Responses to trauma Flashcards
What are the 2 main classes of traumatic events ?
Type 1 - single trauma event which is sudden and unexpected
Type 2 - this is repetitive trauma
- usually involves betrayal of trust in primary-care giving relationships e.g. parent or teacher etc
- ongoing abuse, hostage taking (piracy), genocide
- Developmental trauma - bandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death
Is the chances of developing PTSD higher with type 1 or type 2 trauma ?
Type 2 (x3’s)
Define a major incident ?
Any situation associated with multiple casualties and fatalities, and damage to property, due to natural or unnatural causes, that is beyond what can be coped with ordinarily by the deployment of the emergency services
What is the relationship of trauma and bipolar disorder ?
High percentage of patients with bipolar disorder have a history of childhood deprivation or abuse
On MRI scanning what is seen in patients with PTSD?
implicates the anterior cingulate area, with failure to inhibit amygdala activation +/- lowered amygdala threshold to fearful stimuli
What are the cortisol levels in someone with PTSD (cortisol is a stress hormone)?
Cortisol levels are low
What are the normal reactions to trauma ?
- numbness, shock, denial
- Fear
- depression or elation
- anger, irritability
- guilt
- impaired sleep
- hopelessness, helplessness
- perceptual changes
- avoidance
- intrusive experiences (e.g., flashbacks)
- hyperarousal, hypervigilance
What are some of the psychological problems which may develop after trauma?
- Depression
- Grief Reactions
- Panic Attacks +/- agoraphobia
- Alcohol/Drug Dependence
- Brief Hypomania
- Specific Phobias (e.g., travel)
- PTSD
What are some of the main traumatic experiences which result in PTSD?
- Road Traffic accidents 10%
- Burns 35%
- Rape and sexual assault 57% (F)
- Vietnam combat veterans 31% (M) 37% (F)
- Falklands War veterans 22%
- Civil violence (NI) 23%
What anxiety disorder has the strongest risk for suicide ?
PTSD
What conditions are people with PTSD commonly co-morbid for ?
- depression
- drug and alcohol abuse
- and other anxiety disorders
What is the diagnostic criteria for PTSD?
- History of a stressor - person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence
- Needs to be experiencing intrusive symptoms (1 or more required)
- Needs to be experiencing avoidance symptoms (3 or more)
- Arousal symptoms (2 or more)
- negative alterations in cognitions and mood associated with the traumatic event beginning or worsening after the TE
- Symptoms need to have been present for 1 month
- distress and impairment in social or occupational functioning
What are the intrusive symptoms that a patient with PTSD may experience ?
- recurrent distressing recollections
- nightmares
- flashbacks, in any modality
- distress accompanies reminders
- physiological reactions (fight or flight) after exposure to reminders
What are the avoidant and emotional numbing symptoms a person with PTSD may experience ?
- avoidance of thinking or talking about the event
- avoidance of reminders such as activities, places or people
- amnesia for important aspect of trauma
- loss of interest in activities
- detachment
- emotional numbing - numb to emotions and relationships
- sense of foreshortened future - fate is untamable, life can have no meaning or pleasure
What are the hyperarousal symptoms that a patient with PTSD may experience ?
- sleep disturbance
- irritability / anger
- concentration difficulties
- hypervigilance
- exaggerated startle response
