Responses to Trauma Flashcards
What are trauma-related risk factors for developing PTSD?
Man-made situations
Prolonged exposure
Perceived threat to life
Personally relevant factors
What are patient-related risk factors for developing PTSD?
Severe acute stress reaction
Serious physical injury
Loss of normal daily function
Past experience of trauma
What are environmental-related risk factors for developing PTSD?
Lack of a support network
Ongoing life stresses
Reactions of others
Lack of economic resources, disadvantage
What is a resistant response to trauma?
Little response
What is a resilient response to trauma?
Experience distress but recover and return to normal in days-weeks
What is a recovery response to trauma?
Develop illness but recover over time
What are the possible responses to trauma?
Resistant Resilient Recovery Chronic and persistent pattern Chronic and progressive pattern
What is a chronic and progressive pattern in response to trauma?
Spiral of loss
What is an acute stress reaction?
A normal bodily response to a sudden stressful or traumatic event
Symptoms develop shortly after the event and last about 2 days
What is acute stress disorder?
When the normal bodily response to trauma becomes prolonged - up to 4 weeks
Often a precursor to PTSD
What is the presentation of acute stress reaction/disorder?
Increased arousal: anxiety, irritability, restlessness, insomnia, feeling on edge, autonomic arousal (tachycardia, sweating)
Dissociative symptoms: shock, denial, amnesia, emotional numbness, depersonalization, derealization
Re-experiencing: flashbacks, recurrent images or thoughts, disturbing dreams
Cognitive: depression, guilt, hopelessness
What are the management options for acute stress reaction/disorder?
Emotional support
Encourage talking about the event
Short course of benzodiazepines
Psychological therapies if symptoms are severe
What is adjustment disorder?
When an individual fails to adjust to new life circumstances, often following a traumatic event
Symptoms developing within 3 months of the event and resolving within 6 months
What is the presentation of adjustment disorder?
Mood: depression, anxiety, irritability
Panic attacks, poor concentration and angry outbursts
Preoccupation with the causative event
What are the management options for adjustment disorder?
Psychoeducation and self-help
Counselling
Pharmacological: SSRIs, short course of benzodiazepines
What is PTSD?
A severe and delayed psychological disturbance following an exceptionally traumatic event
Symptoms can develop months to ears after the event
What is acute and chronic PTSD?
Acute: symptoms develop within 3 months
Chronic: symptoms develop after 3 months
What is the biological basis of PTSD?
Low cortisol levels
Hippocampal atrophy
Increased activity of the amygdala
What are the key symptoms of PTSD?
Intrusive phenomena
Avoidance
Negative alterations in cognition and mood symptoms
Alterations in arousal and reactivity
How do intrusive phenomena present in PTSD?
Recurrent distressing recollections
Nightmares
Flashbacks - often experienced in response to a trigger
Physiological reactions - sweating, tachycardia, breathless, tingling in hands and feet, need to reorient themselves to the present
How does avoidance present in PTSD?
Refusal to talk about events
Avoidance of external reminders
Usually as a coping mechanisms for the intrusions
How do negative alterations in cognition and mood symptoms present in PTSD?
Amnesia for important aspects
Loss of interest in activities
Negative affect - fear, horror, anger, guilt, shame
Overly negative thoughts and assumptions about self/world
Exaggerated blame (self/others) for causing traumatic events
Feeling isolated or detached
Emotional numbing
Survivors guilt
Dissociation - feels like an observer and not a precipitant, the world appears strange
How do alterations in arousal and reactivity present in PTSD?
Irritability or aggression Anxiety Hypervigilance Exaggerated startle response Unable to relax or sleep Concentration difficulties Risky or destructive behaviour
What are common co-morbidities in PTSD?
Depression
Substance misuse
Self harm
What is complex PTSD?
Core PTSD symptoms PLUS
Negative self-concept - low self-esteem, self-blame, hopelessness
Emotional dysregulation - violent or emotional outbursts, self-destructive behaviour, dissociation
Chronic interpersonal difficulties - issues with trust, maintaining relationships etc.
When is PTSD treated?
If symptoms have persisted longer than 3 months - unless severe
What are psychological management options for PTSD?
CBT - trauma focused
EMDR (eye movement desensitisation and reprocessing)
What are pharmacological management options for PTSD?
SSRI - paroxetine Antipsychotics - risperidone for severe hyperarousal Mood stabilisers - carbemazepine Mirtazapine, amitriptyline Prazosin
What is the phase-based approach used in complex PTSD?
- Stabilisation and safety - resourcing
- Trauma treatment - reprocessing
- Reintegration/rehabilitation
