Trauma And Stress Related Disorders

Question 1

Define trauma

Answer 1

Trauma is psychological distress following direct or indirect exposure to a stressful or life threatening event.

Question 2

6 examples of Severe traumatic events

Answer 2

Rape
Assult
Road traffic accident
Combat/war exposure
Child physical/Sexual/emotional abuse
Severe child neglect
Natural disasters

Question 3

6 examples of less Severe traumatic events

Answer 3

Breakup/divorce
Financisl difficulties
Getting married
Becoming a parent
Failing exams/assessment
Changes @work /school environment

Question 4

Classify Trauma and Stress Related disorder

Answer 4

1. Adjustment disorder
2. Acute stress disorder
3. PTSD
4. Reactive attachment disorder
5. Disinhibited social engagement disorder

Question 5

Pre traumatic risk factors of Trauma and stress related disorders

Answer 5

Gender (men more likely to xperience traumatic events)
Younger age
Past hx of child abuse
Childhood adversity (extreme poverty/ family dysfunction)
Adverse life events
Pre existing mental health disorders
Family hx of PTSD (genetic predisposition)

Question 6

Risk factors linked to trauma

Answer 6

Severity of trauma
Type of trauma (sexual abuse -PTSD)
Some responsibility for the trauma ( road accident, soldier)

Question 7

Moral injury

Answer 7

Occurs in a traumatic/ stressful event in which a person is involved, witnessed or failed to prevent which strongly contradicts their personal beliefs, values and expectations

Question 8

What are the key emotions of moral injury

Answer 8

Guilt
Shame
Disgust
Anger

Inability to self-forgive
Self sabotaging behavior

Question 9

Post traumatic risk factor

Answer 9

Poor social support following trauma

Question 10

Pathophysiology of trauma and tress related disorders

Answer 10

-altered response and stress response hormones release (i.e. cortisol)

-hypothalamic-pituitary axis hyperactivity

-sympathetic nervous system up-regulation

-Initial high glutamate release (Acute stress disorder)

-Initial lower cortisol release (in PTSD)

-Amygdala, hippocampus, preaqueductal grey area abnormalities

Question 11

Adjustment Disorder -The stressor

What is adjustment disorder?

Answer 11

Psychological distress that develops within one months following exposure to an identifiable external stressor which resolves once the individual is able to adapt to the stressor or the stressor is removed

Question 12

Adjustments disorder stressor may be

Answer 12

Single event
Multiple stressors
Continuous stressor
Stressor affecting an individual or a larger group
Accompanying specific developmental events (age related illnesses)

Question 13

The dx criteria for Adjustment Disorder

Answer 13

A. Dev. of emotional or behavioral sx in response to an identifiable stressor occuring withing one to 3 months of onset of exposure

B. Sx or behaviora in one of the following
1. Distress out of proportion to severity of stressor

 2. Sugnificant impairment in sound, occupational or other important areas of functioning

C. Stress related disturbances that do3s not meet the criteria of any other mental disorder and not merely an exacerbation of another mental disorder

D. Symptoms that doent represent normal bereavement.

E. Sx that dont persist over 6 months once stressorand its consequences is removed

Question 14

Is adjustment disorder associated with increased suicide attempts and completed suicided?

Answer 14

Yes

Question 15

Name 6 differential dx of Adjustment disorder

Answer 15

Major depressive disorder
Acute stress disorder
PTSD
personality disorder
Normal stress reaction
Grief

Question 16

How do you manage adjustment disorder

Answer 16

Hx and exam

Pharmacological
Meds not generally indicated though they may alleviate accompanying sx

Psychotherapy
Tx of choice
Supportive therapy - address the stressor
CBT - to remodel maladaptive habits
Insight oriented approaches - strengthen coping mechanisms
Family therapy - if situation is family oriented
Couple therapy - if situation is couple oriented or negatively affects relationship

Question 17

Acute stress disorder
What si acute stress disorder?

Answer 17

Development of psychological distress from 3 days after traumatic experience, with sx lasting < 3months

Question 18

In acute stress disorder the stressor is severe and can result form

Answer 18

Direct exposure to traumatic event
Witnessing traumatic event
Learning that close relative or friend has been exposed to a traumatic event
Repeated exposure to traumatic events

Question 19

Acute stress disorder dx criteria

Answer 19

A. Exposure to stressful/traumatic event in one of the following ways
1. Direct exposure to traumatic event
2.Witnessing traumatic event
3. Learning that traumatic event happened to a close person
4. Repeated exposure to traumatic event

B. Presence of nine or more of the following sx
1. Recurrent distressing memories of traumatic event
2. Children reeperiencing through repetitive play
3. Dissociative reactions as though trauma of reoccuring
4. Intense prolonged distress in response to cues

5. Persistent inability to experience positive emotions
6. Cannot be happy, feel or express love
7. Altered sense of reality or oneself
8. Inability to remember NB aspects of traumatic event
9. Avoiding thoughts/ memories linked to traumatic event
10. Avoiding external reminders of traumatic event(people, places etc.)
11. Sleep problems
12. Irritability with little to no provocation
13. Hypervigilance
14. Exaggerated startle response
15. Difficulty concentrating

Question 20

Additional sx of acute stress disorder

Answer 20

-ve thougts about ones role in traumatic event
- somatic sx (dizziness,shortness of breath and feeling hot)
- panic attacks
- chaotic, impulsive and reckless behavior

Question 21

What are the differential dx of acute stress disorder?

Answer 21

Adjustment disorder
Anxiety disorder
OCD
Traumatic brain injury
Psychotic disorder

Question 22

How do you manage Acute stress disorder?

Answer 22

Detailed hx and exam
Supportive care until psychologically abd physiologically safe
Avoid debriefing and probing question or reminders to the traumatic event
Psychoeducation
Address issues of suicidality, depression, self harm and substance abuse if there’s any

Pharmacotherapy
Antidepressants (SSRIs and SSNRIs) and Anticonvulsants to reduce intrusion sx
Effective pain management following physical trauma

Avoid Benzodiazepines.. as the invrease risk for longterm PTSD sx

Psychotherapy
Trauma focused CBT
Patient education
Exposure therapy
Cognitive therapy
Addressing interpersonal issues

Question 23

PTSD

What is PTSD?

Answer 23

PTSD is a psychological distress persisting for at leats a month after traumatic experience plus at least one or more intrusive sx, at least one or more avoidance sx, 2 or more cognitive/ mood sx, 2 or more hyperarousal sx.

Question 24

Dx criteria for PTSD

Question 25

Dx of PTSD in children

Question 26

Specifiers of PTSD

Answer 26

PTSD with dissociative sx
- Depersonalization (feeling detached from oneself)
- Derealization (experience of unreality, distance ir distortion)
PTSD with delayed onset
- Full dx criteria not met until at leats 6 months after trauma

Question 27

How do you manage PTSD?

Answer 27

Psychological Firts Aid (PFA)
- psychoeducation
- provision of individual”s needs
- Avoidance of making invalidating comments (i.e. its not a big deal)

Other Evidence based Therapies for PTSD
- Trauma Focused CBT
- Cognitive Processing Thetapy
- Eye Movement Desensitization Processing (EMDR)

Pharmacotherapy
- SSRI (Fluoxetine , Sertraline)
- SSNRI (Venlafaxine and Duloxetine)
- Guanfacine (selectice alpha 2 A adrenergic agonist)
- Prazosin ( alpha 1 antagonist)

Note
Do not used Benzodiazepine as they worsen the course of PTSD

Question 28

Features of a mini menta exam

Answer 28

Temporal orientation
Spatial orientation
Immediate memory
Attention
Delayed recall
Naming and verbal repetition
Verbal comprehension
Writing
Copying