Stress Disorders

Question 1

PTSD epi
which group most likely?
comorbid disorders?

Answer 1

8%
50% exposed –> 15% develop PTSD
young adults (highest exposure to trauma)
borderline/antisocial PD
risk proportional to severity/type/proximity of stressor and to vulnerability of individual

Question 2

high risk exposures for PTSD

other RF’s

Answer 2

captive, kidnapped, tortured
life-threatening illness
combat
rape
shot/stabbed

female gender
hx of trauma
family hx of PTSD/depression
lack of social supports
use of benzos/alcohol

Question 3

male vets w/combat-related PTSD have high rates of what?

Answer 3

physical/sexual abuse

Question 4

what’s the deal w/hippocampi and PTSD?

Answer 4

small hippo predispose

size of hippo is genetically determined

Question 5

PTSD folks have hyperactive what?
e.g. of compounds that enhance/reduce sx?
PTSD folks have low levels of what?

Answer 5

noradrenergic system
yohimbine (agonist)
prazosin (reduces)

cortisol (enhanced neg fdbk on HPA)

Question 6

behavioral model of PTSD development?

Answer 6

classical conditioning –> avoidance of stimuli –> emotional detachment and social isolation

Question 7

4 core sx of PTSD

hyperarousal sx?

Answer 7

exposure to trauma then...
intrusive/dissociative sx
negative mood
avoidance
hyperarousal (insomnia, irritability, hypervigilance)

Question 8

remission of PTSD?

Answer 8

50% remit in 3 months

many have sx 12+ months

Question 9

key difference of acute stress disorder?

Answer 9

TIME FRAME
sx start immediately after event
don’t last longer than ONE MONTH
risk factor for dev PTSD

Question 10

the PTSD disturbance and sx must occur for longer than?

Answer 10

one month

Question 11

PTSD requires exposure to what 3 types of events?

Answer 11

actual/threatened death
injury
sexual violence

Question 12

somatic tx of stress disorders
SSRI ineffective for what?
what for nightmares/insomnia?
avoid what medication?

Answer 12

1st line: SSRI (sertraline and paroxetine)
–> can also tx comorbid depressive d/o
no effective for combat PTSD

also prazosin for nightmares/insomnia
atypical antipsychotics
benzos –> might actually increase risk

Question 13

psychotherapy of PTSD: 3 types of therapies

Answer 13

no more debriefing, instead monitored

prolonged exposure: people learn to fear what reminds them of past event –> learn that they don’t have to fear them and change how they react to stressful memories

cognitive processing: affects how people think/interpret subsequent events –> WRITTEN exposure and how they think differently as a result; therapist challenges interpretations and helps ID “cognitive distortions” and replace with more accurate interpretations

Question 14

co-morbid conditions in PTSD

Answer 14

mood, anxiety, substance use
75% pts have more than 1 psych dx
50% have 3 others
6x increase in MDD and 4x in panic d/o

Question 15

PTSD ddx

Answer 15

acute stress d/o
GAD
schizophrenia

Question 16

PTSD prognosis
impede?
improve?

Answer 16

impede: lang barrier, isolation, severity of trauma, duration of sx, somatic sx, BZD use
improve: social interaction, family support, prazosin and co-morbid tx

Question 17

PTSD pts have low levels of what hormone?

Answer 17

Cortisol (enhanced neg fbdk)