mood&. impulsiveness), Noradrenaline (hyper Arousal, Opiate system(numbing)
-Neuroendocrine -HPA axis (cortisol)
Considering the different brain structures
What are the normal information processing and PTSD malfunctions in the brain
✔️ Prefrontal cortex- complex thinking, decision making, appropriate behaviour
-In PTSD there’s dysfunctional thought process, impaired decision making, inappropriate responses to situations
✔️ Hippocampus- Transfers and stores information into memories
-In PTSD Stores memories incorrectly and affects memory retrieval
✔️Amygdala- Sets off fight or flight in response to danger
In PTSD sets of flight of fight in response to memories or thoughts about danger
✔️Hypothalamus- Releases hormones such as cortisol to help manage stress and direct efforts to stressors
In PTSD the hypothalamus is over reactive which leads to imbalances in hormone levels and increases stress and anxiety
What are the risk factors for development of PTSD before the traumatic event occurs (atleast 5)
-Childhood emotional problems by age 6
-History of mental illness in family or self esp depression and anxiety disorders
-Previous trauma
-Lower education
-Lower intelligence
-Female gender
-Younger age
-General childhood adversity
-Minority racial/ethnic groups
What are the risk factors for development of PTSD during and after the trauma (atleast 5)
-Severity of the trauma
-ASD
-Lack of support
-Dissociation
-Additional stressors
-trauma perpetrated by caregiver
-being a perpetrator
-Witnessing atrocities(extremely cruel act)
-killing the enemy
What are the 5 Goals of Acute Stress Management
ERASE (we are trying the erase the trauma and not debrief which involves recall and reheasing of traumatic event which delays healing)
E -Reduce exposure to stress (source space)
R- Restore physiological needs (food or pain meds)
A- Access to information/orientation
S - Locate source of support eg family
E- Emphasise expectation of returning to normal
What are the 3 things you should not do in a person with Acute Stress
3Ps
Do not pathologise - emphasize that this is normal response to an abnormal situation
Do not Psychologise- Do not forcefully facilitate emotional reactions eg group counselling or debriefing. Provide supportive counselling to those who request it.
Do not Pharmacologise- Do not use Bemzos etc in the first few hours
What are the treatment options (not goals) for Acute Stress Disorder
Here we’re trying to prevent PTSD
Refer back to your 3Ps)
✔️Watchful waiting and reassurance recommended in the first 4weeks of trauma
✔️Don’t use medication in first few hours (Don’t Pharmacologise)
✔️Normalise the experience and provide reassurance that only a minority of people will develop PTSD (Don’t Pathologise)
✔️Must educate victim and carers about symptoms, when to seek help as well as what treatment is available
How is PTSD screened for according to DSM5
Sometimes things happen to people that are unusually or especially frightening, horrible,
or traumatic. For example: a serious accident or fire, physical or sexual abuse or assault,
seeing someone killed or seriously injured, seeing a loved one die through homicide or
suicide.
If no stop, if yes continue
(Ask about the symptoms of PTSD laws owaziyo nje)
n the past month, have you…
1. Had nightmares about the event(s) or thought about the event when you didn’t want
to? Y/N (Re-experiencing)
2. Tried not to think about the event(s) or went out of your way to avoid situations that
reminded you of the event(s)? (Avoidance)Y/N
3. Been constantly on guard, watchful, or easily startled? (Arousal) Y/N
4. Felt numb or detached from people, activities, or your surroundings? (Dissociation) Y/N
5. Felt guilty or unable to stop blaming yourself or others for the event(s) or any
problems the event(s) may have caused? (Negative mood) Y/N
If yes to any three of the five questions then a more detailed assessment for PTSD is
warranted
What biological treatments are used in treating PTSD
• SSRI’s and SNRI are pharmacological treatments of
choice.
• Evidence strongest for Sertraline, Paroxetine,
Fluoxetine & Venlafaxine
• Response seen as early as 2-4 weeks of starting
medication but could take up to 12 weeks.
• Benzodiazepines relatively contraindicated
What impact can PTSD patients have on clinicians treating them
Contagiousness of trauma
Trauma fatigue/burnout
Need for introspection
Triggered
Ethical or legal concerns (conflicts around confidentiality/child protection/ military/ police etc)
Management of PTSD
Risk assessment
Special investigations
Collateral
Biological treatment
Psychological
Social
