Responses to Trauma

Question 1

What are the different classes of trauma?

Answer 1

Intentional = assault, robbery, rape
Unintentional = motor accident, industrial accident
Community disasters may be natural or man made

Question 2

What is type 1 trauma?

Answer 2

Single incident trauma

Question 3

What is type 2 trauma?

Answer 3

Repetitive trauma = usually a betrayal in trust in primary caregiver, 3x higher risk of PTSD than type 1

Question 4

What people are more likely to experience trauma?

Answer 4

The poor and the marginalised

Question 5

What is needed to treat patients with chronic depression who have a history of early life trauma?

Answer 5

Need psychotherapy as adjunct to medication

Question 6

How common is early trauma in patients with bipolar disorder?

Answer 6

50% of bipolar patients have history of childhood deprivation or abuse

Question 7

Dysregulation of what systems has been linked to how patients respond to trauma?

Answer 7

Catecholamine system, serotonin system, HPA axis, endogenous opioid system, immune response to trauma, glutamate system, GABA-benzodiazepine system, thyroid function, neuropeptide Y

Question 8

What are anxiety and fear?

Answer 8

Genetically ingrained functions of nervous system = not weaknesses, promote survival

Question 9

What causes emotion to arise during fear and anxiety?

Answer 9

Emotions arise from neural processes that prompt us to freeze (distant threat) or to flee (near threat)

Question 10

Where do anxiety and fear responses originate from?

Answer 10

In the PAG or ventral tegmental area

Question 11

What are some features of the freeze response?

Answer 11

Can be voluntary when distant threat

Types = tonic immobility, frozen fight/flight/attach/hide, attention or attentative freeze, low arousal freeze

Question 12

What is the response to an inescapable threat?

Answer 12

Tonic immobility = involuntary state of profound motor inhibition, occurs especially when direct physical contact with threat is present

Question 13

What changes can be seen in descendants of those exposed to trauma?

Answer 13

Have altered cortisol responses and are more likely to suffer from PTSD

Question 14

What effect does trauma have on the brain?

Answer 14

Adult trauma reduces brain volume on right side

Childhood trauma reduces brain volume on left side

Question 15

What does hippocampal size correlate to?

Answer 15

Severity of PTSD

Question 16

Where is activity seen in the brain when a threat is near?

Answer 16

The PAG in the midbrain

Question 17

Where is activity seen in the brain when the threat is far?

Answer 17

Rostral anterior cingulate cortex and medial prefrontal cortex

Question 18

What is neuroception?

Answer 18

How neural circuits distinguish whether situations or people are safe or life threatening

Question 19

Where does neuroception take place?

Answer 19

In primitive parts of the brain = not under conscious control

Question 20

What does neuroception trigger?

Answer 20

Neurobiologically determined prosocial or defensive behaviours = not aware of threat on cognitive level but neuronal processes have already started reacting

Question 21

What is the superior colliculi responsible for?

Answer 21

Basic urge of actions is orienting towards or away from

Responsible for orientation to social information

Question 22

What is the PAG responsible for?

Answer 22

Generates emotional response to traumatic event = extensively linked to superior colliculi

Question 23

Where does healing of deep wounds take place?

Answer 23

On the level of the superior colliculi and PAG

Question 24

What are some trauma related risk factors for PTSD?

Answer 24

Man-made events, prolonged exposure, perceived threat to life, exposure to grotesque scenes, proximity, personally relevant factors

Question 25

What are some environmental risk factors for PTSD?

Answer 25

Lack of support network, ongoing life stress, reactions of others, lack of economic resources, disadvantage, displacement

Question 26

What are some features of resilience?

Answer 26

Up to 50% of people recover psychosocially without requiring specialist intervention
Resilience isn’t global but domain based

Question 27

What are normal acute reactions to trauma?

Answer 27

Numbness, shock, denial, fear, depression, anger, guilt, impaired sleep, hopelessness, perceptual changes, avoidance, intrusive experiences, hypervigilance

Question 28

What are the psychological reactions to trauma?

Answer 28

Acute stress disorder, PTSD, depression, grief, panic attacks +/- agoraphobia, substance dependence, brief hypomania, specific phobias, CPTSD, dissociative disorder

Question 29

What are some examples of intrusive phenomena?

Answer 29

Recurrent distressing recollections, nightmares, flashbacks, distressing accompanying reminders, physiological reactions

Question 30

What are some examples of avoidance symptoms?

Answer 30

Avoidance of thoughts or feelings about event

Avoidance of external reminders

Question 31

What is the diagnostic criteria for PTSD?

Answer 31

Traumatic events
Intrusive symptoms >= 1 (of 5)
Avoidance symptoms = 1 or both (of 2)
Increased arousal or reactivity >= 2 (of 6)
Negative alterations in cognition/mood >= 1 (of 7)
Functional impairment
Symptoms lasting for 1 month

Question 32

What are some examples of negative alterations to cognition/mood?

Answer 32

Amnesia for important aspects of trauma
Negative affect
Loss of interest in activities
Overly negative thoughts about self and world
Exaggerated blame for causing event
Feeling isolated or detached
Difficulty experiencing positive emotion

Question 33

What are some examples of alteration in arousal or reactivity?

Answer 33

Sleep disturbance, irritability, concentration difficulties, hypervigilance, exaggerated startle response, risky behaviour

Question 34

What is complex PTSD?

Answer 34

The core symptoms of PTSD plus negative self concept, emotional dysregulation and chronic interpersonal difficulties

Question 35

What are some responses to being in an RTA experienced by victims aged 18-70?

Answer 35

Acute stress syndrome (20%), mood disorders (10%), PTSD (10%), phobic travel anxiety (10%)

Question 36

How common are comorbidities in patients with PTSD?

Answer 36

About 80% will have >= 1 comorbid psychiatric condition

60% of male patients and 40% of female patients meet criteria for >= 3 other psychiatric diagnoses

Question 37

What are some psychological therapies for PTSD?

Answer 37

CBT, cognitive processing therapy, narrative exposure therapy, deep brain reorienting, EMDR, comprehensive resource model, sensorimotor psychotherapy, brainspotting, EFT

Question 38

What is the preferred treatment for single event PTSD?

Answer 38

1st line = CBT

2nd line = EMDR

Question 39

What is the phased treatment for complex PTSD?

Answer 39

Stabilisation and safety = enhance coping, resilience, medication, DBT, psychoeducation
Trauma treatment = working through traumatic event
Reintegration and rehabilitation

Question 40

Why are alternative therapies to CBT needed?

Answer 40

Top-down processing won’t address brainstem-led responses to trauma
Reactivation of memory doesn’t need to be spoken
CBT may be too reactivating for some
CBT may not target clinical consequences of freeze states

Question 41

When are medications indicated for treating PTSD?

Answer 41

For symptomatic treatment of acute phase

For augmentation of trauma-focused psychological treatment of chronic PTSD

Question 42

What medications may be used to treat PTSD?

Answer 42

Antidepressants = venlafaxine, SSRI
Antipsychotics = risperidone (for severe hyperarousal)
Alternatives = prazosin, mood stabilisers