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Psychiatry > PTSD > Flashcards

PTSD Flashcards

1
Q

what part of the brain is responsible for active & passive defence responses?

A

midbrain Superior Colliculi & periaqueductal gray (PAG)

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2
Q

what are examples of defence responses?

A

o Fight, flight, freeze, hide, avoid, attach, submit, despair & uncontrolled activation states

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3
Q

what is the orientating response?

A

Arousal → Arrest - pause in or slowing of movement and activity → Alert → Muscular change - both flexion & extension → Orient/scan - search for the location → Locate - source of the stimulus is found → Identify - novelty is recognised &/or identified → Evaluate → Take action or not

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4
Q

what is the role of the 3 looping systems?

A

Defence activation

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5
Q

what are the 3 looping systems?

A

First loop – midbrain/brainstem origin
Peri-aqueductal Gray (PAG) & Superior Colliculi (SC)
Second loop – Mesolimbic- Dopamine System
Third loop – Stimulus-response learning system

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6
Q

acute stress response causes the release of which NT?

A

release of cortisol and catecholamines

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7
Q

what is PTSD?

A

Severe psychological disturbance following a traumatic event

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8
Q

what are the different types of risk-factors involved in PTSD?

A

Pre-traumatic
Peri-traumatic
Post-traumatic

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9
Q

what are the pre-traumatic risk factors in PTSD?

A

severe acute stress reactions, FH or PH of mental disorder, genetics, past experience of trauma, coping stupes, personality traits, lower educational or socioeconomic levels

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10
Q

what are the peri-traumatic risk factors in PTSD?

A

sudden, unexpected events, man made rather than natural, prolonged exposure, perceived threat to life, dose response, personal involvement

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11
Q

what are the post-traumatic risk factors in PTSD?

A

lack of support network, ongoing life stresses, reactions of others, economic resources, disadvantages, displacement

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12
Q

what pathophysiology of PTSD occurs during trauma itself?

A

high levels of stress hormones secreted suppress hypothalamic activity

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13
Q

what is the characteristic NT finding in PTSD?

A

• LOW LEVELS OF CORTISOL and high secretion of catecholamines in urine

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14
Q

what parts of the brain are implicated in PTSD?

A

Dysfunction of the amygdala, hippocampus, septum, and prefrontal cortex may lead to enhanced fear response.

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15
Q

what systems in the brain are implicated in PTSD?

A

abnormality in the hypothalamic-pituitary-adrenal (HPA) axis and locus coeruleus-noradrenergic system

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16
Q

what is the involvement of Brocas Area in PTSD?

A

decreased rCBF - fragmented memories, emotional memory on RHS brain

17
Q

what is the onset of clinical features of PTSD?

A

arise within 6mths of the traumatic event or are present for at least 1mth, with clinically significant distress or impairment in social, occupational, or other important areas of functioning (DSM-IV).

18
Q

what are the common clinical features in PTSD?

A 
2 or more of
increased psychological sensitivity and arousal’
o	Difficulty falling or staying asleep
o	irritability or outbursts of anger
o	difficulty in concentrating
o	hypervigilance
o	exaggerated startle response.
19
Q

what is DSM criterion A for PTSD?

A

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): Direct, Witnessing, Learning that a relative or close friend was exposed to a trauma, Indirect exposure to aversive details of the trauma, usually in the course of professional duties

20
Q

what is DSM criterion B for PTSD?

A

o The traumatic event is persistently re-experienced in the following way(s): Unwanted upsetting memories, Nightmares, Flashbacks, Emotional distress after exposure to traumatic reminders, Physical reactivity after exposure to traumatic reminders

21
Q

what is DSM criterion C for PTSD?

A

o Avoidance of trauma-related stimuli after the trauma, in the following way(s):
 Trauma-related thoughts or feelings
 Trauma-related external reminders

22
Q

what is DSM criterion D for PTSD?

A

Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
 Inability to recall key features of the trauma
 Overly negative thoughts and assumptions about oneself or the world
 Exaggerated blame of self or others for causing the trauma
 Negative affect
 Decreased interest in activities
 Feeling isolated
 Difficulty experiencing positive affect

23
Q

what is DSM criterion E for PTSD?

A 
o	Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
	Irritability or aggression
	Risky or destructive behavior
	Hypervigilance
	Heightened startle reaction
	Difficulty concentrating
	Difficulty sleeping
24
Q

what is DSM criterion F for PTSD?

A

o Symptoms last for more than 1 month.

25
Q

what is DSM criterion G for PTSD?

A

o Symptoms create distress or functional impairment (e.g., social, occupational).

26
Q

what is DSM criterion H for PTSD?

A

o Symptoms are not due to medication, substance use, or other illness.

27
Q

what is the psychological management PTSD?

A

CBT, EMDR

28
Q

what is the pharmacological management PTSD?

A

o SSRO

o TCA, MAOIs, venlafaxine, mirtazapine

29
Q

what is the pharmacological management of sleep disturbance in PTSD?

A

mirtazapine, levomepromazine, prazosin, or specific hypnotics (e.g. zopiclone, zolpidem)

30
Q

what is the pharmacological management of anxiety symptoms in PTSD?

A

BDZs, buspirone, antidepressants, propranolol

31
Q

what is the pharmacological management of intrusive symptoms PTSD?

A

carbamazepine, valproate, topiramate, lithium

32
Q

what is the pharmacological management of psychotic symptoms PTSD?

A

carbamazepine, valproate, topiramate, lithium

33
Q

what is the management of PTSD if mild & <4 weeks from trauma?

A

watchful waiting

34
Q

what is the management of PTSD within 3 months of trauma?

A

 Brief psychological intervention (trauma focussed CBT)

 Hypnotic medication for sleep disturbance

35
Q

what is the management of PTSD more than 3 months of trauma?

A

Trauma focussed CBT or EMDR

Psychiatry (11 decks)

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