Responses to Trauma

Question 1

What are trauma-related risk factors for developing PTSD?

Answer 1

Man-made situations
Prolonged exposure
Perceived threat to life
Personally relevant factors

Question 2

What are patient-related risk factors for developing PTSD?

Answer 2

Severe acute stress reaction
Serious physical injury
Loss of normal daily function
Past experience of trauma

Question 3

What are environmental-related risk factors for developing PTSD?

Answer 3

Lack of a support network
Ongoing life stresses
Reactions of others
Lack of economic resources, disadvantage

Question 4

What is a resistant response to trauma?

Answer 4

Little response

Question 5

What is a resilient response to trauma?

Answer 5

Experience distress but recover and return to normal in days-weeks

Question 6

What is a recovery response to trauma?

Answer 6

Develop illness but recover over time

Question 7

What are the possible responses to trauma?

Answer 7

Resistant
Resilient
Recovery
Chronic and persistent pattern
Chronic and progressive pattern

Question 8

What is a chronic and progressive pattern in response to trauma?

Answer 8

Spiral of loss

Question 9

What is an acute stress reaction?

Answer 9

A normal bodily response to a sudden stressful or traumatic event
Symptoms develop shortly after the event and last about 2 days

Question 10

What is acute stress disorder?

Answer 10

When the normal bodily response to trauma becomes prolonged - up to 4 weeks
Often a precursor to PTSD

Question 11

What is the presentation of acute stress reaction/disorder?

Answer 11

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

Question 12

What are the management options for acute stress reaction/disorder?

Answer 12

Emotional support
Encourage talking about the event
Short course of benzodiazepines
Psychological therapies if symptoms are severe

Question 13

What is adjustment disorder?

Answer 13

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

Question 14

What is the presentation of adjustment disorder?

Answer 14

Mood: depression, anxiety, irritability
Panic attacks, poor concentration and angry outbursts
Preoccupation with the causative event

Question 15

What are the management options for adjustment disorder?

Answer 15

Psychoeducation and self-help
Counselling
Pharmacological: SSRIs, short course of benzodiazepines

Question 16

What is PTSD?

Answer 16

A severe and delayed psychological disturbance following an exceptionally traumatic event
Symptoms can develop months to ears after the event

Question 17

What is acute and chronic PTSD?

Answer 17

Acute: symptoms develop within 3 months
Chronic: symptoms develop after 3 months

Question 18

What is the biological basis of PTSD?

Answer 18

Low cortisol levels
Hippocampal atrophy
Increased activity of the amygdala

Question 19

What are the key symptoms of PTSD?

Answer 19

Intrusive phenomena
Avoidance
Negative alterations in cognition and mood symptoms
Alterations in arousal and reactivity

Question 20

How do intrusive phenomena present in PTSD?

Answer 20

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

Question 21

How does avoidance present in PTSD?

Answer 21

Refusal to talk about events
Avoidance of external reminders
Usually as a coping mechanisms for the intrusions

Question 22

How do negative alterations in cognition and mood symptoms present in PTSD?

Answer 22

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

Question 23

How do alterations in arousal and reactivity present in PTSD?

Answer 23

Irritability or aggression
Anxiety
Hypervigilance
Exaggerated startle response
Unable to relax or sleep
Concentration difficulties
Risky or destructive behaviour

Question 24

What are common co-morbidities in PTSD?

Answer 24

Depression
Substance misuse
Self harm

Question 25

What is complex PTSD?

Answer 25

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.

Question 26

When is PTSD treated?

Answer 26

If symptoms have persisted longer than 3 months - unless severe

Question 27

What are psychological management options for PTSD?

Answer 27

CBT - trauma focused

EMDR (eye movement desensitisation and reprocessing)

Question 28

What are pharmacological management options for PTSD?

Answer 28

SSRI - paroxetine
Antipsychotics - risperidone for severe hyperarousal
Mood stabilisers - carbemazepine
Mirtazapine, amitriptyline
Prazosin

Question 29

What is the phase-based approach used in complex PTSD?

Answer 29

1. Stabilisation and safety - resourcing
2. Trauma treatment - reprocessing
3. Reintegration/rehabilitation