Responses to Traumatic Stress Flashcards
types of traumatic events
intentional
unintentional
examples of intentional trauma
assault
robbery
rape
examples of unintentional trauma
motor vehicle accident
industrial accident
what is human made trauma
technological
train/plane crash
what is natural trauma
hurricane, tornado
earthquake, flood
what is type 1 trauma
single incident, trauma unexpected
what is type 2 trauma
repetitive trauma ongoing abuse betrayal of trust developmental trauma attachment/attunement disruption may effect as many as 1 in 10 1 in 7 children x3 risk of PTSD
what is a major incident
any situation associated with multiple casualties and fatalities and damage to property due to natural or unnatural causes that is belyond what can be coped with ordinarily by the deployment of the emergency services
true/false trauma is equal opportunity without respect for social class or economic status true/false
poor and marginalised are much more likely to be victims
what does a history of trauma predict in depression
that the need psychotherapy as well as pharmacotherapy
how can childhood predict future mental heath
high percentage of patients with bipolar had childhood deprivation or abuse
what is anxiety and fear
a genetically ingrained function of the nervous system
evolutionary significants - promotes survival
what are peoples responses to fear/trauma
more than ‘fight or flight’
fight flight freeze hide avoid attach submit despair uncontrolled activation status
what is the freeze response
either voluntary - to ‘stop, watch and listen’
not voluntary - inescapable threat
- tonic immobility occurs
- involuntary state of profound (but reversible) motor inhibition
- especially when direct physical contact with predator/aggressor
features of tonic immobility
decreased vocalisation intermittent eye contact rigidity and paralysis muscle tremors in extremities chills unresponsiveness to pain
may be associated with peri-traumatic dissociation
how can tonic immobility increase survival
predators less likely to attack immobile prey
if attack immobility may cause a loosening of grip
decrease risk of extreme violence which fighting back could trigger
some attackers loose interest if victim is immobile and unresponsive
aka, playing possum
what is the reptilian brain hypothesis
as predator closes in, brain activity shifts from ventromedial prefrontal cortex to periaqueductal grey
activity in PAG correlated with the subjective experience of dread and capture
trauma related risk factors
Sudden, unexpected events Man-made events Prolonged exposure Perceived threat to life Multiple deaths and/or mutilation Dose response - relationship Personally relevant factors
what are patient related risk factors
Severe acute stress reaction low serum cortisol increase acutely family or personal history of mental disorder serious physical injury loss of normal daily function extremes of age genetic predisposition epigenetic - transgenerational effects past experiences of trauma
environmental risk factors
lack of a support network ongoing life stresses reactions of others economic resources disadvantage displacement
is resilience global
No
not global- can be resilient to some situations and not others
what are some psychological reactions after trauma
Depression Grief reactions Panic attacks/agrophobia Alcohol/drug dependance Brief hypomania Specific phobia eg. travel
PTSD criteria
traumatic event 1 or more intrusive symptoms 3 or more avoidance symptoms 2 or more increased arousal duration 1 months distress and impairment in social or occupational functioning acute/chronic/delayed onset
what is intrusive phenomena
recurrent distressing recollections nightmares flashbacks, in any modality distress accompanies reminders physiological reactions (fight or flight)
what are avoidance symptoms
Avoidance of thinking or talking about the event
Avoidance of reminders such as activities, places or people
Amnesia for important aspects of trauma
Loss of interest in activities
Detachment
Emotional numbing
Sense of foreshortened future
what are hyperarousal symptoms
sleep disturbance irritability/anger concentration difficulties hyper-vigilance exaggerated startle response Risky and destructive behaviour
what are associated symptoms with PTSD
Dissociative symptoms -depersonalisation - observing self from distance -derealisation - things dont feel real -awareness of surroundings Survivor guilt Performance guilt
what is the just world hypothesis
after v bad trauma any underlying assumption of justice and fairness if shattered
confirmation that the world is a bad place
what is complex PTSD
PTSD symptoms +
- cognitive disturbance
- identity disturbance
- emotional dysregulation
- chronic interpersonal difficulties
- dissociation
- somatisation
- tension reduction activities
areas of the brain involved in PTSD
Hippocampus
-involved in explicit memory and stress response
Amygdala
-role of fear during both trauma and its recollection
why is the hippocampus smaller in PTSD sufferers
due to high cortisol level (also seen in cushings)
how can PTSD affect broca’s area
Broca’s area is decreased
brain can’t tell the difference between a memory and a real life event, so every memory is like you experiencing it again
memory formation filters
1st filter - is it important
2nd filter - is it emotionally important organisation
then memory is processed and stored?
what does the amygdala trigger
HPA and production of cortisol??
general principles of PTSD treatment
Ensure safety before starting treatment - eg. trauma is not still going on
importance of therapeutic relationship
guidance
general principles of PTSD treatment
Ensure safety before starting treatment - eg. trauma is not still going on
importance of therapeutic relationship
guidance - trauma focused psychological therapy
main treatment for PTSD
psychological therapy
drugs - second line to manage individual symptoms
