PTSD Flashcards
How is PTSD defined by DSM 5?
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Exposure to actual or threatened death, serious injury or sexual violence (1 or more)
- Directly experiencing the traumatic event
- Witnessing in person, the event(s) as it occurred to others
- Learning that it occurred to close family member or close friend (even must be violent or accidental)
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
What are the 3 symptoms clusters of PTSD?
- Intrusions
- Avoidance
- Hyperarousal
What are intrusions?
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Traumatic event is persistently re-experienced
- Recurrent & intrusive distressing recollections
- Recurrent distressing dreams
- Dissociative rxns: acting or feeling as if reliving the event (Continuum: to complete loss of awareness of the present)
- Intense psychological distress at exposure to internal or external cues
- Physiological reactivity to exposure to cues
What is avoidance?
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Persistent avoidance of stimuli associated w/ the trauma
- Efforts to avoid distressing memories, thoughts, feelings, about the traumatic event
- Avoid external reminders activities, places or people, conversations, objects, situations that arouse recollections
What is the “numbing” process that is a component of avoidance?
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Negative alterations in cognitions & mood (“numbing”)
- Inability to recall important aspects of the trauma
- Persistent & exaggerated negative beliefs or expectations about self, others or world
- Persistent, distorted cognitions about the cause or consequence of the event
- Persistent negative emotional state (fear, guilt, shame, anger)
- Markedly diminished interest or participation in activities
- Feeling of detachment or estrangement from others
- Persistent inability to experience positive emotions
What is hyperarousal?
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Persistent symptoms of increased arousal, marked alterations in arousal & reactivity
- Sleep disturbance, difficulty falling or staying asleep
- Irritability or outbursts of anger
- Difficulty concentrating
- Hypervigilance
- Exaggerated startle response
- Reckless or self-destructive behaviors
What is the Horowitz Theory of Integration?
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Over-control
- Numbing
- Denial
- Dissociation
- *negative alterations in mood & cognitions
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Under-control
- Flashbacks
- Nightmares
- Hyperarousal
- *intrusions
PTSD
Duration of symptoms > ______
Disturbance causes significant _____ or _________ in social, occupational or other important areas of functioning
>1 month
distress, impairment
What is the prevalence of traumatic events in PTSD?
- 80% of population exposed to traumatic event
- Disasters may create significant impairment in 40-50% of those exposed
- Up to 45% of those exposed to natural disaster may develop PTSD or major depression or other psychiatric symptomatology
What are the crisis-related symptoms of PTSD?
- Anxiety, Panic
- Elevated startle response
- Insomnia
- Anger
- Helplessness
- Depression
- Suicidal ideation
- Impulsivity
- Violence
- Self-Medication
What are the 3 key neurobiological players of trauma?
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Amygdala
- PET imaging shows amygdala activation to traumatic vs. neutral stimuli
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Hippocampus
- Reduced hippocampal volumes
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Prefrontal cortex
- LESS activation
What are some highlights of the amygdala regarding PTSD?
- Set of nuclei at the center of each temporal lobe
- Dozen distinct areas, 2 involved in fear conditioning
- Receive inputs from senses & memory; physiologic & behavior outputs
- “Quick & dirty route” vs. cortical route makes processing implicit
- No conscious effort required
- **Amygdala activation mediates anxiety **
How are defense responses elicited from the amygdala?
Innate or learned sound –> Auditory Thalamus –> Auditory Cortex –> Lateral Amygdala –> Central Amygdala
- From the Central Amygdala:
- Central Gray: Freezing
- Lateral Hypothalamus: BP
- Paraventricular Hypothalamus: Hormones
What are some highlights of the hippocampus regarding PTSD?
- The hippocampus contextualized fear & regulates it on the basis of the situation we are in
- Context is a psychological construction; a memory created on the spot about the various factors involved in a situation
_________ hippocampal volume may be related to memory dysfunction in PTSD.
Reduced hippocampal volume may be related to memory dysfunction in PTSD
Prefrontal Cortex-Amygdala Pathways
What are the 3 types of therapy pathways?
Different pathways for 3 different types of therapy
- Talk therapy (PFC-L; not directly connected to A)
- CBT (PFC-M; directly connected to A)
- Drug (directly connected to A & other brain areas)
