Trauma and Stress

Question 0

Adjustment order?

Answer 0

not able to adjust to change

stressor needed -w/in 3 mo

Question 1

• depressed mood
• fired from job 3 mo ago –> withdrawn
• overwhelmed that no one will hire pt
• does not meet criteria for MDD
• PE and neuro norm

Answer 1

adjustment dissorder

Question 2

Adjustment disorder - caution?

Answer 2

SUICIDAL RISK IS HIGH

Question 3

Adjustment disorder - timeline?

Answer 3

resolves in 6 mo

Question 4

Adjustment disorder - RF?

Answer 4

children and adult: war, natural disasters = TRAUMATIC EVENT
abuse, neglect, etc
military
elderly

Question 5

Adjustment disorder - tx?

Answer 5

brief therapies
antidepressants
avoid benzos d/t risk for abuse

Question 6

Adjustment disorder - prognosis?

Answer 6

adolescents may develop major mood and anxiety disorder: suicidality substance use or impulsive behavior

Question 7

• depressed mood
• raped 1 yr ago: nightmares
• trouble concentrating
• trouble w/ marriage (emotionally)
• PE: norm
• denies pyschotic (hallucination)/suicidal/homicidal - attacker would die horrible death

Answer 7

post traumatic stress disorder

Question 8

PTSD?

Answer 8

IMMEDIATELY after exposure (life threatening) for at least 1 mo
LIFE THREATENING!!!

Question 9

PTSD - ‘exposure’?

Answer 9

direct: participating
witness: witness incident
learned: a loved one’s incident affects you
repeated exposure: continuously exposed to victims of incidents

Question 10

PTSD - sx?

Answer 10

intrusion sx
avoidance of stimuli
negative cognition/mood alterations
marked arousal/reactivity alterations

Question 11

PTSD - intrusion sx?

Answer 11

recurrent and involuntary memories
recurrent dreams
dissociative rxns (flashbacks)
coming out of the blue
physical and psychological response

Question 12

PTSD - tx?

Answer 12

SSRI/SNRI (sertraline, fluoxetine, paroxetine, venlafaxine)
weigh benefits to risk: suicidality, QTc prolongation
AVOID BENZO: increase PTSD, interfere w/ psychotherapies

Question 13

• depressed mood
• left her job 1 wk ago: filed sexual misconduct charges
• insomnia
• irritability
• feeling of guilt
• worthlessness
• avoids coworker
• relationship probs w/ bf
• brain fog
• replay incident
• talking about it makes her naseous

Answer 13

Acute stress disorder

Question 14

Acute stress disorder - dx?

Answer 14

like PTSD sx that happens for at least 3 days up to a mo

longer than 1 mo: PTSD

Question 16

Acute stress disorder - sx?

Answer 16

9 or more sx in five major areas:

• intrusion
• avoidance
• dissociative
• negative alterations in cognition/mood (fear, horror, detachment)
• marked arousal and reactivity (self destructive, sleep disturbance, concentration probs)

Question 16

Childhood disorders?

Answer 16

• reactive attachment disorder

- disinhibited social engagement disorder

Question 17

Acute stress disorder - tx?

Answer 17

CBT

+/- SNR

Question 18

Reactive attachment disorder and disinhibited social engagement disorder?

Answer 18

social neglect
changes in caregivers
orphanages
child and family services systems

Question 19

Reactive attachment disorder?

Answer 19

lack of attachments to caregivers
age 9mo - 5 yrs old
negative emotion displays
dampened positive affect (in kids: damper on positivity –> could be seen as irritability)

Question 20

Disinhibited social engagement?

Answer 20

attachments with EVERYONE
age 9mo to adolescence
high risk of abuse and abductions