Response to trauma Flashcards
what is type 1 trauma
single unexpected traumatic incident
what is type 2 trauma
ongoing, repetitive trauma
betrayal of trust
developmental trauma
severity of trauma is more important than the perception of that trauma, true or false
false
perception is more important
consequences of trauma
impact on mental health
leads to impact on physical health
antidepressants alone are effective for management of trauma, true or false
false
need additional psychotherapy
criteria for PTSD (NICE)
anyone who has witnessed a traumatic event
experience “reliving” of the situation
exhibit avoidance
what is the difference between normal and pathological responses to trauma
severity, duration and frequency of symptoms
RFs for PTSD
severe acute stress reaction low serum cortisol increase acutely FH or personal history of mental disorder serious physical injury loss of normal daily function extremes of age genetics previous traumatic experiences lifestyle female
pre traumatic risk/resilience factors
person related
peri traumatic risk/resilience factors
trauma related
post-traumatic risk/resilience factors
environment related
normal reactions to trauma
numbness, shock, denial fear depression/elation anger, irritability guilt impaired sleep hopelessness, helplessness avoidance intrusive experiences - flashbacks hyperarousal hypervigilance
psychological reactions after trauma
depression grief reactions panic attacks +- agoraphobia alcohol/drug dependence brief hypomania specific phobias
comorbidities of PTSD
depression
drug and alcohol misuse
anxiety disorders
what are intrusive phenomena
recurrent distressing collections
eg nightmares, flashbacks in any modality, distress accompanies reminders
what are avoidance symptoms
avoidance of thinking or talking about the past, activities, places, people amnesia for important aspect of trauma loss of interest in activities detachment emotional numbing sense of foreshortened future
hyperarousal symptoms
sleep disturbance irritable/angry concentration difficulties hypervigilance exaggerated startle response risky and destructive behaviour
association symptoms
dissociative: depersonalisation, derealisation, near death or out of body experiences
survivor guilt
performance guilt
DSM 5 criteria for PTSD
duration 1 month intrusive symptoms avoidance symptoms hyperarousal symptoms association symptoms negative changes in cognition and mood impairs social functioning
symptoms < 1 month
acute distressive disorder
what is complex PTSD
PTSD symptoms PLUS: cognitive disturbances identity disturbance emotional dysregulation chronic interpersonal difficulties dissociation somatisation tension reduction activities eg bing-purging, self harm, substance misuse
role of hippocampus
memory forming and stress response
role of amygdala
fear during trauma and its recollection
receptors for cortisol are more sensitive in people with PTSD, true or false
true
chronic PTSD has low/high serum cortisol levels
low
is there is hippocampal atrophy in PTSD
yes
there is increased/decreased activity of the amygdala
there is activation/deactivation of Broca’s areas
increased
deactivation
what should be ensured before starting treatment
safety of the patient
what are the main psychological therapies for PTSD
Trauma focussed:
Cognitive Behavioural Therapy CBT
Eye Movement Desensitisation and Reprocessing EMDR
when should psychological therapies be offered
regardless of time lapse since traumatic event
if there is failure to respond to psychological therapies, what should be done
augment with medication
in the acute phase, medication can be considered for what?
symptomatic treatment
what is first line management of PTSD
trauma focussed psychological therapies
CBT and EMDR
what medications can be given 2nd line if psychological therapy does not work
SSRIs
tricyclics
mirtazapine
PTSD is/isnt a normal adaptation to severe traumatic stress
isnt
most trauma exposed people develop PTSD, true or false
false
__ months after event = PTSD
6 months
