PTSD Flashcards
what are the 4 groups of symtpoms according to DSM 5
- intrusion symptoms
- avoidance
- negative alterations in cognition and mood
- alterations in arousal and reactivity
how severe must the symtoms be for diagnosis
enough to impair function
how common are comorbid conditions in PTSD
very common - 80%
eg depression, anxiety, anger and substance misuse
is PTSD related to suicide
it has a stronger association than any other anxiety disorder - x6
what is the difference between centrifugal and centripetal disasters
- Centrifugal disasters are where the people are together only at the moment of disaster (e.g. plane crash), centripetal disasters are in an existing community
who is more likely to be exposed to trauma
- Certain groups are more likely to be exposed to trauma, e.g. refugee, military, police, emergency service workers
- Higher frequency exposure in inner cities and where natural disasters occur
- The poor and marginalized are more likely to be victims
what is type 1 trauma
single incident trauma, unexpected
what is type 2 trauma
complex, repetitive trauma eg ongoing abuse, betrayal of trust relationship
does type 1 or 2 trauma have a higher risk for PTSD
type 2
in which type of trauma does the victim often ‘freeze’ - tonic immobility
sexual assault
what is tonic immobility
an involuntary state or profound, reversible motor inhibition
a survival instinct when the threat is decieded to be inescapable
what is peri traumatic dissociation
disturbed awareness, impaired memory or altered perceptions during and immediately after a traumatic experience
what does peri traumatic dissociation increase the likelihood of
PTSD
which brain areas are responsible for actions during threat and fear
the amygdala, hippocampus and midbrain areas (superior colliculi and PAG)
shift away from pre frontal cortex - reasoning and making integrated decisions
what are the 2 types of memory
- conscious memory - hippocampus
- emotional memory - amygdala
- can recognise and remember danger
what is wrong with memory of the traumatic event in PTSD
- improper storage of traumatic event in implicit memory
- cant remember key features about event
- memories are based on fear and emotional memory (amygdala)
what is different about the hippocampus in PTSD
smaller
which side of the hippocampus is damaged in adult and childhood trauma
right in adult and left in childhood
when do hippocampal changes occur
from 6 months after trauma
what does current hippocampal size correlate to
current severity of PTSD
- small hippocampus could be a risk factor for lack of recovery
- or PTSD effects on hippocampal size could be reversible as PTSD recovers
what happens to amygdala activity in PTSD
increased - failure of the prefrontal networks to regulate it - hyperreactivity to threat
what can the timeless quality of traumatic memory be attributed to
right hemispheric lateralization
what are cortisol levels like in PTSD
low !
what happens to the cortisol feedback system in PTSD
- normally puts a stopper on the stress adrenaline release response
- however in PTSD, the negative feedback system is oversensitive so low levels of cortisol inhibit the production of ACTH and CRH - failure to contain sympathetic response - consolidation of traumatic memories
what changes occur in Brocas area in PTSD
decreased regional CBF when individuals access personal traumatic memories - this means that emotional memories are stronger than higher cortical memories
is inidividuals having negative views of themselves pre trauma a risk factor PTSD
yes. conversly strong optimisic beliefs can act as a buffer to developing PTSD
is thre a diference inhow males and females cope with trauma
males cope better
do different ages cope with trauma better or worse
extremes of age and development are pre traumatic risk factors
are behavioural problems pre traumaic risk factors
yes
which types of event are more likely to cause PTSD
human made, not natural
does event duration affect development of PTSD
prolonged exposure is a risk factor
management of someone with mild/moderate symptoms presenting <3 months after trauma
watchful waiting
what psychological treatments are indicated
- trauma focused CBT
- eye movement desensitization and reprocessing
- non trauma CBT
is there an indication for pharamcotherapy
can be used symptomatically for acute phases
ADs can be used to reduce the severity of core symptoms
what are the first and second line agents
1 - paroxetine and mirtazapine
2 - amitriptyline or phenelzine
