Stress Disorders

Question 1

PTSD: epidemiology

Answer 1

o Life prevalence: 8%
• 50-60% of U.S. population has been exposed to traumatic event but <20% develop PTSD
o Women = 2x likely to have PTSD than men
o Most likely to develop during young adulthood
o Co-morbidity is common: depressive disorders, substance use disorders, anxiety disorders, bipolar disorder

Question 2

PTSD: pathophysiology

Answer 2

Genetic factors
• Small hippocampi: predispose to PTSD development
• Hyperactive noradrenergic systems
• Low plasma cortisol levels from enhanced negative feedback in HPA axis (related to severity or duration of trauma)

Behavioral model:
• Classic conditioning: trauma (unconditional stimulus) paired with reminders of trauma (conditional stimuli) → fear response without trauma present
• Leads to avoidance pattern

Question 3

PTSD: Risk factors

Answer 3

o	Proportional to severity, type, and proximity of stressor
o	Gender (females)
o	History of previous trauma
o	Family history of PTSD and depression
o	Lack of social supports post trauma
o	Use of benzodiazepines or alcohol 
o	Genetic factors

Question 4

PTSD: clinical presentation

Answer 4

o Dissociative symptoms: flashbacks
o Intrusive symptoms: nightmares, negative mood and cognition
o Avoidance symptoms = may result in emotional detachment and social isolation
o Hyperarousal symptoms: insomnia, irritability, hypervigilance

Question 5

PTSD: prognosis

Answer 5

o About 50% cases: remission within 3 months
o May have persistent symptoms lasting >12 months
o May have symptom reactivation (due to reminders of trauma, life stressors, new traumatic events)

Question 6

PTSD: treatments

Answer 6

Medical:
o SSRI’s = 1st line
• Sertraline and paroxetine
• May be useful for depression (common co-morbidity)
o Prazosin (α1-adrenergic antagonist) = treats re-experiencing symptoms (especially nightmares)
o Anticonvulsants and atypical antipsychotics = some evidence of efficacy
o Avoid benzodiazepines = may increased risk of developing PTSD

Psychotherapy:
o Debriefing after event may increase risk of PTSD development
• Instead = monitor for development

Cognitive processing therapy
• Type of CBT
• Involves prolonged exposure = gradually expose patient to stimuli/triggers
• Allows patient to process these experiences = able to end link between triggers and emotional response
• Help identify “cognitive distortions” and replace with more accurate thoughts