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
What method is this:
Flooding (implosive therapy)
balanced with:
Systematic Desensitization
Behavioral Deconditioning
What is the structure of Cognitive Behavioral Therapy
Look at the Fear structure:
Physiological responses + Ascribed meaning
What brain pathways are involved in Talk therapy?
PFC-Lateral: not directly connected to the AMygdala
What brain pathways are involved in CBT?
PFC-Medial; directly connected to amygdala
What brainpathways are invovled in drug therapy:
Drug (directly connected to A and other brain areas)
What types of Cognitive Behavioral Therapies are the most effective?
Stress Innoculation Training
Imagery Rescripting and Reprocessing Therapy
Cognitive Restructuring Within Reliving
Imaginal/In Vivo Exposure
Prolonged Imaginal Exposure
Cognitive Processing Therapy
Physician Screen tool for Type I trauma
- Have you experienced any vivid thoughts about the accident/injury?
- What do you believe is the cause of the accident/injury?
- Are you able to return to the place of the accident/injury?
- What do you think could be done to prevent the accident/injury?
What types of changes do we look for when screening individual who experienced a traumatic event?
- Problems with concentration
- Sleep disturbances
- Hypervigilance/increased startle response
- Increased irritability
- Changes in mood
- Changes in appetite
What changes are suggesting and used in the Physician Screening tool for Type II trauma (multpile/prlonged)
- Somatic complaints; all diagnostic testing is negative
- Chronic depression and/or anxiety
- Difficulty sleeping
- Difficulty concentrating
• Memory problems: chunks of time during childhood that are not remembered
Flashback, nightmares or images of the past that continually intrude
Startle response greater than witnessed in others
Difficultwithappetite/foodortexturesthatare unappealing
Difficultyidentifying,experiencing,toleratingor expressing anger
Problems knowing who to trust
suggestive of Type II trauma
Comorbidities associated with PTSD
- Panic Disorder
- Agoraphobia
- OCD
- Social Phobia
- Specific Phobia
- Major Depressive Disorder • Somatization Disorder
• Substance-Related Disorders
