PTSD

Question 1

Which areas of the brain are affected in PTs with PTSD?

Answer 1

medial prefrontal cortex, amygdala, pituitary, hypothalamus

Question 2

What is the PTSD Checklist for DSM-5?

Answer 2

list of 20 questions relating to symptoms of PTSD scored from 0 to 4 - score of 38 out of 80 is associated with a diagnosis of PTSD

Question 3

What is Criterion A for PTSD in the DSM-V?

Answer 3

exposure to actual or threatened death, serious injury, or sexual violence: directly, witnessing in person, learning about a close family member/friend, exposure to aversive details of traumatic events (does not include exposure through electronic media/TV/movies/pictures)

Question 4

What is Criterion B for PTSD in the DSM-V?

Answer 4

presence of one or more intrusion symptoms associated with the traumatic event: recurrent memories, recurrent dreams, flashbacks, intense psychological distress at exposure, marks physiological reactions to cues

Question 5

What is Criterion C for PTSD in the DSM-V?

Answer 5

persistent avoidance of stimuli associated with the traumatic event: avoidance of memories/thoughts/feelings and avoidance of external reminders that arouse distressing memories

Question 6

What is Criterion D for PTSD in the DSM-V?

Answer 6

negative alterations in cognitions and mood associated with the traumatic event: dissociative amnesia, persistent and exaggerated negative beliefs about oneself, distorted cognitions about the cause or consequence of the traumatic event, markedly diminished interest in significant activities, detachment/estrangement from others, inability to experience positive emotions

Question 7

What is Criterion E for PTSD in the DSM-V?

Answer 7

marked alterations in arousal and reactivity associated with the traumatic event: irritability, reckless/self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance

Question 8

What is Criterion F for PTSD in the DSM-V?

Answer 8

duration of the disturbance (criteria B, C, D, E) is more than one month

Question 9

What is Criterion G for PTSD in the DSM-V?

Answer 9

disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Question 10

What is Criterion H for PTSD in the DSM-V?

Answer 10

disturbance is not attributable to the physiological effects of a substance or another medical condition

Question 11

What are the two subtypes of PTSD?

Answer 11

(1) with dissociative symptoms - individual experiences depersonalization (perception of being outside observer of one’s mental processes or body) or derealization (unreality of surroundings) and (2) with delayed expression - full diagnostic criteria not met until at least 6 months after the event

Question 12

What is the first line medication treatment for PTSD?

Answer 12

6 to 8 week trial of selective serotonin reuptake inhibitors (SSRIs)

Question 13

What are the usual and therapeutic doses of paroxetine (Paxil) for treatment of PTSD?

Answer 13

20 mg starting and 20-60 mg therapeutic

Question 14

What are the usual and therapeutic doses of sertraline (Zoloft) for treatment of PTSD?

Answer 14

50 mg starting and 50-200 mg therapeutic

Question 15

What are the usual and therapeutic doses of fluvoxamine (Luvox) for treatment of PTSD?

Answer 15

50 mg starting and 100-300 mg therapeutic

Question 16

What are the usual and therapeutic doses of fluoxetine (Prozac) for treatment of PTSD?

Answer 16

20 mg starting and 20-60 mg therapeutic

Question 17

What are the usual and therapeutic doses of citalopram (Celexa) for treatment of PTSD?

Answer 17

20 mg starting and 20-40 therapeutic

Question 18

What are the usual and therapeutic doses of escitalopram (Lexapro) for treatment of PTSD?

Answer 18

10 mg starting and 20-30 therapeutic

Question 19

What are the usual and therapeutic doses of venlafaxine (Effexor) for treatment of PTSD?

Answer 19

37.5 mg starting and 37.5-300 mg therapeutic

Question 20

What have been the major changes in the definition of Criterion A of PTSD between DSM-III and DSM-V?

Answer 20

“outside the range of usual human experience … markedly distressing to almost anyone” (DSM-III) deemed too vague; “response involved intense fear, helplessness, or horror” (DSM-IV) removed - not the emotions most highly associated with PTSD; limited vicarious trauma to individuals interpersonally close to the trauma victim

Question 21

What are the common pathways to the development of acute stress disorder and PTSD?

Answer 21

peritraumatic panic (panic occurring at the time of the trauma), anxiety sensitivity, negative cognitions about oneself

Question 22

What is acute stress disorder?

Answer 22

describes acute posttraumatic symptoms 2 days to 1 month following traumatic exposure - includes symptoms of intrusion/re-experiencing, avoidance, arousal and requires dissociative symptoms

Question 23

What is accelerated resolution therapy?

Answer 23

brief exposure-based therapy for PTSD delivered in 1-5 sessions over a 2-week time frame - includes a narrative component (imagery rescripting), in vivo and/or imaginal exposure, cognitive restructuring, and relaxation/stress modulation

Question 24

What are the best evidence-based, trauma-focused psychotherapy approaches for addressing PTSD?

Answer 24

cognitive processing therapy, prolonged exposure, eye movement desensitization and reprocessing (EMDR)

Question 25

What is prolonged exposure therapy for PTSD?

Answer 25

asking patients to repeatedly recount the trauma to extinguish fear associated with the memory (imaginal exposure) or practice facing trauma reminders and triggers in the real world (in vivo exposure) - 9-12 weeks of 90 minute sessions

Question 26

What is cognitive processing therapy?

Answer 26

changing maladaptive beliefs related to the trauma - with an option of writing an account of the trauma

Question 27

What is EMDR?

Answer 27

comprises exposure and cognitive restructuring but asks patients to maintain dual focus on an external stimulus (eye movement tracking of therapist hand movements) while thinking about the trauma

Question 28

What are common pretrauma risk factors for developing PTSD?

Answer 28

gender, age at trauma, ethnicity, lower education, lower SES, previous trauma, general childhood adversity, personal/family psychiatric history, reported childhood abuse, poor social support, initial severity of reaction to the traumatic event

Question 29

What are the four core clusters of symptoms of PTSD in children?

Answer 29

intrusion, avoidance, negative alterations in cognition/mood, hyperarousal - marked difference from child's behavior prior to the traumatic event and cause significant distress or impairments in role functioning

Question 30

What is dissociation?

Answer 30

disruption of the usually integrated functions of consciousness, memory, identity, awareness of body/self/environment

Question 31

What are common dissociative symptoms seen in PTSD?

Answer 31

decreased responsiveness to external stimuli (emotionally/physically numb, blunted affect, robotic movements), memory impairment, disturbance of identify and awareness

Question 32

How does CBT work?

Answer 32

cognitive approaches help patients correct erroneous cognitions while behavioral approaches aim to decrease symptoms through exposure to reminders of the traumatic event

Question 33

How does avoidance perpetuate PTSD?

Answer 33

avoiding triggers can interfere with the extinction of fear by limiting the amount of exposure to realistically safe reminders of the traumatic event

Question 34

What is the basis of psychotherapy for PTSD as described in emotional processing theory?

Answer 34

PTSD emerges due to the development of a fear network that fails to be disrupted due to escape and avoidance behaviors - extinguishing the fear requires (1) activation of the fear memory and (2) replacement of the fear response with corrective information about the trigger (e.g., that it cannot harm the patient)

Question 35

What is cognitive therapy?

Answer 35

meanings we impose on events contribute to emotional states - changing how we think about them can reduce PTSD symptoms and improve well being (uses Socratic questioning)

Question 36

What is cognitive processing therapy?

Answer 36

PTs writes a detailed account of the trauma and reads it in the presence of the therapist and at home - helps challenge faulty assumptions and self-statements and modifies maladaptive thoughts and over-generalized beliefs

Question 37

Which types of psychotherapy are recommended in PTs with PTSD?

Answer 37

exposure therapy - PTs with extreme fear and avoidance; cognitive therapy - PTs with extreme guilt and trust issues; virtual reality - PTs who are highly avoidant

Question 38

What is the role of D-cycloserine in PTSD?

Answer 38

has shown promise in augmenting extinguishing of fear through exposure therapy for patients with several types of anxiety orders (has not yet been proven effective in PTSD)

Question 39

Which drugs can be used to treat insomnia/sleep disturbance in PTSD?

Answer 39

mirtazapine (Remeron) and trazodone (Desyrel)

Question 40

Which drugs can be used to treat irritability, aggression, and impulsiveness in PTSD?

Answer 40

carbamazepine (Tegretol) and valproic acid (Depakote)

Question 41

Which drugs can be used to treat hyperarousal in PTSD?

Answer 41

clonidine (Catapres) and propranolol (Inderal)

Question 42

Why should benzodiazepines be used cautiously in the treatment of PTSD?

Answer 42

many PTs with PTSD suffer from comorbid substance abuse disorder

Question 43

What are second line pharmacological treatments for PTSD if SSRIs are ineffective?

Answer 43

quetiapine or risperadol - monitor weight gain, lipids, and blood sugar