Responses to Trauma Flashcards
What are the different classes of trauma?
Intentional = assault, robbery, rape
Unintentional = motor accident, industrial accident
Community disasters may be natural or man made
What is type 1 trauma?
Single incident trauma
What is type 2 trauma?
Repetitive trauma = usually a betrayal in trust in primary caregiver, 3x higher risk of PTSD than type 1
What people are more likely to experience trauma?
The poor and the marginalised
What is needed to treat patients with chronic depression who have a history of early life trauma?
Need psychotherapy as adjunct to medication
How common is early trauma in patients with bipolar disorder?
50% of bipolar patients have history of childhood deprivation or abuse
Dysregulation of what systems has been linked to how patients respond to trauma?
Catecholamine system, serotonin system, HPA axis, endogenous opioid system, immune response to trauma, glutamate system, GABA-benzodiazepine system, thyroid function, neuropeptide Y
What are anxiety and fear?
Genetically ingrained functions of nervous system = not weaknesses, promote survival
What causes emotion to arise during fear and anxiety?
Emotions arise from neural processes that prompt us to freeze (distant threat) or to flee (near threat)
Where do anxiety and fear responses originate from?
In the PAG or ventral tegmental area
What are some features of the freeze response?
Can be voluntary when distant threat
Types = tonic immobility, frozen fight/flight/attach/hide, attention or attentative freeze, low arousal freeze
What is the response to an inescapable threat?
Tonic immobility = involuntary state of profound motor inhibition, occurs especially when direct physical contact with threat is present
What changes can be seen in descendants of those exposed to trauma?
Have altered cortisol responses and are more likely to suffer from PTSD
What effect does trauma have on the brain?
Adult trauma reduces brain volume on right side
Childhood trauma reduces brain volume on left side
What does hippocampal size correlate to?
Severity of PTSD
Where is activity seen in the brain when a threat is near?
The PAG in the midbrain
Where is activity seen in the brain when the threat is far?
Rostral anterior cingulate cortex and medial prefrontal cortex
What is neuroception?
How neural circuits distinguish whether situations or people are safe or life threatening
Where does neuroception take place?
In primitive parts of the brain = not under conscious control
What does neuroception trigger?
Neurobiologically determined prosocial or defensive behaviours = not aware of threat on cognitive level but neuronal processes have already started reacting
What is the superior colliculi responsible for?
Basic urge of actions is orienting towards or away from
Responsible for orientation to social information
What is the PAG responsible for?
Generates emotional response to traumatic event = extensively linked to superior colliculi
Where does healing of deep wounds take place?
On the level of the superior colliculi and PAG
What are some trauma related risk factors for PTSD?
Man-made events, prolonged exposure, perceived threat to life, exposure to grotesque scenes, proximity, personally relevant factors
What are some environmental risk factors for PTSD?
Lack of support network, ongoing life stress, reactions of others, lack of economic resources, disadvantage, displacement
What are some features of resilience?
Up to 50% of people recover psychosocially without requiring specialist intervention
Resilience isn’t global but domain based
What are normal acute reactions to trauma?
Numbness, shock, denial, fear, depression, anger, guilt, impaired sleep, hopelessness, perceptual changes, avoidance, intrusive experiences, hypervigilance
What are the psychological reactions to trauma?
Acute stress disorder, PTSD, depression, grief, panic attacks +/- agoraphobia, substance dependence, brief hypomania, specific phobias, CPTSD, dissociative disorder
What are some examples of intrusive phenomena?
Recurrent distressing recollections, nightmares, flashbacks, distressing accompanying reminders, physiological reactions
What are some examples of avoidance symptoms?
Avoidance of thoughts or feelings about event
Avoidance of external reminders
What is the diagnostic criteria for PTSD?
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
What are some examples of negative alterations to cognition/mood?
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
What are some examples of alteration in arousal or reactivity?
Sleep disturbance, irritability, concentration difficulties, hypervigilance, exaggerated startle response, risky behaviour
What is complex PTSD?
The core symptoms of PTSD plus negative self concept, emotional dysregulation and chronic interpersonal difficulties
What are some responses to being in an RTA experienced by victims aged 18-70?
Acute stress syndrome (20%), mood disorders (10%), PTSD (10%), phobic travel anxiety (10%)
How common are comorbidities in patients with PTSD?
About 80% will have >= 1 comorbid psychiatric condition
60% of male patients and 40% of female patients meet criteria for >= 3 other psychiatric diagnoses
What are some psychological therapies for PTSD?
CBT, cognitive processing therapy, narrative exposure therapy, deep brain reorienting, EMDR, comprehensive resource model, sensorimotor psychotherapy, brainspotting, EFT
What is the preferred treatment for single event PTSD?
1st line = CBT
2nd line = EMDR
What is the phased treatment for complex PTSD?
Stabilisation and safety = enhance coping, resilience, medication, DBT, psychoeducation
Trauma treatment = working through traumatic event
Reintegration and rehabilitation
Why are alternative therapies to CBT needed?
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
When are medications indicated for treating PTSD?
For symptomatic treatment of acute phase
For augmentation of trauma-focused psychological treatment of chronic PTSD
What medications may be used to treat PTSD?
Antidepressants = venlafaxine, SSRI Antipsychotics = risperidone (for severe hyperarousal) Alternatives = prazosin, mood stabilisers
