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Psychiatry > Responses to Traumatic stress > Flashcards

Responses to Traumatic stress Flashcards

1
Q

what are centrifugal and centripetal disasters

A

centrifugal= when individuals are only together at the moment of the disaster (train/ plane crash)

centripetal- affects an existing community (hurricane, tornado, earthquake, flood)

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2
Q

what are type 1 and 2 trauma

A

type 1 trauma
-single incident, enexpected

type 2 (complex) trauma

  • repetitive
  • ongion abuse, hostage taking (piracy), genocide
  • betrayal of trust in primary care giving relationship
  • developmental trauma
  • attachment/ attunement disruption
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3
Q

how common is type 2 trauma

A

may affect as many as 1 in 7 children

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4
Q

which type of trauma is more likely to cause PTSD

A

type 2

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5
Q

what are the types of traumatic event

A

individuals exposed:

  • intentional (assault, robbery, rape)
  • unintentional (RTA, industrial accident)

communities/ populations exposed

  • human made (technological, train/ plain crash)
  • natural disasters
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6
Q

define a major incident

A

Any situation associated with multiple casualties and fatalities, and damage to property, due to natural or unnatural causes, that is beyond what can be coped with ordinarily by the deployment of the emergency services

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7
Q

is trauma/ disasters exceptional events

A

no part of daily life and in some areas/ for some people a repetitive event

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8
Q

who is more likely to be victims (and die) from trauma

A

poor and marginalised people

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9
Q

is panic a common response to a traumatic event

A

no most people behave rationally

panic is rare

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10
Q

are survivors of traumatic events left dazed and apathetic

A

activism is much more common that fatalism
only 15-20% of victims show passive or dazed reactions
after disasters most start reconstruction quickly

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11
Q

what impact can trauma have in later life

A

chronic depression
bipolar disorder
PTSD
can affect physical health (infections, pain disorders, hypertension, diabetes, asthma, allergies)

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12
Q

what physical health effects is PTSD associated with

A

increased mortality

chronic cardio, GI (inc liver disease), MSK, endocrine and resp diseases increased

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13
Q

what does anxiety and fear make us do

A

freeze (distant or inescapable threat)

or to flee (threat nearby and escapable)

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14
Q

what part of brain do decisions such as: Fight, flight, freeze, hide, avoid, attach, submit, despair & uncontrolled activation states
in response to fear originate from

A

PAG (periaqueductal grey) or ventral tegmental area

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15
Q

what is the purpose of the freeze response to fear

A

in distant threats: stop, watch, listen- pattern of vigilance

in inescapable threat: tonic immobility occurs (involuntary state of profound, reversible, motor inhibition), especially when direct physical contact with predator/ aggressor

predators less likely to attack immobile prey
if still may loosen grip increasing chances of escape
decreased risk of extreme fighting with fighting back
some attackers loose interest if victim immobile and unresponsive

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16
Q

what response is seen in 1/3-2/3 of all sexual assault causes

A

tonic immobility

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17
Q

what are the features of tonic immobility

A 
decreased vocalisation 
intermittent eye contact 
rigidity and paralysis 
muscle tremor in extremities 
chills 
unresponsiveness in pain

may be associated with peri-traumatic dissociation

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18
Q

what are the types of freeze response

A 
Frozen fight
Frozen flight
Frozen attach
Frozen hide
Attentive freeze (broad field)
Attention freeze (narrow field)
Tonic immobility
Low arousal freeze
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19
Q

what are the orienting responses

A

Arousal -unfamiliar stimulus registers in nervous system
Arrest -pause in or slowing of movement and activity
Alert -all senses heightened (to take in more information)
Muscular change -both flexion & extension
Orient/scan -search for the location (“where is it”)
Locate -source of the stimulus is found
Identify -novelty is recognised &/or identified
Evaluate -what is it? Is it dangerous/friendly? Do I pay attention?
Take action -not dangerous, normal activity resumed
-dangerous- defensive or emergency sequence activated
Reorganise-the nervous system re-equilibrates

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20
Q

what causes the orienting response to vary

A

the nature of the stimulus: abrupt/ gradual, familiar/ unfamiliar

internal state of the person: existing arousal level, level of consciousness, configuration of mental/ emotional/ physical components

the persons previous experience
-esp past traumatic experience

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21
Q

where in brain is active when dread of capture is felt

A

periaqueductal gray (PAG)

22
Q

what does increased proximity to a predator do to brain activity

A

shifts brain activation from prefrontal cortex to the midbrain Superior Colliculi & periaqueductal gray (PAG)
region responsible for active & passive defence responses

23
Q

PSTD is associated with a deficiency where

A

deficiency in top-down modulation of amygdala activation by the prefrontal cortex

24
Q

what can act as a protective/ resilience factor when exposed to trauma

A

an ability to regulate emotional responses to negative stimuli

25
Q

what are the three looping systems of defence activation

A

First loop – midbrain/brainstem origin
Peri-aqueductal Gray (PAG) & Superior Colliculi (SC)
Second loop – Mesolimbic- Dopamine System
Third loop – Stimulus-response learning system

26
Q

what can activate the mesolimbic dopamine system (ML-DA)

A 
PAG Inputs:
FEAR
RAGE
PANIC/
    Grief
Shame
(dtnorphins, CRF)

CARE/Nurturing
Play/Joy
Sexual Desire
(oxytocin, prolactin, opiods)

27
Q

what does the acute stress response lead to

A

dose-dependent increase in catecholamines and cortisol
cortisol acts as to mediate (& shut down) the stress response
through negative feedback it acts on the pituitary, hypothalamus, hippocampus and amygdala

28
Q

are cortisol levels high or low in PTSD

A

low

29
Q

how many people recover from a traumatic event with psychosocial intervention

A

50%

30
Q

what are the risk factors for PTSD

A

in trauma: sudden. unexpected events, man made disaster, prolonged exposure, perceived threat to life, multiple deaths/ mutilation (the grotesque), dose response (proximity), personally relevant factors

patient: severe actute stress reaction, FHx of mental health, physical injury (patients perception), loss of function, extremes of age, genetic predisposition, past trauma experience, coping styles, hopelessness/ powerlessness, personality traits (anxious), aldolescent behavioural problems, lower education/ intelligence/ socioeconomic status, life style, female, substance missuse
environment: lack of support, ongoing life stresses, reactions of others, economic resources, disadvantage, displacement

31
Q

what are the normal reactions to trauma

A 
numbness, shock, denial
fear
depression or elation
anger, irritability
guilt
impaired sleep
hopelessness, helplessness
perceptual changes
avoidance
intrusive experiences (e.g., flashbacks)
hyperarousal, hypervigilance
32
Q

what are the psychological reactions to trauma

A 
Depression
Grief Reactions
Panic Attacks +/- agoraphobia
Alcohol/Drug Dependence
Brief Hypomania
Specific Phobias (e.g., travel)
33
Q

what is commonly comorbid with PTSD

A

depression, drug and alcohol abuse, and other anxiety disorders

Approximately 80% of patients with PTSD will have >1 co-morbid psychiatric condition

34
Q

what is the diagnostic criteria for PTSD

A

traumatic event(s)
intrusive symptoms: 1 or more (of 5)
avoidance symptoms: 1 or both (…of 2)
negative alterations in cognitions & mood 1 or more (of 7)
increased arousal & reactivity: 2 or more (of 6)
duration 1 month
distress and impairment in social or occupational functioning

35
Q

what are intrusive symptoms

A 
recurrent distressing recollections
nightmares
flashbacks, in any modality
distress accompanies reminders
physiological reactions (fight or flight)
36
Q

what are Avoidant & emotional numbing symptoms

A

avoidance of thinking or talking about the event
avoidance of reminders such as activities, places or people
amnesia for important aspect of trauma
loss of interest in activities
detachment
emotional numbing
sense of foreshortened future

37
Q

what are hyperarousal symptoms

A 
sleep disturbance
irritability / anger
concentration difficulties
hypervigilance
exaggerated startle response
38
Q

what are the associated symptoms of ptsd

A 
dissociative symptoms 
depersonalisation, derealisation, awareness of surroundings
near death or out of body experiences
survivor guilt
performance guilt
39
Q

what are the features of complex PSTD

A 
PTSD symptoms &
Cognitive disturbances- low self-esteem, self-blame, hopelessness, helplessness, pre-occupation with threat
Identity disturbance
Emotional dysregulation
Chronic interpersonal difficulties
Dissociation 
Somatisation
Tension reduction activities - binge-purging, self mutilation, substance misuse etc)
40
Q

what does the limbic system do

A

emotional and somatosensory memory, attachment

41
Q

what does the frontal cortex do

A

Regulatory abilities, cognitive and executive functioning

42
Q

when in brain for memory

A

hippocampus

43
Q

what is bottom up/top down regulation

A

Processing led by either
Mammalian brain
“top-down” processing

Reptilian brain 
 “bottom-up” processing
acting on fear response, 
physiological mechanisms, 
can’t orientate to other things, 
all about escape
44
Q

what parts of the brain are important in PTSD

A

Hippocampus
knowledge of its role in declarative or explicit memory & the stress response

Amygdala
role of fear during both trauma & its recollection

45
Q

what can happen to the size of the hippocampus after trauma

A

atrophys

46
Q

what happens to brocas area when individuals access personal traumatic memories

A

deactivated

47
Q

what might explain the timeless quality of traumatic memories

A

right hemispheric lateralisation

48
Q

what are the general principles for the treatment of PTSD

A

Ensure safety before starting treatment
management of ongoing trauma (e.g., domestic violence, civil disturbances)
create theraputic relationship
psychological therapy rather than drugs (CBT/ eye movement desensitisation and reprocessing)- should be long, regular and with same therapist

49
Q

what are the aims of PSTD Tx

A 
normalise reactions
enable catharsis
inspire hope, restore sense of safety &/or trust
treat core symptoms and comorbidity
limit kindling of symptoms
educate
50
Q

when should medication for PTSD be considered

A

Consider symptomatic treatment for acute phase
Consider medication second for augmentation of Trauma-focused psychological treatment for chronic PTSD
Consider issues of patient choice & ongoing threat

51
Q

is PTSD a stress response

A

no is an overwhelming of the stress response

Psychiatry (27 decks)

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