Response to Stress Flashcards
how can traumatic events be classified?
individuals - intentional (assult, robbery etc) - unintentional communities - human made - natural
types of disasters?
centrifugal
- together only at time of disaster (plane crash etc)
centripetal
- affects an existing community (natural disaster etc)
type 1 trauma?
single incident trauma, unexpected
type 2 trauma?
AKA complex trauma repetitive ongoing abuse (e.g hostage taking etc) betrayal of trust developmental trauma
how can childhood trauma predict future mental health?
predicts need for psychotherapy as an adjunct to pharmacotherapy
high percentage of bipolar patients have childhood trauma
function of fear and anxiety?
genetic ingrained function of nervous system
not a sign of weakness
generally not really under your control
has adaptive evolutionary use to promote survival
can be trained to have opposite response
intergenerational effect of anxiety and fear?
if the fear response is changed in a person (via trauma etc), it is seen in generations afterwards
main responses in anxiety and fear?
not just "fight or flight" freeze flee hide avoid attach etc all originate in PAG or ventral tegmental area
when is the freeze response used?
response to a distant threat (voluntary)
or an inescapable threat (tonic immobility occurs)
what is tonic immobility?
involuntary freezing/rigidity in face of inescapable threat
especially occurs on contact with the aggressor
- very common in sexual assaults
features of tonic immobility?
decreased vocalisation, eye contact, rigidity/paralysis, muscle tremors, chills, unresponsive to pain
reptilian brain hypothesis?
as the predator closes in, brain activity shifts from the ventromedial prefrontal cortex (human part) to the periaqueductal gray (reptilian part) which correlates with the subjective experience of dread of capture
- automatic escape response?
definition of traumatic event?
DSM definition
- experienced, witnessed or confronted threat of death or serious injury to self or others, feelings of intense fear, helplessness or horror
ICD definition
- delayed and/or protracted response to exceptionally threatening or catastrophic event, likely to cause pervasive distress in almost anyone
trauma related risk factors?
sudden unexpected trauma (not in case of type 2)
man-made rather than natural
prolonged exposure to trauma
perceived threat to life
multiple deaths and/or mutilation (“the grotesque”)
dose response relationship (proximity to event)
personally relevant factors (involvement of child/family member etc)
patient related risk factors?
severe acute stress reaction low serum cortisol increase acutely personal/family history of mental health disorder serious physical injury (patient perception of "serious") loss of normal daily function extremities of age genetics epigenetics past trauma coping styles personality traits behavioural problems life style role of race female gender
environmental risk factors?
lack of support network ongoing life stresses reactions of others economic resources disadvantage displacement
reactions to traumatic event long term>
resistant - don't really change resilient - bounce back recovery - recover over time some have chronic symptoms, don't really get better some just get worse over time
resilience is not global, what does this mean?
can be resilient in one area of life (e.g school - keep getting good grades) but awful in another (cant cope at home)
possible psychological reactions after trauma?
depression grief panic attacks/agoraphobia alcohol/drug dependence brief hypomania specific phobias
diagnostic criteria for PTSD?
traumatic event 1 or more intrusive symptoms 3 or more avoidance symptoms 2 or more areas of increased arousal lasting 1 month distressed and impairment in social or occupational functioning
types of intrusive phenomena in PTSD?
recurrent, distressing recollections nightmares flashbacks in any modality distress accompanies reminders physiological reactions (sweaty, palpitations etc)
types of avoidance symptoms in PTSD?
avoid thinking/talking about it avoiding reminders (activities, places, people etc) amnesia for aspects of trauma loss of interest in activities detachment emotional numbing sense of foreshortened future
hyperarousal symptoms?
sleep disturbance irritability/anger concentration difficulties hypervigilance exaggerated startle response risky and destructive behaviour
other associated symptoms in PTSD?
dissociative symptoms (depersonalisation, derealisation, near death or out of body experiences)
survivor guilt
performance guilt
what is the just world hypothesis?
belief that we get what we deserve and deserve what we get 3 main beliefs - world is benevolent - world is meaningful - the self is worthy
what is complex PTSD?
PTSD symptoms +
- cognitive disturbance
- identity disturbance
- emotional dysregulation
- chronic interpersonal difficulties
- dissociation
- somatisation
- tension reduction activities
what trauma types account for most cases of PTSD?
rape and sexual assault veterans burns RTAs civil violence
what areas of brain are significant in PTSD?
prefrontal cortex
limbic system
hippocampus (memory and stress response)
amygdala (role in fear during both trauma and its recollection)
biological paradox in PTSD?
high cortisol levels damage the hippocampus, but cortisol levels are low in PTSD
may be due to an increase in the sensitivity of cortisol receptors in people with PTSD
cortisol in PTSD?
cortisol levels usually rise in acute stress but levels are low in PTSD both at time of event and afterwards in chronic PTSD
hippocampus in PTSD?
hippocampus size correlates with severity of PTSD (smaller = more severe)
- either small hippocampus is a risk factor or the hippocampus shrinks reversibly during PTSD
when else is decreased hippocampal volume seen?
bipolar
ageing before dementia
cushings
alcohol misuse
how can PTSD affect brocas area?
when memory etc of trauma is brought up, brocas area is inhibited so literally cant put it into words
what happens in the limbic system?
processes emotional aspects of sensory inputs????
1st filter - is it important?
2nd filter - is it emotionally important?
organisation - processing of memory and storage in correct areas
limbic system in PTSD?
sensory input bypasses the organisation stage
brain doesn’t know that the memory happened a long time ago, feels like its happening right now so elicits same feelings when you are reminded of the event
amygdala activation in PTSD?
increased activity of the amygdala is seen in PTSD in response to stimuli which are somehow connected to the traumatic event
leads to an increased emotional response
general principles of PTSD management?
ensure safety before starting (manage ongoing trauma etc)
importance of therapeutic relationship
drug treatments not really used routinely in preference to trauma focused therapy unless there is a specific need (not slept in 3 weeks etc)
main psychological therapies in PTSD?
CBT
EMDR (eye movement desensitisation and reprocessing)
what is the key ingredient in successful psychological therapy in PTSD?
exposure - imaginal exposure or in vivo exposure phased approach for complex PTSD - stabilise and resource - reprocessing of trauma memories/material - reintegration
can medication be used in PTSD?
can be used in symptomatic treatment of acute phase
can be used for augmentation of PTSD treatment
what medications can be used in PTSD?
non-specialist = paroxetine or mirtazapine specialists = amitriptyline or phenelzine alternatives = prazosin, atypical antipsychotics or mood stabilizers (carbamazepine)
