PTSD

Question 1

Define PTSD

Answer 1

an intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event

Question 2

RFs PTSD

Answer 2

• Exposure to a major traumatic event* → professions at risk (police, army, doctors…), groups at risk (refugees and asylum seekers)
• Pre-trauma → previous trauma, Hx of mental illness, females, low socioeconomic background, childhood abuse
• Peri-trauma → severity of trauma, perceived threat to life…
• Post-trauma → concurrent life stressors, absence of social support

Question 3

CFs

Answer 3

Must occur within 6 months of the event + divided into 4 categories:

1. Reliving the situation → flashbacks, vivid memories,
2. Avoidance (reminders of the trauma) → includes inability to recall aspects of the trauma
3. Hyperarousal (irritability to outbursts, difficult to sleep, difficult conc, hypervigilance, exag. Startled response)
4. Emotional numbing (negative thoughts about oneself, difficult experiencing emotions, feeling of detachment from others, giving up enjoying activities)

Question 4

Ix PTSD

Answer 4

• CT head (brain injury)

* Questionnaires: Trauma screening questionnaire and post-traumatic diagnostic scale

Question 5

Rx PTSD

Answer 5

PTSD (symptoms <3months)
•	Mild: Watchful waiting
•	Trauma focused CBT
•	Short term drug Rx for sleep disturbance → zopiclone (non-benzodiazepine hypnotic)
•	Risk assessment

PTSD (symptoms >3months)
• Trauma focussed psychological intervention
o EITHER CBT
o OR eye movement desensitisation and processing (EDMR) → a form of psychotherapy
o Drug Rx (if psychotherapy not working) → Paroxetine, mirtzapine (TCA), amitriptyline, phenelzine

Question 6

Define adjustment disorder

Answer 6

• Normal adjustment refers to psychological reactions involved in adapting to new circumstances
• Adjustment disorder: when there is significant distress (greater than expected), accompanied by impairment of social functioning

Question 7

Pathophysiology + aetiology

Answer 7

Caused by an identifiable stressor (e.g. physical illness)

Question 8

CFs adjustment disorder

Answer 8

• Identifiable (non-catastrophic) psychological stressor (redundancy, divorce…) w/in 1 month of onset of symptoms
• Symptoms must be present for <6months
• Symptoms = clinically significant (marked distress + impairment of normal functioning)
• Subthreshold manifestations of: mood disorders, anxiety disorders, stress-related disorders, somatoform disorders, or conduct disorders

Question 9

Rx adjustment disorder

Answer 9

• Psychological → supportive psychotherapy (enhance the capacity to cope w/ a stressor) → financial support, OT assessment, support groups, cares, childcare
• Pharmacological → if Sx’s persistent + distressing or psychological Rx failed → SSRIs or anxiolytics/hypnotics