ptsd_flashcards

Question 1

What is Post-traumatic stress disorder (PTSD)?

Answer 1

PTSD can develop in people of any age following a traumatic event, for example, a major disaster or childhood sexual abuse. It encompasses what became known as ‘shell shock’ following the first world war. One of the DSM-IV diagnostic criteria is that symptoms have been present for more than one month.

Question 2

What are the features of PTSD?

Answer 2

Features include re-experiencing, avoidance, hyperarousal, emotional numbing, depression, drug or alcohol misuse, anger, and unexplained physical symptoms.

Question 3

What are the re-experiencing symptoms of PTSD?

Answer 3

Re-experiencing symptoms include flashbacks, nightmares, repetitive and distressing intrusive images.

Question 4

What are the avoidance symptoms of PTSD?

Answer 4

Avoidance symptoms include avoiding people, situations or circumstances resembling or associated with the event.

Question 5

What are the hyperarousal symptoms of PTSD?

Answer 5

Hyperarousal symptoms include hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating.

Question 6

What are the emotional numbing symptoms of PTSD?

Answer 6

Emotional numbing symptoms include lack of ability to experience feelings and feeling detached from other people.

Question 7

What other symptoms can be associated with PTSD?

Answer 7

Other symptoms can include depression, drug or alcohol misuse, anger, and unexplained physical symptoms.

Question 8

What is the recommended management for PTSD?

Answer 8

Management includes avoiding single-session interventions, watchful waiting for mild symptoms lasting less than 4 weeks, trauma-focused CBT, and EMDR therapy for more severe cases. Drug treatments are not routine first-line treatments.

Question 9

Are single-session interventions recommended after a traumatic event?

Answer 9

No, single-session interventions (often referred to as debriefing) are not recommended following a traumatic event.

Question 10

What is the initial approach for mild PTSD symptoms lasting less than 4 weeks?

Answer 10

Watchful waiting may be used for mild symptoms lasting less than 4 weeks.

Question 11

What specific therapies may be used for more severe PTSD cases?

Answer 11

Trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy may be used in more severe cases.

Question 12

What is the role of drug treatments in managing PTSD?

Answer 12

Drug treatments for PTSD should not be used as a routine first-line treatment for adults.

Question 13

Which drugs are recommended if drug treatment is used for PTSD?

Answer 13

If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried.

Question 14

Which drug may be used in severe cases of PTSD?

Answer 14

In severe cases, NICE recommends that risperidone may be used.

Question 15

summarise ptsd

Answer 15

Post-traumatic stress disorder

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. It encompasses what became known as ‘shell shock’ following the first world war. One of the DSM-IV diagnostic criteria is that symptoms have been present for more than one month.

Features
re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
avoidance: avoiding people, situations or circumstances resembling or associated with the event
hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
emotional numbing - lack of ability to experience feelings, feeling detached
from other people
depression
drug or alcohol misuse
anger
unexplained physical symptoms

Management
following a traumatic event single-session interventions (often referred to as debriefing) are not recommended
watchful waiting may be used for mild symptoms lasting less than 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
drug treatments for PTSD should not be used as a routine first-line treatment for adults. If drug treatment is used then venlafaxine or a selective serotonin reuptake inhibitor (SSRI), such as sertraline should be tried. In severe cases, NICE recommends that risperidone may be used

Question 16

A young couple enters the general practice. The wife explains how her partner has been acting out of character, specifically, checking on their daughter subtly throughout the day and even during the night. On average, he would check ten to twenty times. When asked, he explains that last month he nearly lost his daughter in the park where it was a scary ordeal and he repeatedly relives what happened in his mind. The husband says that he does not go to the park anymore, feels anxious and has difficulty sleeping. There is no past medical or psychiatric history of note.

Which of the following is the most likely diagnosis?

Generalised anxiety disorder (GAD)
Obsessive compulsive disorder (OCD)
Panic disorder
Paranoid delusion disorder (PDD)
Post traumatic stress disorder (PTSD)

Answer 16

Post traumatic stress disorder (PTSD)

Common features of PTSD
re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems

With this history, the most likely is diagnosis is PTSD. An incident must occur which elicit the following features; flashbacks, hyperarousal and avoidance. For a diagnosis, symptoms must persist for over a month.

GAD and OCD could present in a similar fashion with constant anxiety and the behaviours exhibited. GAD tends to slowly progress starting in the teenage years. OCD can develop in the early 20’s but would be less likely than PTSD to develop straight after the incident in the park.

Panic disorder presents differently, it occurs when the sympathetic system is stimulated causing an intense episode of fight or flight when there is no matching stimulus.

PDD is a self-referential delusion, the patient does not hold fixed false beliefs about himself.

Question 17

A 40-year-old man has been receiving eye movement desensitisation and reprocessing therapy (EMDR) for PTSD. Despite receiving EMDR therapy for 6 months he is still experiencing distressing flashbacks.

What is the most appropriate next step for treatment?

Amitriptyline
Cognitive behavioural therapy
Haloperidol
Olanzapine
Venlafaxine

Answer 17

Venlafaxine

If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI

Venlafaxine is correct. This patient is experiencing distressing symptoms of PTSD despite having tried eye movement desensitisation and reprocessing (EMDR) therapy. Therefore, the first-line medication is venlafaxine or an SSRI such as sertraline. In severe cases NICE recommend risperidone.

Amitriptyline is incorrect. Amitriptyline is a tricyclic antidepressant used particularly in neuropathic pain however, it is not indicated for PTSD.

Cognitive behavioural therapy is incorrect. Therapies such as CBT and EMDR are first-line options for PTSD. However, this patient has already trialled the alternative first-line option of EMDR with no improvement. Therefore, the next stage in management is medication such as venlafaxine or an SSRI.

Haloperidol is incorrect. Haloperidol is a typical antipsychotic, it is not indicated for PTSD.

Olanzapine is incorrect. Olanzapine is an atypical antipsychotic, it is not indicated for PTSD.

Question 18

A 34-year-old man confides in you that he experienced childhood sexual abuse. Which one of the following features is not a characteristic feature of post-traumatic stress disorder?

Hyperarousal
Emotional numbing
Nightmares
Loss of inhibitions
Avoidance

Answer 18

Loss of inhibitions

The correct answer is Loss of inhibitions. Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event. Its symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions (hyperarousal). Loss of inhibitions is not typically associated with PTSD. It refers to the inability to control one’s impulses or behaviour, which can be seen in conditions such as mania or certain personality disorders.

Hyperarousal, on the other hand, is a characteristic feature of PTSD. This term refers to the state of being constantly on guard for threats, leading to restlessness, sleep disturbances and difficulty concentrating. It represents the body’s heightened response to fear and stress.

Emotional numbing also occurs in PTSD. This involves feeling detached from others and emotionally unresponsive. Individuals may lose interest in activities they once enjoyed and find it difficult to experience positive emotions.

Nightmares are part of the Intrusive memories symptom category of PTSD. They involve recurrent, unwanted distressing dreams about the traumatic event. These nightmares can significantly disrupt sleep patterns and contribute to fear and anxiety.

Lastly, Avoidance is another key feature of PTSD where individuals will actively avoid places, people or thoughts that remind them of the traumatic event as these triggers could cause distressing memories or flashbacks.

In conclusion, while hyperarousal, emotional numbing, nightmares and avoidance are all characteristic features of post-traumatic stress disorder according to DSM-5 criteria; loss of inhibitions isn’t typically associated with this condition.