PTSD & OCD Flashcards
What is PTSD?
- Intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event.
- Post-traumatic stress disorder (PTSD) can develop in people of any age following a traumatic event, for example, a major disaster or childhood sexual abuse. The person must be involved directly or as a witness
What are risk factors for PTSD?
- Exposure to major traumatic event: examples are professions (armed forces, police, fire services, journalist, doctor) and groups (refugees, asylum seekers)
- Pre-trauma: previous trauma, history of mental illness, females, low socioeconomic background, childhood abuse
- Peri-trauma: severity of trauma, perceived threat to life, adverse emotional reaction during or immediately after event
- Post-trauma: concurrent life stressors, absence of social support
What are symptoms of PTSD?
PTSD symptoms must occur within 6 months of the event and can be divided into 4 categories
- Reliving: flashbacks, vivid memories, nightmares, repetitive and distressing intrusive images
- Avoidance: avoiding people, situations or circumstances resembling or associated with the events. Inability to recall aspects of trauma
- Hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
- Emotional numbing: lack of ability to experience feelings, feeling detached from toher people, giving up previously enjoyed activities and negative thoughts about oneself
Other symptoms: depression, drug or alcohol misuse, anger, unexplained physical symptoms
What is the ICD-10 Criteria for PTSD?
(A) Exposure to a stressful event or situation of extremely threatening or catastrophic nature
(B) Persistent remembering of stressful situation
(C) Actual or preferred avoidance of similar situations resembling or associated with the stressor
(D) Either (1) or (2)
- Inability to recall some important aspect of the period of exposure to the stressor
- Persistent symptoms of increased psychological sensitivity and arousal
(E) Criteria B, C & D all occur within 6 months of stressful event or the end of period of stress
What is the investigations of PTSD?
- Questionnaires: Trauma screening questionnaire, Post-traumatic diagnostic scale
- CT head: if head injury suspected
What is the management for PTSD if symptoms presents within 3 months of trauma?
- Watchful waiting may be used for mild symptoms lasting <4 weeks
- Military personnel have access to treatment provided by the armed forces
- Trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases
- Short term drug treatment may be considered in acute phase for management of sleep disturbance. Following a traumatic event single-session intervention (often referred to as debriefing) are not recommended
- Risk assessment important to assess risk for neglect or suicide
What is the management for PTSD if symptoms presents after 3 months of trauma?
- Offered course of trauma-focused psychological intervention. 2 options for psychological intervention are CBT and eye movement desensitization and reprocessing (EMDR). The goal of EMDR is to reduce distress in shortest period of time. Form of psychotherapy with one technique involving eye movement to help brain process traumatic events
- Drug treatments for PTSD should not be used as a routine first-line treatment for adults. Drug treatment considered if (1) little benefit from psychological therapy; (2) patient preference not to engage in psychological therapy; (3) co-morbid depression or severe hyperarousal which would benefit from psychological interventions
- If drug treatment is used then venlafaxine, phenelzine, sertraline, mirtazapine or amitriptyline should be tried. In severe cases, NICE recommends that risperidone may be used
What is the defintion of OCD?
- Characterised by recurrent obsessional thoughts or compulsive acts or commonly both. Symptoms can cause functional distress or impairment.
- Associations: depression (30%), schizophrenia (3%), Sydenham’s chorea, Tourette’s syndrome, Anorexia nervosa
What are obsessions and compulsions?
- Obsessions: unwanted intrusive thought, images or urges that repeatedly enter individuals’ mind. They are distressing for the individual who attempts to resist them and recognizes them as absurd and a product of their own mind
- Compulsions: repetitive, stereotyped behaviours or mental acts that a person feels driven into performing. They are overt (observable by others) or covert (mental acts not observable)
What is the pathophysiology of OCD?
- Biological: related to ↓ serotonin and abnormalities of the frontal cortex and basal ganglia. Genetic contribution as well. Childhood group A beta-haemolytic streptococcal infection may have a role by setting up an autoimmune reaction which damages basal ganglia (PANDAS)
- Psychoanalytic: filling the mind with obsessional thought to prevent other undesirable ideas from entering consciousness
- Behavioural: learned and maintained by operant conditioning.
What are risk factors of OCD?
- Most common in early adulthood and equally common in men and women
- OCD more common in relatives of OCD patient than in general population
- Developmental factors such as neglect, abuse, bullying and social isolation
What is the ICD-10 criteria for OCD?
(A) Either obsession or compulsion present on most days for a period of at least 2 weeks
(B) Obsessions (thoughts, ideas or images) or compulsions (acts) share a number of features, all of which must be present (FORD Car)
- Failure to Resist
- Originate from patient’s mind
- Repetitive and Distressing
- Carrying out the obsessive thought (or compulsive act) is not in itself pleasurable but reduces anxiety levels
(C) The obsessions or compulsions cause distress or interfere with subjects social or individual functioning usually by wasting time
What are common obsessions and compulsions of OCD?
- Common obsessions: contamination, Fear of harm, excessive concern with order or symmetry, sex, violence, blasphemy, doubt
- Common compulsions: checking (e.g., gas taps, water taps, doors), Cleaning, Washing, repeating acts (e.g., counting, arranging objects), mental compulsions (e.g., special words repeated in a set manner, hoarding
What are investigations for OCD?
- Yale-Brown obsessive-compulsive scale (Y-BOCS) – 10 item questionnaires with each item graded from 0-4.
How is OCD with mild functional impairment managed?
- Low-intensity psychological treatments (<10 hours of therapist input per patient): cognitive behavioural therapy (CBT) including exposure and response prevention (ERP)
- If ineffective then offer choice of either a course of an SSRI (either fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram) or more intensive CBT (including ERP)
