PTSD and trauma

Question 1

What are some classifications of trauma?

Answer 1

Individual vs Community
Individual = Intentional vs unintentional
Community = Human vs natural

Question 2

What are some forms of individual, intentional trauma?

Answer 2

Assault
Robbery
Rape

Question 3

What are some forms of individual unintentional trauma?

Answer 3

Motor vehicle accident
Industrial accident

Question 4

What are some forms of human-made community trauma

Answer 4

Industria disasters
Transportation disasters

Question 5

What are some forms of natural community trauma

Answer 5

Earthquake
Floods

Question 6

What are the 2 types of trauma?

Answer 6

Type 1 = Single incident trauma
Type 2 = Repetitive (Complex) trauma

Question 7

What are some examples of type 2 trauma?

Answer 7

Ongoing abuse, hostage taking, ACEs

Question 8

What is PTSD?

Answer 8

Mental and behavioral disorder that can develop because of exposure to a traumatic event

Question 9

What are some trauma-related risk factors for PTSD?

Answer 9

• Man-made rather than natural events
• Prolonged exposure
• Perceived threat to life

Question 10

What are some patient-related risk factors for PTSD?

Answer 10

• Family or personal history of mental disorder
• Serious physical injury (patient’s perception)
• Past experience of trauma, especially childhood/developmental trauma

Question 11

What are some environmental risk factors for PTSD?

Answer 11

• Lack of a support network
• Lack of economic resources
• Disadvantage
• Ongoing life stresses

Question 12

Describe the neurobiology of fear and anxiety

Answer 12

When under threat, activity shifts from the pre-frontal cortex to the brainstem (Superior colliculi and peri-aqueductal grey), which are responsible for active and passive defence responses

Question 13

Describe the freeze response to a distant threat

Answer 13

This is a voluntary response to distant fear allowing the person to stop, watch and listen for danger

Question 14

Describe the freeze response to an inescapable threat

Answer 14

This involves tonic immobility, in which there is an involuntary state of profound but reversible motor inhibition

This is thought to be a protective response as animals tend only to injury non-moving targets rather than kill

Question 15

What are some neurobiological changes that may occur in trauma?

Answer 15

Hippocampal atrophy
- Increased activation of the amygdala and other limbic areas
- Deactivation of Broca’s area - difficult for person to explain trauma verbally to others
- Right-hemispheric lateralisation - may explain the ‘timeless’ quality of traumatic memory

Question 16

What does right-sided hippocampal atrophy suggest?

Answer 16

Adult trauma

Question 17

What does left-sided hippocampal atrophy suggest?

Answer 17

Childhood trauma

Question 18

What are the types of symptoms found in PTSD?

Answer 18

Intrusive phenomena
Avoidance symptoms
Negative alterations in cognition and mood
Alterations in arousal and reactivity

Question 19

What are some intrusive phenomena in PTSD?

Answer 19

• Recurrent distressing recollections
• Nightmares
• Flashbacks
• Distress accompanying reminders
• Physiological reactions

Question 20

What are some avoidance symptoms of PTSD?

Answer 20

• Avoidance of thoughts or feelings about the event - don’t want to talk about it
• Avoidance of external reminders e.g. people, places

Question 21

What are some symptoms of negative alterations in cognition and mood in PTSD?

Answer 21

• Amnesia for important aspects of trauma
• Loss of interest in activities
• Negative affect (fear, horror, anger, guilt, or shame)
• Overly negative thoughts and assumptions about self/world
• Exaggerated blame (self or others) for causing traumatic event(s)
• Feeling isolated/detached
• Difficulty experiencing positive emotion (including numbing)

Question 23

What are the diagnostic criteria for PTSD based on symptoms?

Answer 23

• ≳ 1 intrusive symptoms
• 1 or both avoidance symptoms
• ≳ 1 negative alterations in cognitions and mood
• ≳ 2 increased arousal and activity
• Functional impairment (social or occupational)
• Symptoms for 1 month

Question 24

What are some additional symptoms of complex PTSD?

Answer 24

• Negative self-concept - low self-esteem, self-blame, hopelessness, helplessness, pre-occupation with threat, pervasive shame or guilt
• Emotional dysregulation - violent or emotional outbursts, reckless or self-destructive behaviour, dissociation
  
  • Includes tension reduction activities e.g. binge-purging, self-mutilation
• Chronic interpersonal difficulties - issues with trust, maintaining relationships etc.

Question 25

What are some of the therapy options available in PTSD?

Answer 25

Question 26

What is Maslow’s hierarchy of needs?

Answer 26

Question 27

What psychological treatment is required in mild PTSD and trauma occurring < 4 weeks ago

Answer 27

Watchful waiting

Question 28

What psychological treatment are used in PTSD occurring within 3 months of trauma?

Answer 28

1. Brief psychological intervention - trauma-focussed CBT
2. Hypnotic medication for sleep disturbance

Question 29

What psychological treatments are used in PTSD lasting longer than 3 months after trauma?

Answer 29

Trauma-focussed CBT or EMDR

Question 30

What are the 3 phases of complex-trauma focussed CBT?

Answer 30

• Stabilisation and safety - resourcing
• Trauma treatment - reprocessing
• Reintegration/rehabilitation

Question 31

What are some possible pharmacological management options in PTSD?

Answer 31

• Antidepressants - venlafaxine or an SSRI
• Antipsychotics - risperidone (for severe hyperarousal)
• Alternatives: prazosin, mood stabilisers