Responses to Traumatic Stress

Question 1

what is the difference between centrifugal and centripetal disasters?

Answer 1

centrifugal - together only at moment of disaster eg train / plane crash

centripetal - an existing community eg earthquake

Question 2

what is difference between type 1 and type 2 (complex) trauma?

Answer 2

type 1 - single event

type 2 - repetitive or ongoing

Question 3

what parts of the midbrain do fight, flight, freeze, hide, avoid, attach, submit, despair and uncontrolled activation states originate?

Answer 3

periaqueductal gray

ventral tegmental area

Question 4

when would someone have a “freeze” response to threat?

Answer 4

to distant threat - can be voluntary

inescapable threat - involuntary tonic immobility

Question 5

what are the features of tonic immobility?

Answer 5

decreased vocalisation 
intermittent eye contact 
rigidity and paralysis 
muscle tremors in extremities 
chills 
unresponsiveness to pain

Question 6

activity in which part of midbrain correlates with the experience of dread of capture?

Answer 6

periaqueductal gray (PAG)

Question 7

what does DSM describe as a traumatic event?

Answer 7

experience, witnessed or confronted
threat of death or injury
intense fear, helplessness or horror

Question 8

what does ICD describe as a traumatic event?

Answer 8

delayed and/or protracted response
exceptionally threatening or catastrophic
likely to cause pervasive distress

Question 9

what are normal reactions to trauma?

Answer 9

numbness, shock, denial 
fear
depression or elation 
anger, irritability 
guilt 
impaired sleep 
hopelessness, helplessness
perceptual changes 
avoidance 
intrusive experiences (eg flashbacks)
hyperarousal, hypervigilance

Question 10

what are the common psychological reactions after trauma?

Answer 10

depression 
grief reactions 
panic attacks +/- agoraphobia 
alcohol / drug dependence 
brief hypomania 
specific phobias (eg travel)

Question 11

what are the two most common causes of PTSD?

Answer 11

sexual assault

war veterans

Question 12

PTSD has a stronger association with suicide than any other anxiety disorder - true or false?

Answer 12

true

Question 13

what % of patients with PTSD will have >1 co-morbid psychiatric condition?

Answer 13

80%

common - depression, drug and alcohol abuse and other anxiety disorders

Question 14

what is the DSM IV criteria for diagnosis of PTSD?

Answer 14

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

Question 15

give 5 examples of intrusive symptoms?

Answer 15

recurrent distressing recollections 
nightmares 
flashbacks, in any modality 
distress accompanies reminders 
physiological reactions (fight or flight)

Question 16

give 7 examples of avoidance symptoms?

Answer 16

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

Question 17

give 5 examples of hyperarousal symptoms?

Answer 17

sleep disturbance 
irritability / anger 
concentration difficulties 
hypervigilance
exaggerated startle response

Question 18

complex PTSD is PTSD symptoms plus what other 7 symptoms?

Answer 18

cognitive disturbances 
identity disturbance 
emotional dysregulation 
chronic interpersonal difficulties 
dissociation 
somatisation
tension reduction activities

Question 19

give examples of cognitive disturbances?

Answer 19

low self esteem 
self blame 
hopelessness
helplessness
pre-occupation with threat

Question 20

give examples of tension reduction activities?

Answer 20

binge-purging
self mutilation
substance misuse

Question 21

what 2 brain areas are of interest in PTSD?

Answer 21

hippocampus

amygdala

Question 22

what role does the hippocampus have in PTSD?

Answer 22

declarative or explicit memory and the stress response

Question 23

what role does the amygdala have in PTSD?

Answer 23

fear during both trauma and its recollection

Question 24

what is the apparent paradox at PTSD neurobiology and what is the suggested explanation?

Answer 24

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

Question 25

does the hippocampal size correlate with current severity of PTSD?

Answer 25

yes

smaller = more severe

Question 26

where does activity shift to when under threat?

Answer 26

PAD

Question 27

does hippocampus undergo hypertrophy or atrophy?

Answer 27

atrophy

Question 28

what areas of brain has increased activity and what area is deactivated?

Answer 28

increased activity of amygdala and other limbic areas

deactivation of brocas area when individuals access personal traumatic memories

Question 29

what hemisphere undergoes lateralisation?

Answer 29

right - this may explain the timeless quality of traumatic memory

Question 30

is treatment of PTSD difficult?

Answer 30

yes for many reasons

Question 31

what are the three general principles of PTSD treatment?

Answer 31

ensure safety before treatment (eg domestic violence)

therapeutic relationship

guidance - drug should not be used in preference to psychological therapy

Question 32

what are the two main psychological therapies used in PTSD?

Answer 32

CBT (cognitive behavioural therapy)

EMDR (eye movement desensitisation and reprocessing)

Question 33

if there is a failure to respond to psychological therapies, should you augment with medication?

Answer 33

yes

Question 34

what medications can non-specialists prescribe for PTSD?

Answer 34

paroxetine

mirtazapine

Question 35

what medications can specialists prescribe for PTSD?

Answer 35

amitriptyline

phenelzine

Question 36

what are alternative medications which can be given for PTSD?

Answer 36

prazosin

atypical antipsychotics or mood stabilisers (carbamazepine)