PTSD Flashcards
Define PTSD?
Is a mental disorder diagnosed after an exposure to trauma, including actual or threatened death, serious injury, or sexual violation. It is characterized by intrusive and distressing memories or dreams, dissociative reactions, and substantial psychological or physiological distress related to the event.
Define Trauma?
Trauma – an event that is violent and life threatening to the extent that it evokes feelings of fear ,helplessness and terror in the person experiencing it.
What are the risk factors for PTSD?(10)
1.Psychiatric co-morbidity
2.Early childhood experiences(neglect , physical or emotional abuse)
3.Prior traumatic exposure or repeated exposure to reminders
4.Lack of social support
5.Gender (women>men)
6.Genetic Factors
7.Neurobiological factors
8.Type and severity of the trauma (intentional vs unintentional trauma)
9.Socioeconomic factors : Low status/education
10.Temperamental traits : inappropriate coping strategies and negative appraisals
What are the neurobiological factors associated with PTSD?(3)
1.HPA dysfunction
2.Underdeveloped hippocampus
3.History of severe illness
Describe the pathophysiology of the HPA dysfunction and how it results in PTSD?
Hypothalamic- Pituitary Axis dysfunction- normally the hypothalamus releases corticotropin releasing hormone which stimulates the pituitary gland to release adrenocorticotropin hormone which causes the release of cortisol. Now in PTSD cortisol levels are low whilst CRH levels are high. This results in stimulation of noradrenaline giving an increased sympathetic nervous system response. And this can manifest as tachycardia, HTN, increased startle response and hyperarousal, all of which I seen in PTSD.
How does an underdeveloped hippocampus put one at risk of PTSD?
Underdeveloped hippocampus :the hippocampus helps regulate the HPA axis. A smaller hippocampus may lead to less effective HPA axis regulation resulting in overactive stress response resulting in the symptoms we mentioned in the above explanation.
Which mental disorders are usually comorbid with PTSD ?(4)
- Depressive disorders
2.Anxiety disorders
3.Substance Use (Alcohol) - Borderline Personality Disorder
What are the 4 categories in which the signs and symptoms of PTSD are categorized into?
- Re-experiencing the traumatic event
2.Avoidance and numbing - Increased anxiety and emotional arousal
- Negative alteration in cognition and mood
What are the intrusive thoughts experienced by someone with PTSD?
1,Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
2.Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). In children, there may be frightening dreams without recognizable content.
3.Dissociative reactions (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.) In children, trauma-specific reenactment may occur in play.
4Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5.Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s
- recurrent, intrusive , distressing , involuntary memories of the event
- Flashbacks / dissociative reactions
3.Nightmares/recurrent distressing dreams - Feelings of intense or prolonged distress when reminded of trauma
- Intense physical reaction to reminders of the event/external or internal cues that symbolize it resemble an aspect of the traumatic event (muscle tension, nausea , vomiting,sweating, pounding ear & rapid breathing)
What are the symptoms of avoidance experienced by someone suffering from PTSD?
1.Avoidance of the distressing memories, thoughts and feelings closely associated with the traumatic event.
2.Persistent avoidance of external reminders: activities, places, people, conversations, objects and situations that arouse the distressing feelings associated with the traumatic experience.
3.Feeling emotionally numb
What are the symptoms of arousal and anxiety experienced by someone suffering from PTSD?(5)
1.Aggressive or irritable
2.Difficult concentrating
3.Hypervigilance (on constant “red alert”)
4.Feeling jumpy and easily startled
5.Difficult falling or staying asleep
What are the symptoms of negative cognition and mood alteration experienced by someone with PTSD
1.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).
2.Persistent and exaggerated negative beliefs/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”).
3.Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
Feelings of detachment or estrangement from others.
6. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Criterion E (Changes in Arousal)
- Persistent negative emotional state
2.Anhedonia - Inability to experience positive emotions - inability to experience happiness, satisfaction or love feelings
- Persistent, distorted cognition about the cause or consequences of the traumatic event that leads to the individual blaming themselves.
5.inability to remember important aspects of the trauma - dissociative amnesia - Persistent and exaggerated negative beliefs about oneself
Besides the 4 categories what are other symptoms someone suffering from PTSD experience?(6)
1.Feelings of mistrust
2.Depression and hopelessness
3.Feeling alienated and alone
4.Suicidal thoughts and feelings
5.Dissociation: Depersonalization/ derealization
6.Self medicate : Alcohol and drug use
Define Depersonalization?
this involves feeling disconnected from oneself, as if observing one’s own thoughts, feelings, body or actions from outside. As if you’re watching yourself from a distance.
Define Derealization?
Derealization-involves a sense of detachment from one’s environment. These people feel like the world around them is strange, dreamlike, foggy or unreal. Objects people or surroundings may seem distorted, unfamiliar or colorless.
Describe the DSM5 criteria for PTSD pertaining to those above the age of 6?
A. Exposure to actual or threatened death, serious injury, or sexual violence .
B. Presence of at least 1or more of intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred.
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred evidenced by at least 1 of the symptoms.
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred evidenced by at least 2 of the symptoms
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred evidenced by at least 2 of the symptoms.
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G. The disturbance causes. clinically significant distress or impairment in social, occupational, or other important areas of functioning
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
What pneumonic is used for PTSD and describe it?
Traumatic event
Re-experiences
Avoidance
Unable to function
Month(at least 1)
Arousal
List 10 differentials and how to differentiate them from PTSD?
1.Adjustment stress disorder –is an excessive and abnormal reaction to a life stressor and it doesn’t necessarily have to be trauma.
2.Acute Stress Disorder - there is a restriction of the duration of symptoms being between 3 days to 1 month following exposure to the traumatic event.
3.Anxiety disorders- the arousal and dissociative symptoms (panic disorder) or avoidance and irritability ( generalized anxiety disorder) are not linked toa specific traumatic event.
4.Obsessive-compulsive disorder – In OCD, there are also recurrent intrusive thoughts, but, are not related to an experienced traumatic event. Compulsions are also usually present in OCD, while this is absent in PTSD. A compulsion is a repetitive behavior or mental act that an individual feels driven to perform in response to an obsession (excessive handwashing –one might feel anxiety about germs so they will repeatedly wash their hands to alleviate the anxiety)
5.Major depressive disorder- major depression does not include any intrusion or avoidance symptoms
6.Personality disorders- Not associated with interpersonal difficulties unlike PTSD
7.Dissociative disorders- no trauma is required but if the PTSD criteria is met as well subtype “PTSD with dissociative symptoms “ should be considered.
8.Conversion disorder- no trauma required
9.Psychotic disorders- Associated with hallucinations, delusions, illusions and not flashback
10.Traumatic brain injury- hard to differentiate as the symptoms can be the same(concertation, emotional and behavioral changes),disorientation and confusion are more specific to TBI
What are the 2 ways of managing PTSD? and what is the 1st line treatment?
1.Pharmacological management
2.Psychological management
What are the types of Psychological management offered?
- Trauma-focused cognitive behavioral therapy
2.Exposure Therapy
3.Cognitive processing therapy - Eye Movement Desensitization and reprocessing
- Group psychotherapy
6.Family therapy
What is Trauma-Focused CBT?
Combines cognitive behavioral techniques with trauma-specific interventions, to reduce distress, challenge unhelpful thoughts and build coping skills.
What are the core features of Trauma-Focused CBT? And explain them?
1.Psychoeducation: teaches the victim about the normal reactions to traumatic experiences which helps them reduce feelings of guilt about what happened .
2,Coping skills: including relaxation exercises like deep breathing, mindfulness, acceptance, identifying and redirecting thoughts, and other methods.
3,Gradual exposure, which involves gradually introducing the patient to memories of their traumatic experience, with the goal of reconditioning their response to triggers and easing emotional distress.
4,Cognitive processing, which can include developing skills to recontextualize unhelpful feelings and thoughts, and regulate emotions.
5.Caregiver involvement, which may include rebuilding trusting adult relationships for the child and training the caregiver in how to best be a resource for the child.
What is exposure therapy and how is it done? How does it help with PTSD?
1.It involves gradually facing the thoughts and memories of the traumatic event or situations (places where the event occurred) that make one anxious.
2.This can be done by using imaging techniques or by actually returning to the place where one had an accident in a safe, controlled way to help a person face and gain control of fear and distress and learn to cope.
3.Exposure should be gradual and done with help of an experienced clinician
How does cognitive processing therapy work in PTSD?
-It focuses on changing painful negative emotions (such as shame, guilt) and beliefs due to trauma .
-Therapists, help the person confront such distressing memories and emotions by writing about the trauma and identifying cognitive distortion related to it.
-When the write these thoughts down, the therapist uses Socratic questioning(a method of inquiry used to stimulate critical thinking) help the patient question his/her thoughts about the trauma (e.g. the self blaming thoughts ) in order to modify any maladaptive thinking.
-The patient becomes more aware of the relationship between thoughts and emotions and begins to identify “automatic thoughts” that may be maintaining the PTSD symptoms.
-He or She uses those skills to continue evaluating and modifying beliefs related to traumatic events improving overall function and quality of life.
