PTSD Flashcards
DSM 5 criteria for PTSD
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 (event must be violent or accidental)
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
Traumatic event is persistently reexperienced
1) recurrent and intrusive distressing recollections
2) recurrent distressing dreams
3) Dissociative reactions: acting or feeling as if reliving the event. Continuum: to complete loss of awareness of the present
4) intense psychological distress at exposure to internal or external cues
5) physiological reactivity to exposure to cues
Intrusions
How does Avoidance have a role in PTSD
Persistent avoidance of stimuli associated with the trauma
1) efforts to avoid distressing memories, thoughts, feelings, about the
traumatic event
2) avoid external reminders activities, places or people, conversations, objects, situations that arouse recollections
Ways in which Avoidance leads to numbing
Negative alterations in cognitions and mood
1) inability to recall important aspects of the trauma
2) Persistent and exaggerated negative beliefs or expectations about self, others or world
3) Persistent, distorted cognitions about the cause or consequences of the event
4) Persistent negative emotional state (fear, guilt, shame, anger)
5) markedly diminished interest or participation in activities
6) feeling of detachment or estrangement from others
7) Persistent inability to experience positive emotions
1) Sleep Disturbance, difficulty falling or staying asleep
2) Irritability or outbursts of anger
3) Difficulty concentrating
4) Hypervigilance
5) Exaggerated startle response
6) Reckless or self-destructive behaviors
Hyperarousal seen in PTSD
Explain Horowitz Theory of Integration
It’s being on a continuim:
Over control: numbing/denial/dissociation leading to negative alterations in mood
to
Under-control: flashbacks/nightmares/hyperarousal which are intrusive
PTSD:
- Duration of symptoms is more than ____
- Disturbance causes significant distress or impairment in :
1 month
social, occupational, or other important areas of functioning
How prevalent are traumatic events
80% of population exposed to traumatic event
Disasters may create significant impairment in 40% to 50% of those exposed
Up to 45% of those exposed to natural disastermay develop PTSD or major depression or other psychiatric symptomotology
How prevelant is PTSD in population; what about veterans
• Adults 18 and older – 6.8%
- Men – 3.6%
- Women – 9.7%
vs Veterans
- Men – 30.9%
- Women – 26.9%
What are crisis related synmptoms
Anxiety, Panic, Elevated Startle Response, Insomnia, Anger, Helplessness, Depression
Suicidal Ideation, Impulsivity, Violence, Self-Medication
What are the Three Key brain areas involved in PTSD and how are they affected?
Amygdala: activation
Hippocampus: reduced volume
Prefrontal cortex:Less activation
Set of nuclei at the center of each temporal lobe; – dozen distinct areas, two involved in fear conditioning
Amygdala
Amygdala Receive inputs from ___and____;
has_____and____ outputs
senses and memory
physiologic and behavioral
What routes do the amygdala take when processing information
Quick and dirty route” vs. cortical route makes processing implicit (no conscious effort required)
What part of the amygdala receives inputs from the autidory coretx and auditory thalamus
What part of Amygdala gives output to the Central gray, Lateral hypothalamus, adn Paraventricular hypothalamus
Central Amygdala
The following areas receive input from Central Amygdala and are responsible for what fnx?
Central Gray:
Lathera Hypothalamus:
Paraventriclar Hypothalamus:
Central Grey: freezing
Latheral Hypothalamus: Blood Pressure
Paraventricular Hypothalamus: Hormones
The_____ contextualizes fear and regulates it on the basis of the situation we are in (i.e. a lion in the zoo fascinates; a lion on the street invokes fear)
• Context is a psychological construction…a memory created on the spot about the various factors involved in a situation
hippocampus
What is the difference between a health and unhealthy hippocampus
Reduced hippocampal volume may be related to memory dysfunction in PTSD:
debate is do people have premorbid hippocampus, thus are predisposed to PTSD
What is the relationship between the Prefrontal cortex and the Amygdala
PFC and Amygdala are RECIPROCALLY related…when PFC is activated, the Amygdala is inhibited, making it harder to express fear.
(behavior of animals with PFC damage is similar to humans with PTSD: they develop fear reactions that are highly unregulated)
How is the Amygdala connected to the PFC
Amygdala is only connected to the Medial part of PFC
while Lateral and medial are connected, only Medial goes to amygdala
Describe three main brain areas that are related to PTSD
Dysfunction in 3 main brain areas related to PTSD
- Hyperactivity of the A has been shown in neutral conditions
- PFC and A activation are inversely related
- H decreased volume
Traumatic memories are stored in a state of high physiologic arousal.
Traumatic events are state dependent thus how do we access them?
Traumatic memories must be accessed in a state of similar emotional arousal.
Describe behavioral treatment for PTSD
- Anxiety attempts to avoid fear-evoking stimuli
- PTSD (avoidance) blocks exposure that promotes extinction
- Focus on exposure treatments to facilitate extinction
