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
