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Module 3 > PTSD > Flashcards

PTSD Flashcards

1
Q

What is PTSD?

A

3 main cluster of symptoms, lasting longer than 4 weeks:

  • Re-experiencing
  • Hyperarousal
  • Avoidance

HAS TO BE EVIDENCE OF SEVERE TRAUMA.

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2
Q

What is reliving?

A

Flashbacks
Recurring memories related to the traumatic event
Recurring dreams of the event.

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3
Q

What is hyperarousal?

A

Difficulty falling asleep
Irritability/anger outbursts
Difficulty concentrating
Startle response

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4
Q

What is avoidance?

A

Efforts to avoid thoughts, feelings associated with trauma.

Avoid activities, places and people that remind them of it.

Feeling detached and reduced interest in participation in general activities.

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5
Q

What was the DSM-5?

A

Negative alterations in cognitions and mood.

Persistent negative cognitions about self and others.

Negative emotional state.

Diminished interest in significant activities and inability to experience positive emotions.

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6
Q

What are the types of trauma?

A

Type I : Single event

Type II: Prolonged and repeated trauma

Interpersonal vs natural disaster

Intergenerational trauma

Catastrophic trauma

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7
Q

What is the aetiology of PTSD?

A

Not really known.

Heritability 30%
Impaired sensitivity of HPA axis.

Reduced hippocampal volume.

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8
Q

What is the prevalence of PTSD?

A

8% in general population.

31% of Vietnam veterans.

More prevalent n interpersonal trauma than disaster victims.

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9
Q

What is important in history taking in PTSD?

A 
Current mental state
Past psychiatric symptoms
Developmental history 
Employment history
Substance abuse

Risk to self and others
What led to the breakdown
Suicidal thoughts

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10
Q

What are some comorbidities?

A

Alcohol abuse
Drug abuse
MDD
Physical conditions

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11
Q

What is the treatment?

A

Watchful waiting in mild/moderate

Pharmacotherapy

Psychological interventions (trauma focused CBT)

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12
Q

What does management involve?

A 
Evaluate severity of PTSD
Evaluation of risk to self and others
Treat comorbidity
Physical health checks
Social support
Voluntary work
Carers assessment
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13
Q

How have the DSM classifications changed over time?

A

DSM I classed patients as fundamentally resilient and able to bounce back, underlying individual weakness.

DSM II- underlying character weakness or constitutional vulnerability

DSM IV (2000): Normal response to catastrophic trauma

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14
Q

What are the problems with the current DSM classification?

A

Complex PTSD- this is extreme stress that is not specified in criteria. There is an enduring personality change. (problem for insurance based healthcare as you cant diagnose them)

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15
Q

What is EPCACE and how is it diagnosed?

A

This is when ICD added a new diagnostic category: Enduring personality change after catastrophic experience.

It is a change of at least 4 years duration in a persons pattern of perceiving/relating to the environment and self following exposure to catastrophic stress.

There has to be evidence of struggle during childhood/adolescence. There can be no prior personality disorder, or brain injury/mental health disorder.

CATASTROPHIC TRAUMA NECESSARY

Permanent hostile attitude, social withdrawal, feeling empty/hopeless.

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16
Q

What is the definition of catastrophic trauma?

A

Prolonged exposure to life threatening circumstances, with imminent possibility of being killed. (war trauma, concentration camp etc.)

17
Q

What did the systematic review into PTSD find?

A

There are no prospective studies that have investigated long term personality change following trauma.

Research quality is also poor- researchers did not exclude prior pathology, retrospective events susceptible to recall bias, no controls.

18
Q

What did the case control study find?

A

Additional personality pathologies which are not listed in ICD-10 for EPCACE which were observed in 50% of EPCACE patients included:

Frequent mood changes
Impulsivity
Identity problems
No desire for intimacy
Increased suicide ideation.
19
Q

What was done in 2018 with ICD-11?

A

PTSD- Keep three clusters of symptoms

Got rid of EPCACE

Introduce complex PTSD as a new diagnostic category.

20
Q

So what is ICD-11?

A

Exposure to an event or series of events of extremely threatening or horrific nature, most commonly prolonged events from which escape is difficult or impossible (torture, sexual abuse, war etc)

Meet PTSD criteria. Additionally:

  • Affect regulation
  • Feelings of worthlessness, shame and guilt
  • Difficulties sustaining relationships
21
Q

What are the issues with ICD-11?

A

Alot of overlap with criteria for PD. Diagnostic confusion?

Risk factors the same for CPTSD and PD.

Preference for CPTSD (stigma attached to PD diagnosis)

Treatment for CPTSD vs treatment for PD.

Module 3 (25 decks)

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