PTSD Flashcards
What is the function of the amygdala?
responsible for processing of memory and emotional reactions. Central role in interpreting and reacting to fear.
What brain regions coordinate the fear response?
amygdla, entorhinal cortex, orbitofrontal cortex, cingulate gyrus. Dala lama on rhino thats orbiting and gyrating in space.
What is responsible for manipulating emotions and memory and extincting behavioral response to fear?
medial prefrontal cortex
What pathophysiological mechanisms are thought to underlie PTSD?
1) lack of adequate influence of the medial prefrontal cortex on the amygdala may be responsible for lack of ability to suppress attention and response to triggers. so amygdala is hyperactive and causes hyperarousal/increased intensity of emotional trauma 2) decreased function of hippocampus may contribute to deficits in identifying safe contexts as well as the explicit memory deficits seen in PTSD 3) hypothalamic-pituitary-adrenal axis
What is the function of the hippocampus?
memory and learning as well as control of stress responses and contextual fear response
What are the diagnostic criteria for ASD (acute stress disorder)?
1) Trauma as defined in criterion A of PTSD diagnosis and 9 symptoms 2) disturbance lasts for a minimum of 3 days and a maximum of 1 month and occurs within 4 weeks of the traumatic event.
What is the differential diagnosis of PTSD?
BPD, dissociative disorders, adjustment disorder, specific phobia, panic disorder, mood disorder, schizophrenia, psychotic disorders, substance-induced disorders, psychotic disorders due to a general medical condition
Diagnostic criterion A for PTSD
a. Exposure to actual or threatened death, serious injury, or sexual violence in at least one of following ways:
i. Directly experiencing the traumatic event
ii. Witnessing, in person, the event as it occurred to others.
iii. Learning that the traumatic event occurred to a close family member or close friend. In cases of actual or threatned death of a family member or friend, event must have been violent or accidental.
iv. Experiencing repeated or extreme exposure to aversive details of the traumatic events (doesn’t apply to exposure through media unless work related).
Diagnostic criterion B for PTSD
b. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event, beginning after the traumatic event:
i. Recurrent, involuntary, and intrusive distressing memories of the traumatic events. (can manifest as repetitive play in children).
ii. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event. (for kids, this can be just frightening dreams without recognizable content).
iii. Dissociative reactions (e.g. 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. (kids may reenact trauma in play).
iv. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
v. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event.
Diagnostic criterion C for PTSD
c. Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred, as evidenced by one or both of the following:
i. Avoidance or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events.
ii. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event.
Diagnostic criterion D for PTSD
d. Negative alterations in cognitions and mood associated with the traumatic event(s) beginning or worsening after the traumatic event(s) occurred, as evidenced by at least 2 of the following:
i. 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).
ii. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.
iii. Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame himself/herself or others.
iv. Persistent negative emotional state (e.g. fear, horror, anger, guilt, or shame).
v. Markedly diminished interest or participation in significant activities.
vi. Feelings of detachment or estrangment from others.
vii. Persistent inability to experience positive emotions (e.g. inability to experience happiness, satisfaction, or loving feelings.
Diagnostic criterion E for PSTD
e. Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by 2 or more of the following.
i. Irritable behavior and angry outburst (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
ii. Reckless or self-destructive behavior.
iii. Hypervigilance.
iv. Exaggerated startle response.
v. Problems with concentration.
vi. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
Diagnostic criterion F
f. Duration of the disturbance (Criteria B,C,D, and E) is more than 1 month.
Diagnostic criterion G
g. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Diagnostic criterion H
h. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
