Response to Trauma - PTSD Flashcards
How are traumatic events broken up?
Type 1
Type 2
Describe Type 1 traumatic events
Single sudden event
Describe Type 2 traumatic events
Repetitive trauma
Ongoing abuse
Which type of trauma is most likely to develop into PTSD?
Type 2 is 3x more likely to develop into
Where in the brain does Fear and anxiety arise from?
Peri-aqueductal Region
Ventral Tegmental area
What is fear?
Genetically ingrained function that promotes survival
Freeze - focus of fear is distant
Stop Watch Listen - voluntary
Freeze - focus of fear is inescapable
Tonic immobility
Involuntary but reversible motor inhibition
Activity in the Periaqueductal Grey Matter relates to what?
Dread
What can result in right sided hippocampal volume reduction?
Adult trauma
What can result in left sided hippocampal volume reduction?
Childhood trauma
What region of the brain relates to Desire and seeking?
Ventral tegmental
What region of the brain is related to Rage and Anger?
Dorsal PAG
What region of the brain is related to Lust?
Ventral and Dorsal PAG
Where does neuroception occur?
Within the primitive brain
Midbrain Medulla Pons
What is Neuroception?
Unconscious system that determines whether situations are safe or dangerous.
Activates prosocial or defensive behaviours
Means when we become consciously aware i.e we hear see or feel it we are able to react to it faster.
What is the job of the superior colliculi?
Orientates us towards or away from the stimuli
What is the job of the PAG?
Generation of an emotional response to the information supplied by the Superior Colliculi
Based on the regions of the brain associated to stimuli and emotional response which area is focused on when healing?
PAG and Superior colliculi likely best area to try and “rewire” as this is the basis of underlying fear.
Conscious awareness only occurs when at cortical level
What region of the brain is deactivated when exposed to current or the memory of trauma?
Brocas Area
Which protein is known to be protective against PTSD?
Neuropeptide Y - Gamma
What are some trauma related Risk factors for developing PTSD?
Man made Prolonged exposure Perceived threat to life Grotesque scenes Proximity to course Personally relevant i.e children involved
What are some patient related Risk Factors for developing PTSD?
Serious physical injury
FH or PH of mental disorders
What some environmental risk factors for developing PTSD?
Lack of support network
Ongoing life stresses
What percentage of patients recover psychosocial from their experience with no need of specialist care?
50%
What is the normal acute response to a traumatic event?
Numbness Shock Fear Depression Guilt Anger Impaired sleep Helplessness Aviodance
What makes it a pathological response to a traumatic event?
Severity and duration is beyond what is expected
>4 weeks
How long does acute stress disorder last for?
Less than 4 weeks
What are main symptoms of PTSD?
Depression
Panic attacks
Phobias
What are the five categories of PTSD symptoms
Intrusive Avoidance Negative Alterations Increased Arousal and reactivity Functional impairment
In order to be diagnosed with PTSD what intrusive symptoms do you need?
More then 1 of the 5 Recurrent recollections Nightmares Flashbacks Distress from reminders Physiological reactions
In order to be diagnosed with PTSD what avoidance symptoms do you need?
One or both of
Thoughts and feelings
External reminders i.e locations people
In order to be diagnosed with PTSD what Negative alterations do you need?
More than 1 of the 7
Negative alterations in cognition and mood
In order to be diagnosed with PTSD what increased arousal and reactivity symptoms do you need?
More than 2 of the 6 Sleep Irritable Concentration Vigilance Startled Destructive
How long does the functional impairment have to last to get a diagnosis of PTSD?
Over 1 month
What are some Negative alterations?
Amnesia for key aspects
Loss in interest in activities
Negative affect
Overly negative thoughts and assumptions about self and world
Exaggerated blame to self and others
Feeling isolated
Difficulty experiencing positive emotions
Alongside the usual symptoms what is required for a diagnosis of Complex PTSD?
Negative self concept - low self esteem, hopelessness, pervasive shame and/ or guilt
Emotional dysregulation - violent or emotional outbursts, reckless behaviour
What are some tension reducing activities seen in complex PTSD cases?
Binging then purging
Self mutilation
Substance misuse
Why is there a decreased focus on Top down therapies such as CBT for the treatment of PTSD?
CBT focuses on the conscious cortex regions of the brain, these regions are not the source of the issue they simply interpret it. The mammalian brain is the driver behind fear.
What therapies focus on rewiring the mammalian brain i.e superior colliculus and the PAG?
Eye Movement Desensitisation and Reprogramming EMDR
What is the role of pharmacotherapy in PTSD?
Symptomatic treatment for acute
2nd line or augmenting Therapy
What antidepressants are used?
Venlafaxine
SSRIs i.e sertraline
What Antipsychotics are used?
Risperidone ( severe hyperarousal )
What are some alternative medications used?
Mood stabilisers e.g. carbezamapine
Prozosin Alpha 1 Antagonists
