Trauma- and Stress-related disorders

Question 1

Diagnosis of Post-traumatic stress disorder (PTSD)

Answer 1

• exposure to a traumatic event
• re-experiencing of symptoms e.g. flashbacks
• avoidance symptoms e.g. avoidance of thoughts and reminders
• negative changes in cognitions and mood e.g. emotional numbing
• marked alterations in arousal e.g. hypervigilance

Question 2

epidemiology (PTSD)

Answer 2

• lifetime prevalence (in Aus): 1.3%
• similar in children as adults

risk factors for development:

• relatively few people develop PTSD following a trauma
• factors
  
  • F
  • history of psychological disturbance
  • more severe traumatic exposure
  • low social support

Question 3

aetiology (PTSD)

Answer 3

• cognitive models
  
  • maladaptive appraisal of the traumatic event
• learning accounts
  
  • emphasises classical conditioning
• biological accounts
  
  • extreme arousal at time of trauma results in a strong conditioned fear respnse
  • in fear, the amygdala holds on to the emotional reaction
• avoidance
  
  • avoidance of trauma reminders maintain PTSD

Question 4

Treatment (PTSD)

Answer 4

• meds
  
  • particularly selective serotonin reuptake inhibitors (SSRIs)
• CBT (typical duration 9-12 sesh)
  
  • involve psychoedu
  • anxiety management
  • cognitive restructuring
  • imaginal exposure and in vivo exposure
  • relapse prevention

Question 5

Prevention

Answer 5

• difficult to determine whether early interventions are effective or whether the stress response remits naturally
• Posttrauma- stress reactions in the initial month after trauma is classified as acute stress disorder (DSM-IV)
• early interventions use CBT approaches

Question 6

current challenges in treatment and prevention

Answer 6

• high rates of dropout from treatment
• need to better prepare patients to tolerate the distress of exposure therapy
• potentially augment CBT by enhancing the extinction
• internet-based approaches are promising
• also need to develop community-based treatments