SM_125b: Trauma and PTSD

Question 1

Risk factors for PTSD are ____, ____, ____, and ____

Answer 1

Risk factors for PTSD are female sex, recent alcohol intake, other psychiatric disorders, and history of childhood trauma

Question 2

____ account for 30% of the variation in PTSD

Answer 2

Genetics account for 30% of the variation in PTSD

• SNPs in FKBP5 predict susceptibility to PTSD
• Met/Met SNP in COMT confers increased lifetime risk for PTSD

(Major depressive disorder is most common psych comorbidity)

Question 3

Describe relationship between TBI and PTSD

Answer 3

Relationship between TBI and PTSD

• Prior TBI can predispose to PTSD
• TBI is often sustained in the course of the trauma that causes PTSD

Question 4

Neurobiology of PTSD involves ____ of HPA access

Answer 4

Neurobiology of PTSD involves excess regulation of HPA axis

Question 5

Describe DSM-5 criteria for PTSD

Answer 5

PTSD DSM-5 criteria

• Criterion A (≥ 1): exposure to death, threatened death, or actual or threated serious injury or sexual violence
• Criterion B (≥ 1): intrusive thoughts, nightmares, flashbacks, emotional distress after exposure to traumatic reminders, physical reactivity after exposure to traumatic reminders
• Criterion C (≥ 1): avoidance of trauma-related thoughts or feelings, avoidance of trauma-related reminders
• Criterion D (≥ 2): inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or world, exaggerated blame of self or others for causing the trauma, negative affect, decreased interest in activities, feeling isolated, difficulty experiencing positive affect
• Criterion E (≥ 2): irritability or aggression, risk or destructive behavior, hypervigilance, heightened startle reaction, difficulty concentrating, difficulty sleeping

Question 6

PSTD ____ risk of suicide

Answer 6

PSTD increases risk of suicide

• Subthreshold PTSD increases risk of suicidal ideation substantially
• Major predictor of suicide in combat-related PTSD is guilt regarding combat

Question 7

Psychological debriefing is ____ for PTSD

Answer 7

Psychological debriefing is harmful for PTSD

Question 8

Treatment of PTSD involves ____ and ____

Answer 8

Treatment of PTSD involves psychotherapy and medications

• Psychotherapy: CBT, prolonged exposure, EMDR
• Medications: antidepressants, prazosin

Question 9

Benzodiazepines ____ for PTSD

Answer 9

Benzodiazepines should NOT be used for PTSD

(prolonged course, precipitate aggression, lead to worse outcomes)

Question 10

Acute stress disorder occurs ____ and predicts ____

Answer 10

Acute stress disorder occurs within 1st month following trauma and predicts later development of PTSD

(not necessary to develop PTSD however)

Question 11

Describe DSM-5 criteria for acute stress disorder

Answer 11

Acute stress disorder DSM-5 criteria

• ≥ 9 symptoms
• Recurrent, involuntary, intrusive distressing memories of the traumatic event
• Recurring distressing dreams in which content and/or affect of the dream are related to the event
• Dissociative reactions in which the individual feels or acts as if the traumatic event were recurring
• Intense or prolonged psychological distress or marked physiological reactions in response to internal/external cues that symbolize or resemble an aspect of the event
• Persistent inability to experience positive emotions
• Altered sense of reality of one’s surroundings or oneself
• Inability to remember important aspect of traumatic event
• Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with traumatic event
• Efforts to avoid external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event
• Sleep disturbance
• Irritable behavior and angry outbursts, typically expressed as verbal / physical aggression toward people or objects
• Hypervigilance
• Problems with concentration
• Exaggerated startle response

Question 12

____ is used to treat acute stress disorder

Answer 12

CBT is used to treat acute stress disorder

(acute stress disorder develops within 1 month following trauma)

Question 13

Psychogenic amnesia is ____

Answer 13

Psychogenic amnesia is autobiographical retrograde amnesia without anterograde amnesia

(fugue state: impairments in recalling one’s own identity)

Question 14

Fugue state is ____ that occurs in severe cases of ____

Answer 14

Fugue state is impairments in recalling one’s own identity that occurs in severe cases of psychogenic amnesia