PTSD Flashcards
Psych sx following exposure to trauma
Anxiety
fear
anger
aggression
dysphoria
dissociation
time course for subtypes of PTSD
Acute stress disorder
Acute PTSD
Chronic PTSD
Delayed Onset PTSD
Acute stress disorder
- 0-1 mo
Acute PTSD
-0-3 mo
Chronic PTSD
- long
Delayed Onset PTSD
- 6+ mo
PTSD DSM A
6+ years old
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the event(s) as it occurred to others.
- Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
PTSD DSM B
Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
- Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
- Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
PTSD DSM C
Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
- Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
- Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
PTSD DSM D
Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
- Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
- Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
- Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
- Markedly diminished interest or participation in significant activities.
- Feelings of detachment or estrangement from others.
- Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
PTSD DSM E
Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
- Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
- Reckless or self-destructive behavior.
- Hypervigilance.
- Exaggerated startle response.
- Problems with concentration.
- Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
PTSD DSM other
time etc
Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.
- The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
PTSD DSM specification
dissociative sx
depersonalization
derealization
delayed expression
Specify whether:
- With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
- Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
- Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
- With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
TRAUMA
traumatic event
re experience
avoidance
unable to function
month (at least)
Arousal
70% exposure to trauma and % develop PTSD
6%
Negative sx of PTSD look like
depression
Note for DSM you need sx of ___ and ___
intrusive sx
avoidance
fear conditioning and response
Amygdala
Thalamus
Hippocampus
Amygdala
- remember stimuli associated with fearful event
- send response to hypothalmus (endocrine)
-send response to PFC (emotions)
- send response to brain stem/Locus (motor/ANS)
Thalamus
- sensory input to amygdala
Hippocampus
-remembers the context of the fear conditioning
fear extinction
Progressive reduction of the response to a fear stimulus
new learning allows inhibition of fear response
GABA suppress glutamate driver fear response
Fear dysregulation
deficit in fear extinction
inc generalization of fear
neg bias of threat from neutral stimuli
feeling danger in a safe environment
Tx prioritization
CBT
EMDR
psychotherapy
- multiple types
Rx tx FDA approved for PTSD and initial dose
Paroxetine 10-20mg qd
Sertraline 25-60mg qd
Rx tx for PTSD with strongest recc
Paroxetine
Sertraline
Also:
fluoxetine
venlafaxine
note mult moderate reccs including risperidone (only antipsychotic though not all guidelines recommend)
Key NT for amygdala
serotonin
civilian vs combat response
civilian>combat
Prazosin for PTSD
a1 adrenergic receptor antagonist
CNS activity during sleep provides the rationale (nighttime sx)A
crosses BBB
Antipsychotics evidence for PTSD
may dec glutamate and promote neurogenesis
may reduce re-experiencing and hyperarousal sx
Tx psychosis, poss in PTSD
concern for cardiometabolic AE
Antipsychotics RX for PTSD
Multiple guidelines against but some say ok for adjunct and esp r/t disabling sx and behaviors or psychosis
Risperidone
-mixed response
olanzapine
- small trial
quetiapine
- small trial
BZD evidence for PTSD
inc GABA effect
small rct show no improvement vs placebo
some trials suggest worse
- may interfere with extinction
potential misuse
MDMA evidence for PTSD
2017 study as breakthrough tx
seems to inc tolerability and effectiveness of psychotherapy
Pooled RCT showed significant improvement in PTSD sx and reduced overall depression
longitudinal study show sx improved after 12 mo
Cannabinoids evidence for PTSD
pos studies
- improved sleep, dec anxiety/nightmares/hyperarousal/flashback
some studies show no change or worse PTSD sx/violence/alcohol
