Responses to Traumatic Stress Flashcards
what is the difference between centrifugal and centripetal disasters?
centrifugal - together only at moment of disaster eg train / plane crash
centripetal - an existing community eg earthquake
what is difference between type 1 and type 2 (complex) trauma?
type 1 - single event
type 2 - repetitive or ongoing
what parts of the midbrain do fight, flight, freeze, hide, avoid, attach, submit, despair and uncontrolled activation states originate?
periaqueductal gray
ventral tegmental area
when would someone have a “freeze” response to threat?
to distant threat - can be voluntary
inescapable threat - involuntary tonic immobility
what are the features of tonic immobility?
decreased vocalisation intermittent eye contact rigidity and paralysis muscle tremors in extremities chills unresponsiveness to pain
activity in which part of midbrain correlates with the experience of dread of capture?
periaqueductal gray (PAG)
what does DSM describe as a traumatic event?
experience, witnessed or confronted
threat of death or injury
intense fear, helplessness or horror
what does ICD describe as a traumatic event?
delayed and/or protracted response
exceptionally threatening or catastrophic
likely to cause pervasive distress
what are normal reactions to trauma?
numbness, shock, denial fear depression or elation anger, irritability guilt impaired sleep hopelessness, helplessness perceptual changes avoidance intrusive experiences (eg flashbacks) hyperarousal, hypervigilance
what are the common psychological reactions after trauma?
depression grief reactions panic attacks +/- agoraphobia alcohol / drug dependence brief hypomania specific phobias (eg travel)
what are the two most common causes of PTSD?
sexual assault
war veterans
PTSD has a stronger association with suicide than any other anxiety disorder - true or false?
true
what % of patients with PTSD will have >1 co-morbid psychiatric condition?
80%
common - depression, drug and alcohol abuse and other anxiety disorders
what is the DSM IV criteria for diagnosis of PTSD?
traumatic event intrusive symptoms (1 or more) avoidance symptoms (3 or more) increased arousal (2 or more) duration 1 month distress and impairment in functioning acute / chronic / delayed onset
give 5 examples of intrusive symptoms?
recurrent distressing recollections nightmares flashbacks, in any modality distress accompanies reminders physiological reactions (fight or flight)
give 7 examples of avoidance symptoms?
avoidance of thinking or talking about event avoidance of reminders amnesia for aspect of trauma loss of interest in activities detachment emotional numbing sense of foreshortened future
give 5 examples of hyperarousal symptoms?
sleep disturbance irritability / anger concentration difficulties hypervigilance exaggerated startle response
complex PTSD is PTSD symptoms plus what other 7 symptoms?
cognitive disturbances identity disturbance emotional dysregulation chronic interpersonal difficulties dissociation somatisation tension reduction activities
give examples of cognitive disturbances?
low self esteem self blame hopelessness helplessness pre-occupation with threat
give examples of tension reduction activities?
binge-purging
self mutilation
substance misuse
what 2 brain areas are of interest in PTSD?
hippocampus
amygdala
what role does the hippocampus have in PTSD?
declarative or explicit memory and the stress response
what role does the amygdala have in PTSD?
fear during both trauma and its recollection
what is the apparent paradox at PTSD neurobiology and what is the suggested explanation?
high cortisol levels damage hippocampus but cortisol levels are low in PTSD
explanation - receptors for cortisol are more sensitive in people with PTSD at pituitary
does the hippocampal size correlate with current severity of PTSD?
yes
smaller = more severe
where does activity shift to when under threat?
PAD
does hippocampus undergo hypertrophy or atrophy?
atrophy
what areas of brain has increased activity and what area is deactivated?
increased activity of amygdala and other limbic areas
deactivation of brocas area when individuals access personal traumatic memories
what hemisphere undergoes lateralisation?
right - this may explain the timeless quality of traumatic memory
is treatment of PTSD difficult?
yes for many reasons
what are the three general principles of PTSD treatment?
ensure safety before treatment (eg domestic violence)
therapeutic relationship
guidance - drug should not be used in preference to psychological therapy
what are the two main psychological therapies used in PTSD?
CBT (cognitive behavioural therapy)
EMDR (eye movement desensitisation and reprocessing)
if there is a failure to respond to psychological therapies, should you augment with medication?
yes
what medications can non-specialists prescribe for PTSD?
paroxetine
mirtazapine
what medications can specialists prescribe for PTSD?
amitriptyline
phenelzine
what are alternative medications which can be given for PTSD?
prazosin
atypical antipsychotics or mood stabilisers (carbamazepine)
