Responses to Traumatic Stress Flashcards
What are the two types of trauma that individuals themselves are exposed to?`
Intentional - assault, robbery, rape
Unintentional - motor vehicle accident, industrial accident
What two types of trauma can communities/populations be exposed to?
Human made - technological, train /plane crash
Natural - hurricane, tornado, earthquake, flood
What is the difference between Type 1 and 2 trauma?
Type 1 = Single incident trauma, unexpected Type 2 (complex) = prolonged or repetitive e.g. ongoing abuse, hostage taking (piracy)
Type 2 trauma has an increased risk of PTSD developing afterwards. TRUE/FALSE?
TRUE
e.g. combat is considered expected trauma => Type 2 but many veterans experience PTSD
What is the difference between shell shock and PTSD?
Shell shock = specific to combat (term was generated after WWI)
PTSD = for combat AND more generalised things
Trauma is equal opportunity, without respect for social class or economic status. TRUE/FALSE?
FALSE
Poor and marginalised are much more likely to be victims/die.
What relatively common events can cause PTSD?
Fires
Admission to ICU/ITU
How should patients with chronic depression be treated if they have an early life history of trauma?
psychotherapy as an adjunct to pharmacotherapy
Trauma can affect a patient’s physical health. TRUE/FALSE?
TRUE
- infections, pain disorders, hypertension, diabetes, asthma, allergies
PTSD is associated with what chronic physical health conditions?
- cardiovascular
- digestive (including liver disease)
- musculoskeletal
- endocrine
- respiratory
What is the purpose of our anxiety response to fear?
Promote survival
What are the main types of “fight or flight” response?
Freeze (if threat is distant and inescapable)
Flee (if threat is nearby and escapable)
Tonic immobility (if very near stimulus)
What symptoms occur in a tonic immobility response?
Distal tremor Decreased vocalisation Intermittent eye contact Rigidity and paralysis Loss of pain response (in preparation for attack)
Why is tonic immobility used as a tactic?
Evidence that predators are less likely to attack immobile prey
WHat is the difference between an attentive and attention freeze response?
Attentive - broad field => person is aware of all around them
Attention - narrow field => person is fixated one one thing
What causes each persons response to vary to a threatening stimulus?
- Nature of the stimulus (familiar or unfamiliar)
- Internal state of the person (level of consciousness)
- person’s previous experience (e.g. past traumatic experience)
Why is the core of the brain sometimes considered the “reptilian brain”?
parts of the brain which carry out the most basic function
How does brain activity in the “reptilian brain” shift when someone is under threat from a predator closing in?
ventromedial prefrontal cortex to the periaqueductal grey
periaqueductal grey matter correlates with the dread of “capture”
Acute stress increases cortisol levels. TRUE/FALSE?
TRUE
What parts of the brain are involved in negative feedback of cortisol?
pituitary
hypothalamus
hippocampus
amygdala
Are cortisol levels high or low in PTSD?
cortisol levels are low in PTSD
biological paradox
After a major incident or trauma NATO explained that some patients will be resistant, resilient and others will recover. Explain what this means and what groups of patients have been missed out?
Resistant - level of distress not majorly altered by incident
Resilient - affected by incident for 1-2 weeks then recover
Recovery - patients are affected for longer than those who are resilient
Some patients NEVER recover and 1/3 get chronic symptoms
What are the trauma-related risk factors?
- man-made rather than natural events
- prolonged exposure
- perceived threat to life
- multiple deaths and/or mutilation
- personally relevant factors (e.g. involvement of a child)
What patient related risk factors can cause a reaction to trauma?
- low serum cortisol which increases acutely
- family or personal history of mental disorder
- extremes of age
- past experience of trauma
- coping style
- behaviour disorder
What environmental risk factors may make the period after a traumatic event difficult for some patients?
- lack of a support network
- ongoing life stresses
- disadvantage (whether social, educational or economic)
What time period of symptoms would indicate a response to trauma is abnormal?
Symptoms for 3-4 weeks every night which prevents patient from sleeping
=> abnormal
Give examples of symptoms in normal reactions to trauma?
numbness, shock, denial Change in Mood (depression or elation) guilt impaired sleep avoidance of place where it happened intrusive experiences (e.g., flashbacks)
What percentage of PTSD patients will have another comorbid psychiatric condition?
80%
e.g. depression, drug and alcohol abuse, and other anxiety disorders
What are the DSM criteria for a diagnosis of PTSD?
Traumatic event in past - intrusive symptoms - avoidance symptoms - increased arousal - negative alterations in cognition and mood FOR 1 MONTH also impaired daily functioning can be acute / chronic / delayed onset
What is meant by intrusive PTSD symptoms?
nightmares
flashbacks
What is meant by avoidance PTSD symptoms?
avoidance of thinking or talking about the event
loss of interest in activities
detachment
emotional numbing
What symptoms may indicate a patient with PTSD is hyperaroused?
sleep disturbance
irritable
concentration difficulties
exaggerated startle response
What is meant by “bottom-up” and “top-down” processing of the brain?
The mammalian brain functions “top-down”
whereas the reptilian brain functions “bottom-up”
- the basic functions of the reptilian brain causing it to function this way are acting on fear and trying to escape
WHat part of the brain is seen as diminished in size in patients with PTSD?
Hippocampus
- hippocampal size correlated with severity of PTSD
(this is a biological paradox as high cortisol levels can damage the hippocampus, yet cortisol levels are low in PTSD)
What other conditions are associated with small hippocampal volume?
Bipolar disorder dementia Cushing’s syndrome alcohol misuse borderline personality disorder
Why do memories of trauma provoke certain strong emotions?
The memories are not organised correctly in the brain
Usually:
1st filter = thalamus
2nd filter = amygdala (emotional connections)
ORGANISATION
then Storage as memory
If organisation is missed, the memory fragments are stored strongly related to their emotion from the amygdala
Why do patients struggle to discuss the memories they associate with trauma?
deactivation of Broca’s area when individual’s access personal traumatic memories in the brain
=> cant formulate speech well
Why can patients recall traumatic events as if they were yesterday?
The memories lateralise to the Right hemisphere of the brain (which has NO concept of time)
Why is treatment of post traumatic stress and anxiety difficult?
- patients expectations are high
- delayed tx
- co-morbidity
- patients feel they are unworthy of help due to guilt
- Therapists’ fears
What psychological therapies are usually used for post-traumatic treatment?
CBT (cognitive behavioural therapy
EMDR (Eye Movement Desensitisation and Reprocessing)
pharmacological methods usually added in afterwards if patient is not responding to these
What medications are usually given for PTSD if psychological therapies have not worked ?
Non-specialists - paroxetine or mirtazapine
Specialists – amitriptyline or phenelzine
Alternatives:
- prazosin (often used in veterans nightmares)
- atypical antipsychotics (risperidone if hyperarousal)
- mood stabilizers (Carbamazepine)
What is the aim of CBT in PTSD?
To associate the memories with a neutral emotion as opposed to a strong one
=> if it is remembered the emotion with it may not necessarily be negative
Is formal thought disorder (i.e. thought interference, withdrawal, block, broadcasting) a feature of PTSD?
No
- not common
=> passivity phenomena also not common as this is interlinked with formal thought disorder
How soon after an event can PTSD be diagnosed?
Symptoms usually present for 6 months before diagnosis is made
Short time after event = Acute stress reaction
=> this usually resolves
