Stress Disorders

Question 1

What age is PTSD most prevalent?

Answer 1

Young adulthood, when trauma is most likely

Question 2

5 key components to PTSD

Answer 2

Trauma, intrusive / dissociative sxs, neg mood, avoidance, and hyperarousal

Question 3

Common hyperarousal sxs in PTSD

Answer 3

Insomnia, irritability, and hypervigilance

Question 4

Risk factors for PTSD

Answer 4

Female gender, history of previous trauma, family history of PTSD or depression, lack of social supports, use of benzos or alcohol, low SES, very old / young at time of trauma, small hippocampi

Question 5

DSM Criteria for PTSD

Answer 5

A) Exposure to trauma
B) 1+ intrusion sxs associated w/ traumatic event: distressing memories, distressing dreams, flashbacks, psychological / physiological distress caused by exposure to internal / external cues that symbolize traumatic event
C) Persistent avoidance of stimuli associated w/ trauma
D) Neg alterations in cognitions and mood, indicated by 2+ of the following:
• Inability to remember an important aspect of the traumatic event
• Exaggerated neg beliefs about oneself or others such as “I am bad” or “No one can be trusted”
• Distorted cognitions about event that cause person to blame himself
• Persistent negative emotional state
• Anhedonia
• Feelings of detachment / estrangement from others
• Inability to experience positive emotions
E) Alterations in arousal and reactivity associated w/ trauma w/ 2+ of the following:
• Irritable behavior / angry outbursts w/ little or no provocation
• Reckless / self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems w/ concentration
• Sleep disturbance
F) sxs last more than 1 month

Question 6

What occurs biologically w/ PTSD?

Answer 6

Overactivity of NE system. Many pas have low plasma cortisol, possibly due to enhanced neg feedback in HPA axis.

Question 7

Prognosis for PTSD

Answer 7

50% of pxs go into remission w/in 3 months.

Question 8

Good prognosis factors for PTSD

Answer 8

Sxs develop quickly, good pre-morbid functioning, strong social support, absence of other co-morbidities.

Question 9

Acute stress disorder

Answer 9

Similar sxs to PTSD but sxs arise immediately after trauma and do not last more than 1 month. Large majority of pxs w/ ASD go on to develop PTSD.

Question 10

Treating stress disorders

Answer 10

• SSRI’s are 1st line, especially sertraline and paroxetine. Helps w/ co-morbid depression as well. Not effective for combat PTSD.
• Alpha-1 agonist prazosin is good for nightmares and insomnia.
• Atypical antipsychotics may help in PTSD
• Benzos are avoided due to risk of worsening sxs
• Do NOT debrief people after traumatic event until psychiatric disorder is evident.
• Prolonged exposure therapy - Change how px reacts to stressful stimuli
• Cognitive Processing Therapy (CPT) – type of CBT. Pxs write about impact of trauma and how they think differently about safety, trust, esteem, power, and intimacy. Therapist challenges px’s interpretations of traumatic events and helps him identify “cognitive distortions” and replace them w/ more accurate interpretations.

Question 11

What percentage of pas w/ PTSD have at least one other psychiatric diagnosis?

Answer 11

More than 75%

6x increase in depression and 4x increase in panic disorder