PTSD Flashcards
1
Q
What is PTSD?
A
- An anxiety disorder.
- Associated with experiencing or witnessing single, repeated or multiple events that could include:
- Serious accidents
- Assault (physical or sexual)
- Abuse (including childhood or domestic)
- Work-related exposure to trauma (including remote exposure).
- Trauma related to serious health problems or childbirth experiences (e.g. intensive care admission or neonatal death).
- War and conflict.
- Torture.
- There is much evidence that feelings of guilt, shame, sadness, betrayal, humiliation and anger frequently go with PTSD.
2
Q
How common is PTSD?
What are the most common causative traumas?
A
- Estimated lifetime prevalence: 6.8% (these numbers will change according to the diagnostic criteria used).
- Most common traumas are combat for men and sexual molestation for women.
- It can affect people of any age.
- Not everyone who experiences trauma develops PTSD; only 25-30% of people who experience a traumatic event develop PTSD.
3
Q
Describe the manifestation of PTSD.
What are the issues surrounding help-seeking in sufferers?
A
- Symptoms can develop immediately but in some (<15%) the onset of symptoms may be delayed.
- PTSD sufferers may not seek help for months / years despite considerable distress.
- Assessment of PTSD can, however, present significant challenges as many people avoid talking about their problems when presenting with associated complaints.
- Many sufferers may also believe that it is untreatable posing a barrier to seeking and getting treatment.
4
Q
What are the symptoms of PTSD a patient may present with?
A
- Be aware that people with PTSD (including complex PTSD) may present with functional impairment, including:
- Re-experiencing
- Avoidance
- Hyperarousal (including hypervigilance, anger and irritability)
- Negative alterations in mood and thinking
- Emotional numbing
- Dissociation
- Emotional dysregulation
- Interpersonal difficulties or problems in relationships
- Negative self-perception (including feeling diminished, defeated or worthless)
5
Q
Describe re-experiencing.
A
- Intrusive memories.
- Trauma is re-experienced through intrusive and distressing thoughts, images, flashbacks or nightmares.
- Flashbacks feel ‘real’. Acting or feeling like the event is recurring.
6
Q
What is avoidance?
A
- Avoiding thoughts, feelings, people, places and activities related to the event.
7
Q
Describe hyperarousal.
A
- Physiological reactivity (e.g. increased HR)
- Sleep disturbance
- Irritability
- Anger
- Hypervigilance
8
Q
What are the psychological factors which influence PTSD?
A
- Stressors involving intentional harm appear more likely to cause PTSD than are natural disasters.
- Personal impact of the event.
- The extent of perceived control over future threats.
- How one is prepared to deal with a stressor.
- One’s beliefs and assumptions about trauma.
- All affect how severe the impact of a stressor may be and how likely an individual is to develop PTSD.
9
Q
What are the risk factors for PTSD?
A
- Exposure to a traumatic event
- Severity of the incident
- Female sex
- Younger age
- Previous experience of trauma
- Presence of multiple major life stressors
- Low social support; social disadvantage
- History of a mental health disorder
- In children exposed to trauma, the risk of PTSD is reduced by good family support and when there is less parental distress.
10
Q
What is resilience?
A
- The majority of adults are exposed to at least one potentially traumatic event in their lifetime.
- Although most experience confusion and distress, only a small subset of exposed adults develop PTSD.
- The adult capacity to maintain healthy psychological and physical functioning = resilience.
- Characteristics of resilient people:
- Process a flexible adaptation to challenges.
- Sense of continuity in their beliefe about themselves / liver.
- Retain ability to regenerate positive experiences.
11
Q
Describe how PTSD can be associated with medical conditions.
A
- Onset of illness can be stressful:
- MI
- Stroke
- Haemorrhage
- Sudden and life threatening
- Diagnosis of a life-threatening disease:
- Heart failure
- HIV
- Cancer
- Prolonged treatment or unpleasant medical procedures
12
Q
What is the role of psychological debriefing in the prevention of PTSD?
A
- Psychological debriefing: talking through a trauma in a structured way with a counsellor soon after the trauma. Usually a single session.
- But, it may not only be ineffective in preventing PTSD, it may actually increase the risk of disorder.
- Secondary traumatisation
- Medicalising normal distress
- May prevent potentially protective responses of denial and distancing
- NICE guidelines state: Do not offer psychologically-focused debriefing for the prevention or treatment of PTSD.
13
Q
What are the psychological interventions for the prevention and treatment of PTSD in adults?
A
- Offer individual trauma-focussed CBT intervention to adults who have acute stress disorder or clinically important symptoms of PTSD and have been exposed to 1 or more traumatic events within the last month. These interventions include:
- Cognitive processing therapy
- Cognitive therapy for PTSD
- Narrative exposure therapy
- Prolonged exposure therapy
14
Q
Describe trauma-focussed CBT.
A
- Up to 12 sessions typically offered.
- Trauma-focussed CBT consists of a combination of exposure therapy and trauma-focussed cognitive therapy.
- More complex presentations are likely to require longer treatment.
- If a child / young person is being treated, trauma-focussed CBT should be adapted to their age and development, and involve parents or carers as appropriate.
15
Q
Describe exposure therapy.
A
The person confronts traumatic memories (usually by recounting the event) and is repeatedly exposed to situations which they have been avoiding that elicit fear.
