PTSD Week 7

Question 1

PTSD is characterized by ?

Answer 1

intrusive thoughts, nightmares and flashbacks of past traumatic events, avoidance of reminders of trauma, hypervigilance, and sleep disturbance, all of which lead to considerable social, occupational, and interpersonal dysfunction

Question 2

The diagnosis of PTSD can be challenging because of ?

Answer 2

the heterogeneity of the presentation and resistance on the part of the patient to discuss past trauma

Question 3

What is the most frequent type of trauma experienced by women with PTSD?

Answer 3

sexual assault

Question 4

Some causes of PTSD

Answer 4

Sexual relationship violence
Interpersonal-network traumatic experiences (illness of child, sudden death of loved one)
Interpersonal violence
Exposure to organized violence
Participation in organized violence
combat

Question 5

pathophysiology of PTSD unclear but studies using MRI’s have shown what in PTSD pts?

Answer 5

that there is decreased volume of the hippocampus, left amygdala, and anterior cingulate cortex

Question 6

cardinal features of PTSD

Answer 6

relate to psychologically re- experiencing the traumatic event, increased autonomic arousal, (particularly on exposure to environmental triggering stimuli or reminders of the event) leads to intense fear, helplessness or horror

Question 7

then what happens as a result of the intense arousal from certain stimuli?

Answer 7

pts compensate for such intense arousal by attempting to avoid experiences that may begin to elicit symptoms; this can result in emotional numbing, diminished interest in everyday activities, and, in the extreme, may result in detachment from others

Question 8

how long do sx have to last before you can dx?

Answer 8

1 month

Question 9

PTSD included in the general structure of DSM-V 5

Answer 9

anxiety disorder

Question 10

ICD-10 billing code

Answer 10

F43.1

Question 11

what is The PTSD checklist (PCL-5)? What score do you need to dx PTSD?

Answer 11

a 20-item self-report measure, can be used to screen patients for PTSD and monitor the severity of symptoms over time. A score of 38 (out of a maximum score of 80) to dx. Also must be 6yrs or older

Question 12

PTSD is commonly accompanied by

Answer 12

comorbid psychiatric conditions, including depression, substance use disorders, and somatization

Question 13

Diagnostic criteria for PTSD include:

Answer 13

experiencing or witnessing a severe, traumatic event resulting in symptoms in each of four categories (intrusion, negative alteration in mood and cognitions, avoidance, and arousal); social or occupational impairment; and symptoms and impairment lasting at least one month after the trauma.

Question 14

acute stress disorder

Answer 14

Prior to 1 month of sx, patients with PTSD- like symptoms and functional impairment are diagnosed with this

Question 15

clinical manifestations associated with re- experiencing

Answer 15

• Marked cognitive , affective, and behavioral responses
• Intrusive thoughts of the event
• Nightmares and sleep disturbance
• Flashbacks
• Intense psychological and physiological distress when reminded of the event (e.g. severe anxiety)

Question 16

clinical manifestations associated with avoidance and numbing

Answer 16

• efforts to avoid reminders
• inability to recall important aspects of the event
• withdrawal from favored activities/ interests
• strong feelings of detachment/ or estrangement from others
• restricted range of affect (poker face)

Question 17

clinical manifestations associated with arousal

Answer 17

• irritability/ outbursts of anger
• difficulty concentrating/ often confused with memory loss
• Hypervigilance
• Exaggerated startle response

Question 18

Clinician administered PTSD scale for DSM-5 aka CAPS-5

Answer 18

a 30-item, structured interview that can be used to make diagnoses of PTSD in the past week, past month, or lifetime, as well as to assess the severity of PTSD symptoms. There are 3 different versions- for past, week, month and worst month (of lifetime)

Question 19

First line treatments of PTSD

Answer 19

trauma- focused cognitive behavioral therapy 1st if possible then SSRI’s (most pts will need a combo of the two)

Question 20

SSRI’s starting doses and therapeutic doses

Answer 20

*Paroxetine 20mg to start, 20- 60mg therapeutic
Sertraline 50mg to start, 50- 200mg therapeutic
Fluvoxamine 50mg to start, 100- 300mg therapeutic
Fluoxetine 20mg to start, 20- 60mg therapeutic
Citalopram 20mg to start, 20- 40mg therapeutic
Escitalopram 10mg to start, 20- 30mg therapeutic
Venlafaxine 37.5mg to start, 37.5- 300mg therapeutic (this is an SNRI)

Question 21

second line medication tx if SSRI/ SNRI don’t work

Answer 21

they suggest adjunctive treatment with quetiapine or risperidone. (if partial response to SSRI’s to adjunct therapy with these but if no response at all try quetiapine as monotherapy)

Question 22

For patients started on quetiapine or other SGAs, what do you need to monitor?

Answer 22

regular monitoring of weight gain, blood sugar, and lipids should be conducted

Question 23

dissociative subtype of PTSD

Answer 23

consists of meeting the full diagnostic criteria for PTSD and, in addition, having depersonalization and/or derealization

Question 24

Depersonalization

Answer 24

Detachment or estrangement from one’s self;

Question 25

Derealization

Answer 25

The sense that the external world is strange or unreal

Question 26

dissociative subtype of PTSD associated with ?

Answer 26

associated with early onset interpersonal trauma

Question 27

Dissociation is ?

Answer 27

a disruption of the usually integrated functions of consciousness, memory, identify, or awareness of body, self, or environment. Dissociative symptoms can include identity confusion, dissociative amnesia, depersonalization, and derealization

Question 28

Psychophysiological and neuroimaging studies have found the dissociative and hyperaroused subtypes of response in chronic PTSD to be associated with ?

Answer 28

distinct neural and cardiovascular responses when recalling traumatic memories

Question 29

Dissociative PTSD patients typically have complex presentations, characterized by a mixture of dissociative and PTSD symptoms embedded with symptoms of other conditions such as ?

Answer 29

depression, substance abuse, somatoform disorders, eating disorders, and self-destructive, impulsive behaviors

Question 30

Diagnostic criteria for PTSD were revised in DSM-5 to include a subtype, “with dissociative symptoms,” in which PTSD symptoms are accompanied by ?

Answer 30

persistent or recurrent symptoms of depersonalization or derealization

Question 31

(Shaakira/ kelly article) In military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD. Two principal clinical conclusions can be drawn from this review.

Answer 31

First, the available evidence supports the use of either trauma-focused or structured non–trauma-focused therapies, depending on patient preferences or other factors that might promote treatment retention. Second, there is a need for improvement in existing PTSD treatments as well as the development and testing of novel evidence-based treatment strategies, whether trauma-focused or non–trauma-focused

Question 32

(Elizabeth article) comparison of accelerated resolution therapy (ART) for tx of sx of PTSD and sexual trauma between civilian and military adults. What is ART?

Answer 32

is an emerging, brief exposure-based therapy for PTSD that has been recently studied in both civilian and military populations

Question 33

Conclusions of this ART study

Answer 33

In an average of less than 4 treatment sessions, delivery of the ART protocol appears to result in clinically-meaningful reductions in symptoms of PTSD in civilian and military patients with a trend for a potential stronger result in civilians

Question 34

(Prudence/Josh) Is there a common pathway

to developing ASD (acute stress disorder) and PTSD symptoms?

Answer 34

research suggests that a common path to ASD and PTSD may lie in peri-traumatic responses and cognitions. This study showed that peritraumatic panic, anxiety sensitivity, and negative cognitions about self were significant common risk factors for both ASD severity and PTSD severity when controlled for the effect of the other risk factors. The strongest common risk factor was negative cognitions about self.

Question 35

(Anne/Alex) A historical review of trauma-related diagnoses to reconsider the heterogeneity of PTSD

Answer 35

basically the diagnosis of PTSD has evolved to include more things over time; world wars, natural disasters, etd. The article calls for more research to determine whether different trauma types are associated with different symptom pre- sentations.