PTSD

Question 1

Acute stress reaction

Answer 1

transient condition (hrs to days). Immediate dissociation followed by mixed emotions including anxiety, anger and confusion. Usually resolves without psychiatric intervention.

Question 2

PTSD

Answer 2

develops after an exceptionally stressful, life threatening or catastrophic event or situation. There is often denial or suppression of memory of the event. Intentional acts of violence are more likely to cause PTSD.

Question 3

Symptoms of PTSD

Answer 3

re experiencing the event in nightmares or flashbacks often precipitating anxiety or panic attacks, avoidance of things associated with the event, hyper vigilance, sleep disturbance and poor concentration. Depression, emotional numbing or drug, alcohol abuse and anger are often comorbid.

Question 4

PTSD symptoms in children

Answer 4

re experiencing symptoms may take the form of re enacting the experience, repetitive player frightening dreams.

Question 5

Types of trauma

Answer 5

Type 1- single incident trauma

Type 2- complex repetitive trauma

Question 6

tonic immobility

Answer 6

involuntary state of profound but reversible motor inhibition- 1/3-2/3 of sexual assault cases

Question 7

Stress response

Answer 7

acute stress leads to dose dependent increase in catecholamines and cortisol

Question 8

are cortisol levels high or low in PTSD

Answer 8

low

Question 9

PTSD diagnostic criteria

Answer 9

traumatic events 
intrusive symptoms- 1 or more
avoidance symptoms- 3 or more
increased arousal- 2 or more
Duration 1 month
Distress and impairment on social or occupational functioning 
acute/chronic delayed onset

Question 10

Intrusive phenomena

Answer 10

recurrent distressing recollections, nightmares, physiological reactions
Avoidance- avoidance of thinking/talking about event or reminders eg people places activities
Amnesia of important aspect of trauma, loss of interest in activities, detachment, emotional numbing, sense of foreshortened future

Question 11

Hyperarousal symptoms

Answer 11

sleep disturbance
irritability/ anger
concentration difficulties
hypervigilance
exaggerated startle response

Question 12

associated symptoms

Answer 12

dissociative symptoms- depersonalisation, derealisation, awareness of surroundings, near death or out of body experiences
Survivor guilt- performance guilt

Question 13

additional symptoms

Answer 13

Criterion D- negative alterations in cognition and mood associated with traumatic events beginning or worsening after the traumatic event(s)
Criterion E- marked alterations in arousal and reactivity associated with the TE
reckless or self destructive behaviour

Question 14

Complex PTSD

Answer 14

cognitive disturbances- low self esteem, self blame, hopelessness
mood disturbances, somatisation, identity disturbance, emotional dysregulation, chronic interpersonal difficulties, dissociation, tension reduction activities, binge purging, self mutilation etc

Question 15

Treatment aims

Answer 15

normalise reactions, enable catharsis, inspire hope, restore sense of safety and or trust, treat core symptoms and co morbidity

Question 16

Treatment

Answer 16

CBT or EMDR (eye movement desensitisation and reprogramming) - treatment should be long enough and regular enough with the same therapist- extend beyond 12 sessions if complex

Question 17

Treatment if patient does not respond to psychological treatment

Answer 17

medication
non specialist- paroxetine or mirtazipine
specialist- amytryptyline or phenelzine