Trauma Flashcards
What part of the brain is though to control our defence reaction?
Midbrain
What is the neurobiology associated with PTSD?
Deficiency in top down modulation of amygdala activation by the prefrontal cortex
What substances does acute stress cause release of?
Catecholamines and cortisol
What is the role of cortisol in the stress response?
To mediate and shut down the stress response
What does acute stress do to cortisol levels?
Increases
What four structures does cortisol act on in a negative feedback fashion in the acute stress response?
Hypothalamus
Hippocampus
Amygdala
Posterior pituitary
Are cortisol levels low or high in PTSH?
Low
After a traumatic event, what % of people recover psychosocially without requiring specialist intervention?
50%
About what % of patients with PTSD have a comorbid psychiatric condition?
80%
What is the DSM IV criteria for a diagnosis of PTSD?
- Traumatic event(s)
- 1 or more intrusive symtpoms
- 3 or more avoidance symptoms
- 2 or more increased arousal symptoms
- Duration of over 1 month
- Distress and impairment in social functioning
- Can be acute, chronic or delayed onset
What are the intrusive symptoms in PTSD?
- recurrent distressing recollections
- nightmares
- flashbacks, in any modality
- distress accompanies reminders
- physiological reactions (fight or flight)
What are the avoidant and emotional symptoms seen in PTSD?
avoidance of thinking or talking about the event • avoidance of reminders such as activities, places or people • amnesia for important aspect of trauma • loss of interest in activities • detachment • emotional numbing • sense of foreshortened future
What are the hyperarousal symptoms seen in PTSD?
sleep disturbance • irritability / anger • concentration difficulties • hypervigilance • exaggerated startle response
What are other symptoms that might be seen in PTSD?
• dissociative symptoms -depersonalisation, derealisation, awareness of surroundings – near death or out of body experiences • survivor guilt • performance guilt
Where are defence and orientating responses generated in the brain?
Midbrain
What part of the brainstem is the major influences of the autonomic nervous system?
Brainste,
Is a small or a large hippocampus a risk factor for lack of recovery from PTSD?
Small. Hippocampal size corresponds with the current severity of PTSD
What is the role of the insula in PTSD?
Perception of internal states
What happens to brocas area when people think about traumatic memories?
Its activity decreases - represents a predominance of emotional areas over higher cortical areas.
Which part of the brain has increased activity in PTSD?
Amygdala
What theory may explain the “timeless” quality of traumatic memory?
Right hemispheric latealrisation - deficits in right sided cognitive function eg topgraphical memory
What is maslows hierarchy of needs? (From the bottom of the pyramid to the topP
- Physiological (food, water, shelter, warmth)
- Safety (security, stability, freedom from fear)
- Belonging - Love
(Friends, family, spouse, lover) - Self esteem (Achievemtn, mastery, recognition, respect)
5.Self actualisation (pursue inner talent, creativity, fulfilment)
What are the most effective kinds of therapies are used in PTSD?
CBT
EMDR
What is EMDR and how does it work in PTSD?
Eye movement desensitization and reprocessing. Involved in making side to side eye movements whilst recalling the traumatic memory. This is thought to be similar to REM sleep and seem to cause the traumatic memory to lose some of its intensity
A man has presented with symptoms of PTSD following an assault that happened 2 months ago. How many sessions of trauma focussed CBT should he be offered?
8 - 12 (at least once a week, delivered by the same person)
What is the best therapy to use fro patients that present with PTSD within 1 month of the traumatic event?
CBT
What treatment is used for patients who has symptoms of PTSD present 3 months after the trauma has occured?
CBT or EMDR
What drug treatment can be prescribed by any medical professional (eg GP) to assist in PTSD treatment?
Mirtazapine
Paroxetine
What drug treatments may be prescribed by a specialist in the treatment of PTSD?
Amitroptyline
Phenelzine
If an adult with PTSD responds well to drug treatment, how long should you keep them on drug treatment?
At least 12 months before gradual withdrawal
Why would low cortisol levels cause PTSD?
Cortisol acts as a negative feedback regulator in response to trauma. If you has a low cortisol level in prevents the brains stress axis from regulating itself.
What is the role of the hippocampus in a health response to trauma?
The hippocampus in required for inhibiting the amygdala and saying to the brain that the person in now safe.
