Responses to Trauma Flashcards
what is the difference between a centrifugal disaster and a centripetal disaster?
- centrifugal disaster: together only at the moment e.g. plane crash
- centripetal disaster: on an existing community e.g hurricane
what is the difference between type 1 and type 2 traumatic events? which is more likely to lead to PTSD?
-Type 1: single incident trauma (unexpected)
-Type 2: repetitive trauma (complex trauma)
3 times the risk of PTSD with type 1
What is the definition of a major incident?
Any situation associated with multiple casualities/fatalities and damage to property due to natural/unnatural causes, beyond what emergency services can cope with
What are the 4 main implications of trauma?
Chronic depression: pts with everyday life trauma predicts the need for psychotherapy adjunct.
Bipolar disorder: high % patients bipolar disorder have hx of childhood deprivation/abuse
Psychiatric patients: high rates of trauma exposure in in-patients and community
Physical health: trauma exposure associated with effects upon physical health, PTSD associated with effects upon physical health
What is defence activation?
Defence has a midbrain origin with top-down control and has autonomic and motor accompaniements which can be triggered years post-trauma (flight/freeze/hide/avoid/attach/submit/despair/uncontrolled activation states)
What is the difference between the freeze response and tonic immobility in terms of the situations that each occurs?
- the freeze response to a distant threat can be voluntary: stop, watch and listen
- to inescapable threat tonic immobility occurs: involuntary state of profound but reversable motor inhibition
What happens in tonic immobility?
-decrease in vocalisation
-intermittant eye closure
-rigidity and paralysis
-muscle tremors in extremities
-chills
-unresponsiveness to pain
may be associated with peri-traumatic dissociation
Describe the neurobiology of threat
an increase in the proximity of a predator shifts brain activation from prefrontal cortex to the midbrain (region responsible for active and passive defence responses)
(cortical to subcortical)
Describe the neurobiology involved in PTSD?
It is thought to be associated with deficiency in top-down modulation of amygdala activation by pre-frontal cortex
Describe the role of the stress response in PTSD?
Cortisol levels are low in PTSD:
- rise in cortisol levels are lowest in PTSD
- chronic PTSD has low serum cortisol levels
What risk or resilience factors are relevant in the pre/peri/post traumatic periods?
pre-traumatic - person related factors e.g. FH/personality traits
peri-traumatic - trauma related e.g. sudden/unexpected
post-traumatic - environment related e.g. lack support network
What is the intrusive phenomena involved with traumatic experiences? (5 sx)
- recurrent distressing recollections
- nightmares
- flashbacks
- distress accompanies reminders
- physiological reactions
Describe hyperarousal symptoms when associated with PTSD (5)
- sleep disturbance
- irritability/anger
- concentration difficulty
- hypervigilance
- exaggerated/startled response
Describe avoidance symptoms when associated with PTSD (7)
- Avoidance thinking/talking about event
- Avoidance of reminders (places/people/activities)
- Amnesia for important aspects
- Loss of interest in activities
- Detachment
- Emotional numbing
- Sense of foreshortened future
What is the DSM V criteria for PTSD (8)
- Traumatic event – no longer need emotional response at time of trauma
- Intrusive symptoms: 1 or more (of 5)
- Avoidance symptoms: 1 or more (of 2)
- Negative alterations in cognitions & mood: 1 or more (of 7)
- Increased arousal & reactivity: 2 or more (of 6)
- Specify whether with dissociative symptoms
- Duration of 1 month
- Distress and impairment in social or occupational functioning
