PTSD Flashcards
DSM 5: Trauma
experience or the witnessing of ‘an event or events that involved actual or threatened death, serious injury or sexual violation, or a threat to the physical integrity of self or others’.
Acute stress disorder
Limited to the first 4 weeks after traumatic event.
ASD symptoms
Dissociation
Intrusion
Avoidance
Negative mood
Arousal
PTSD
Traumatic event to Re-experiencing to Avoidance to Negative cognitions & mood to Arousal
PTSD: Aetiology
- Bio-psycho-social
- Traumatic event primary (severity, onset, type).
Biological factors:
- Genetics
- Neurochemistry:
Serotonin- low mood, impulsive.
NE- Hyper arousal.
Opiate system- numbing.
- Neuroendocrine: HPA axis (cortisol).
Brain structures
- Prefrontal cortex
- Hippocampus
- Hypothalamus
- Amygdala
Social/Environmental factors
- Protective role of support/validation.
- Endemic violence/insecurity.
- Role of media
- Natural causes vs. human violence
- Shared “meaning-making” of traumatic experiences.
PTSD: Risk factors
Pre-trauma predictive factors.
Predictive factors during and after trauma
Assessment and Tx: Acute aftermath- golden hour
Goal: ERASER
E- reduce Exposure to stress.
R- Restore physiological needs.
A- Provide Access to information/orientation.
S- Locate Source of support.
E- Emphasise expectation of returning to normal.
Assessment and Tx: Acute aftermath- golden hour- what not to do
3 P’s
Do not: pathologise, psychologise, and pharmacologise
ASD Tx
‘watchful waiting’ and reassurance recommended in first 4 weeks after trauma.
No evidence for routine use of medication.
Must educate victim and carers about symptoms, when to seek help, as well as what treatments are available.
Aim is to normalize the experience and provide reassurance that only a minority of people will develop PTSD
PTSD Screening
Screen for symptoms using a valid and reliable tool such as the Primary Care PTSD Screen for DSM -5 (PC-PTSD-5)
PTSD: Course
Duration of symptoms vary, approximately half recover completely within 3 months.
May have waxing and waning course with symptom reactivation in response to reminders of trauma
Co-morbidity is rule rather than exception: Depression, Substance abuse, other anxiety disorders, personality disorders, bulimia.
Impact on clinicians
“Contagiousness” of trauma
Trauma fatigue / burnout
Need for introspection, self reflection
Support - individual or group
Ethical / legal concerns
Conflicts around confidentiality / child protection, military/police etc.
Advocacy role
