PTSD

Question 1

Screening questions for PTSD

Answer 1

1. Have you ever experienced a traumatic event in which you thought your life was in danger?
   - What happened?
   - Have you ever witnessed someone
   else experienced a traumatic event in
   which their life was in danger?
   - Has a close friend or family member
   ever experience a traumatic event in
   which their life was in danger?
2. Have you noticed changes in yourself
   after the trauma?
   - Do you experience dreams or flashbacks going back to the trauma?
   - Have you noticed you’re more uptight or on edge since the incident?
3. Have you noticed you’ve been avoiding people or places you usually don’t?

NEGATIVE ALTERATIONS
- Are there aspects of the trauma you don’t recall?
o Some people who go through a trauma have a very negative view of themselves, others or the world. Is that true for you?
o Do you blame yourself for the trauma?
o Over the past few years, have you been persistently feeling fearful, angry or guilty?
o Have you noticed that since the trauma you’ve lost interest in some things you used to enjoy?
o Do you often feel like you don’t fit in?
o Does it seem like you’ve lost the ability
to feel certain positive emotions?

ALTERATIONS IN AROUSAL
o Do you get irritated or lose your temper easily?
o Would you say you’ve engaged in
reckless or self-destructive behaviour?
o Have you been hyper-alert since the
trauma? Keeping your guard up and an
eye out for possible trouble?
o Do you get startled easily since the
trauma?
o Do you find it hard to concentrate?
o Have you had any trouble sleeping since the trauma

Question 2

What is the diagnostic criteria for PTSD

Answer 2

A. Exposure to trauma (actual or threatened death, serious injury, sexual violence) in one (or more) of the following ways:

1. Direct experience
2. Witnessed
3. Learning that it happened to a close
   family member or friend - must have
   been violent or accidental.
4. Repeated or extreme exposure to
   aversive details (first responders, police,
   – NOT through media)

B. ≥1 of the following sx beginning after it occurred:
1. Recurrent, involuntary and intrusive
distressing memories of the trauma
2. Recurrent distressing dreams about the trauma
3. Dissociative reactions (flashbacks)
4. Intense or prolonged psychological
distress after exposure to cues that
symbolize or resemble the trauma
5. Physiological reactions to cues that
symbolize or resemble the trauma.

C. Persistent avoidance (or efforts to avoid) stimuli associated with the trauma, beginning after the trauma occurred

1. Distressing memories, thoughts,
   feelings about / associated with the
   trauma
2. External reminders (people, places,
   convos, activities, objects, situations)
   that arouse distressing memories,
   thoughts, feelings about or closely
   associated with the trauma

D ≥2 of negative alterations in
cognitions and mood associated with the trauma, beginning / worsening after the trauma: (unable to function)

E. ≥2 alterations in arousal and
reactivity associated with the trauma,
beginning / worsening after the trauma,

G. Exclude other mental illness, medical condition or substance abuse

Also LAST >1 month

Question 3

Define negative alteration in cognition and mood associated with trauma (7)

Answer 3

1. Can’t remember important aspects of the trauma (dissociative amnesia).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (“no one can be trusted”).
3. Persistent, distorted cognitions about the cause or consequences of the trauma, so the person blames himself/herself or others.
4. Persistent negative emotional state (fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (happiness, satisfaction, loving feelings)

Question 4

Define negative alteration in arousal and reactivity associated with trauma (7)

Answer 4

1. Irritable behaviour and angry outbursts (unprovoked) typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behaviour.
3. Hypervigilance (increased alertness)
4. Exaggerated startle response
5. Poor concentration.
6. Sleep disturbance (difficulty falling or
   staying asleep or restless sleep).

Question 5

What are the 4 main symptoms of presentation of PTSD

Answer 5

• Hyperarousal - persistently heightened perception of current threat
• Avoidance of situations/activities - reminiscent of the events or of thoughts/memories of the events
• Re-experiencing the traumatic events
• Distress - strong/overwhelming fear and physical sensations when re-experiencing

Question 6

Specifiers of PTSD

Answer 6

• With dissociative symptoms
  (depersonalisation, derealisation)
• With delayed expression - full diagnostic criteria not met until ≥6 months after the event

Can also have comorbid
- depression/anxiety/substance abuse
- ‘Complex’ PTSD - high comorbidity present e.g. borderline personality disorder, low-grade psychotic symptoms

Question 7

Differential of PTSD

Answer 7

Acute stress disorder
- Exposure to trauma (may not be direct)
Immediately distressing after incident, symptoms persistent 3 days to 1 month -causes functional impairment, not attributable to medicine or medical condition
- 9/14 symptoms of
1 Recurrent distressing memories, or dreams 2 relating to trauma
3 flashbacks (dissociative event)
4. intense of prolonged psychological distress/ reactions in response to cues of the traumatic event
5.inability to feel positive emotions
6. depersonalisation 7. dissociative amnesia
8. avoiding distressing memories, 9. avoid external reminders
10. sleep disturbance
11. irritable behaviour and angry outbursts
12. hypervigilance
13. concentrations problems
14 exaggerated startle response

Others
- brief psychotic disorder

Question 8

What is the bio psycho social management of PTSD

Answer 8

1. Safety
2. psychotherapy + MEds

Psychological - psychoeducation
Psychotherapy -
1. trauma-focusedCBT
2. Eye movement desensitisation and
reprocessing therapy
- Mindfulness and relaxation techniques
- Lifestyle e.g. self-help books, sleep hygiene, diet/exercise, limit alcohol/caffeine intake

Social
- Family/friends support
- Work/school
- Home/living conditions improvement
- Spiritual/cultural

Biological
1. SSRI sertraline or paroxetine
- SNRI : venlafaxine
- can consider adjunctive atypical antipsychotic
2. prazosin for nightmares

Question 9

Explain in lay terms PTSD dx, treatment

Answer 9

Post-traumatic stress disorder (PTSD) is a mental health condition caused by very stressful, frightening or distressing events.

Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.

They may also have problems sleeping, such as insomnia, and find concentrating difficult.

These symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.

PTSD can be successfully treated, even when it develops many years after a traumatic event.
Treatment usually includes a talking therapy with medication