Responses to Trauma Flashcards
What are the two types of traumatic event?
Type 1 - single incident that is sudden and unexpected
Type 2 - repetitive almost expected (abuse, genocide, betrayal), developmental trauma associated with attachment and attunement
What percentage of people will bipolar will have suffered childhood abuse/deprivation?
50%
Describe immune response to orthopaedic trauma
Unhealed fractures have altered IL6 receptor and psychologically PTSD
What is the significance of neuropeptide Y?
Higher in those with special forces training and it is protective against PTSD
Where do freeze/flee responses originate?
Periaqueductal grey area or ventral segmental area in midbrain
Why do you not feel pain in trauma?
Dissociation - the insula in the limbic system cuts off the rest of the body - improving chances of survival
What area of the brain shuts down in fear response?
Broca’s area
Describe a freeze response
Tonic immobility - involuntary state of profound motor inhibition
How does the brain activity change as a predator approaches?
Predator distant - activity in frontal lobe
Predator close - activity in PAG
What is the difference in structural findings between childhood and adult trauma?
Adult - reduction of hippocampal volume on right side
Childhood - reduction of hippocampal volume on left side
What is neuroception?
Allows us to distinguish between safe/dangerous/life threatening stimuli. Takes place in primitive parts of the brain without conscious awareness, triggers prosocial or defensive behaviours
Which two parts of the brain are involved in healing?
Superior colliculus
PAG
What are the risk factors for post traumatic reactions?
Manmade trauma, prolonged trauma, perceived threat to life, proximity to danger, personal factors and environmental factors
How are physiological reactions distinguished from pathological reactions?
- severity
- frequency
- duration
What are the symptoms of clinical trauma?
Numbness, shock, denial, depression, anger, impaired sleep, hopelessness, avoidance, perceptual changes, guilt
What disease can manifest as a result of trauma?
Acute stress disorder (<4weeks) PTSD Depression Grief Panic attacks Hypomania Specific phobias
What is the diagnostic criteria for PTSD?
Traumatic event
<1 intrusive symptoms
1 or 2 avoidance symptoms
>1 negative alterations in cognition and mood
>2 increased arousal and reactivity
Functional impairment and symptoms present for 1 month
What are intrusive symptoms?
Nightmares, flashbacks, physiological reactions, distress when remembering
What are avoidance symptoms?
Avoid talking about trauma
Avoid external reminders (seeing people or doing certain things)
What are negative alterations in mood and cognition?
Amnesia, loss of interest, negative affect, isolation, lame, negative thoughts
What are symptoms of increase arousal and reactivity?
Sleep disturbance, aggression, hyper vigilance, startle, destructive behaviour
What is complex PTSD?
Core PTSD symptoms plus
- negative self concept
- emotional dysregualtion
- chronic interpersonal difficulties
How is PTSD treated?
Psychological therapies (CBT and 3MDR) Pharmacological (symptomatic)
What drugs can help in the management of PTSD?
Antidepressants (venlafaxine/SSRI)
Antipsychotic (rispiredone)
Prazosin (alpha agonist)
Mood stabilisers - carbamazepine
How is complex PTSD treated?
- stabilisation and safety
- trauma treatment
- reintegration
What is the problem with CBT?
It does not address brainstem response to trauma, reactivation does not require speaking and CBT may be too activating
Describe the summary of PTSD treatment
- Mild or <4 weeks since trauma - watchful waiting
- Within 3 months - CBT or hypnotic medication
- More than 3 months - CBT or EMDR
- Limited evidence for drug treatment
