Stress Disorders

Question 0

Social readjustment rating scale

Answer 0

=Commonly used life stress scale

=does not differentiate if you personally feel an event was pos or neg, just uses how most people would feel

Question 1

What is stress?

Answer 1

=challenge to our physical or emotional well being that exceeds our coping abilities and resources
-negative events
-chronic or acute
=distress: negative, causes more psychological damage
=eustress: positive events
=events can be both, ex coming to college

Question 2

Adjustment disorder

Answer 2

=psychological response to common stressors
-victim of crime, retirement, natural disaster
=clinically significant emotional or behavioral symptoms
=most benign, least stigmatizing diagnosis
=symptoms begin within 3 months of stressor, subside by 6 months from stressor

Question 3

Adjustment disorder symptoms

Answer 3

=withdrawing from friends
=somatic symptoms
=feeling sad or hopeless
= aggressive behavior in children

Question 5

Adjustment disorder stigma

Answer 5

= least stigmatizing diagnosis
= sometimes used as a way to get insurance companies to pay for treatment such as therapy
-insurance companies don’t want to pay without diagnosis and patient does not meet anxiety or depression criteria

Question 6

What if stress is severe?

Answer 6

=Acute Stress Disorder
-symptoms develop shortly after experiencing a trauma and last between 2 days and a month
= PTSD
-if the symptoms last at least one month

Question 7

PTSD DSM criteria

Answer 7

A. exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways

1. directly experiencing the traumatic event
2. witnessing in person the event as it occurred to others
3. learning that the traumatic event occurred to a close family member or friend
4. experiencing repeated or extreme exposure to aversive details of the traumatic event
   - ex first responders collecting human remains

Question 8

What must be present for a PTSD diagnosis?

Answer 8

=trauma

-either you felt threatened or a close family or friend did

Question 9

trauma

Answer 9

=a situation where there is real or threatened death or bodily harm
-real death ex: seeing someone die

Question 10

1. most common trauma in women

2. most common trauma in men

Answer 10

1. sexual assault

2. military combat

Question 11

Symptoms connected to PTSD

Answer 11

=reexperiencing
=avoidance
=negative cognitions or mood
=arousal

=these have to cause significant impairment
=and last greater than one month
=need to have at least one symptom in each category

Question 12

Reexperiencing

Answer 12

=spontaneous memories of the specific event
=recurrent related dreams
=flashbacks
=or other intense prolonged psychological distress

Question 13

Avoidance

Answer 13

=actively try to avoid distressing memories, thoughts, feelings, or external reminders of the traumatic event
=ex: avoid asian restaurants if you have PTSD from serving in Vietnam

Question 14

Negative Cognitions or Mood

Answer 14

=similar to depression
=range from persistent and distorted sense of blame towards self or other to estrangement from others
=or significantly diminished interest in activities
=or inability to remember key aspects

Question 15

Arousal

Answer 15

=appearance of aggressive, reckless, or self destructive behavior 
=sleep disturbances 
=higher vigilance or similar behavior 
-on guard for constant triggers 
-ex: fireworks sound like explosives

Question 16

Lifetime prevalence of ptsd

Answer 16

= 6.8% in US
= 9.7% in women
=3.6% in men
-but exposure to traumatic events is higher for men

Question 17

What determines rates of PTSD after exposure to trauma?

Answer 17

=type of trauma
-at hands of other humans (war, assault) is more likely to trigger ptsd than accidental traumas (natural disasters)
-lose faith in people and trust in safely of environment when humans cause trauma
=degree of direct exposure
-personal experience is more likely to cause ptsd than exposure to another’s experience
=method of assessment
-self assessment yield higher rates than clinician diagnosis

Question 18

Specific consideration in the military

Answer 18

=92% of military in Iraq report having been attacked or ambushed
=86% report knowing someone who has been killed or seriously injured
=OEF/OIF vets have ptsd at a rate of at least 4.3%
-most conservative estimate - could be an underestimate
-stigma against seeking help is very strong in military, esp help for a mental, not physical, illness
=effect of longer and more frequent deployments
=sending those with previous psychiatric difficulties into war
=impact of higher casualty wars - impact of killing
=impact of justification for combat
=alcohol abuse, depression, aggression, and suicide also elevated

Question 19

Risk Factors for trauma exposure

Answer 19

=male 
=less than college education 
=conduct problems in childhood 
=family history of psychiatric disorder 
=high on extraversion and neuroticism 
-extraversion: traumatic events are interpersonal
-neuroticism: predisposition to negative mood 
=non white

Question 20

Risk Factors for development of ptsd, given exposure to trauma

Answer 20

=female
=low social support
=high neuroticism
=pre-existing depression and anxiety
=family history of psychiatric difficulties
=appraisals
-blame self
-think people will be ashamed of them for their reaction
=higher risk (s/s) genotype of serotonin transporter gene
=small hippocampal volume
=in women: higher baseline cortisol

Question 21

Protective Factors

Answer 21

=higher IQ 
=SES 
=income 
=education 
=social support

Question 22

ptsd treatment

Answer 22

=prolonged exposure therapy
=crisis: intervention, hotlines
=psychological debriefing -talk about event immediately after, may be helpful for some and counterproductive for others
-solidify and remember all details
-some people may not have done this without the therapist telling them to
=visual spatial puzzle right after trauma
-brain does not solidify memories of trauma because it focuses on the puzzle
-ex tetris
= novel pharmacological treatments right after trauma
-cannabinoids, HDAC2
-prevent memory consolidation of trauma