PTSD

Question 1

Trauma

Answer 1

A negative event outside the range of usual human experience

Question 2

Old and new classification of PTSD

Answer 2

Was with anxiety, not in new category of trauma and stressor related disorders.

Question 3

Diagnostic criteria for PTSD trauma

Answer 3

Exposure to actual or threatened death, serious injury, or sexual violence in one or more ways:

1) Direct exposure
2) Witnessing the event
3) learning the traumatic event happened to a family member or friend
4) Experiencing repeated or extreme exposure to aversive details of the event.

Question 4

Intrusion symptoms

Answer 4

Recurrent and intrusive distressing memories of an event, recurrent distressing dreams of the event, dissociative reactions (flashbacks), intense psychological distress to cues that resemble/symbolize the event, physiological reactivity on exposure to cues.

Question 5

Avoidance

Answer 5

Avoidance of stimuli associated with the trauma, places, thoughts, etc.

Question 6

Negative alterations in cognition and mood

Answer 6

Can’t recall important aspects of the trauma, negative beliefs about oneself, guilt, anhedonia, detachment

Question 7

Alterations in arousal and reactivity

Answer 7

Irritability or outbursts of anger, reckless or self-destructive behavior, hypervigilance, sleep disturbance

Question 8

PTSD includes

Answer 8

Trauma, intrusion symptoms, avoidance behavior, negative alterations in cognition/mood, and alterations in arousal/reactivity. All for greater than one month.

Question 9

Acute Stress Disorder

Answer 9

Basically PTSD for less than 1 month

Question 10

Does everybody who experiences trauma get PTSD?

Answer 10

No, you idiot!

Question 11

How long does PTSD last

Answer 11

80% longer than 3 months, 50% lasts at least 2 years.

Question 12

Predictor of worse outcomes for PTSD

Answer 12

Comorbid medical illnesses, childhood trauma, additional trauma, psych hx, female, alcohol abuse

Question 13

PTSD pathophysiology

Answer 13

Predicted to be a failure to recover from a trauma.

Question 14

Noradrenergic system in PTSD

Answer 14

Abnormal function, sustained hyperactivity of sympathetic nervous system. Increased HR and BP, increased excretion of NE, increased plasma NE.

Question 15

Plasma NE in PTSD?

Answer 15

Increased

Question 16

HPA axis in PTSD

Answer 16

Decreased cortisol, increased CRF, exaggerated suppression by dex suppression test because increased negative feedback sensitivity, increased glucocorticoid receptor sensitivity.

Question 17

HPA axis in MDD

Answer 17

Increased cortisol, decreased sensitivity, decreased CRF, decreased negative feedback. No suppression with dex.

Question 18

Cortisol levels in people who go on to develop PTSD?

Answer 18

Decreased at baseline.

Question 19

Consequences of low cortisol

Answer 19

Increased NE leading to overconsolidation of memories, increased traumatic reminders, etc..

Question 20

Are glucocorticoids useful in the prevention or treatment of PTSD?

Answer 20

Yes.

Question 21

How else can PTSD be treated?

Answer 21

SSRIs – first line.

Question 22

Neurocircuitry of PTSD

Answer 22

Increased sensitivity of the limbic system and decreased cortical inhibition.

Question 23

Is PTSD heritable?

Answer 23

Seems to be, lower CORT in children of holocaust survivors.