Trauma And Stress Related Disorders Flashcards
Define trauma
Trauma is psychological distress following direct or indirect exposure to a stressful or life threatening event.
6 examples of Severe traumatic events
Rape
Assult
Road traffic accident
Combat/war exposure
Child physical/Sexual/emotional abuse
Severe child neglect
Natural disasters
6 examples of less Severe traumatic events
Breakup/divorce
Financisl difficulties
Getting married
Becoming a parent
Failing exams/assessment
Changes @work /school environment
Classify Trauma and Stress Related disorder
- Adjustment disorder
- Acute stress disorder
- PTSD
- Reactive attachment disorder
- Disinhibited social engagement disorder
Pre traumatic risk factors of Trauma and stress related disorders
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)
Risk factors linked to trauma
Severity of trauma
Type of trauma (sexual abuse -PTSD)
Some responsibility for the trauma ( road accident, soldier)
Moral injury
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
What are the key emotions of moral injury
Guilt
Shame
Disgust
Anger
Inability to self-forgive
Self sabotaging behavior
Post traumatic risk factor
Poor social support following trauma
Pathophysiology of trauma and tress related disorders
-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
Adjustment Disorder -The stressor
What is adjustment disorder?
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
Adjustments disorder stressor may be
Single event
Multiple stressors
Continuous stressor
Stressor affecting an individual or a larger group
Accompanying specific developmental events (age related illnesses)
The dx criteria for Adjustment Disorder
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
Is adjustment disorder associated with increased suicide attempts and completed suicided?
Yes
Name 6 differential dx of Adjustment disorder
Major depressive disorder
Acute stress disorder
PTSD
personality disorder
Normal stress reaction
Grief
How do you manage adjustment disorder
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
Acute stress disorder
What si acute stress disorder?
Development of psychological distress from 3 days after traumatic experience, with sx lasting < 3months
In acute stress disorder the stressor is severe and can result form
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
Acute stress disorder dx criteria
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
- Persistent inability to experience positive emotions
- Cannot be happy, feel or express love
- Altered sense of reality or oneself
- Inability to remember NB aspects of traumatic event
- Avoiding thoughts/ memories linked to traumatic event
- Avoiding external reminders of traumatic event(people, places etc.)
- Sleep problems
- Irritability with little to no provocation
- Hypervigilance
- Exaggerated startle response
- Difficulty concentrating
Additional sx of acute stress disorder
-ve thougts about ones role in traumatic event
- somatic sx (dizziness,shortness of breath and feeling hot)
- panic attacks
- chaotic, impulsive and reckless behavior
What are the differential dx of acute stress disorder?
Adjustment disorder
Anxiety disorder
OCD
Traumatic brain injury
Psychotic disorder
How do you manage Acute stress disorder?
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
PTSD
What is PTSD?
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.
Dx criteria for PTSD
Dx of PTSD in children
Specifiers of PTSD
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
How do you manage PTSD?
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
Features of a mini menta exam
Temporal orientation
Spatial orientation
Immediate memory
Attention
Delayed recall
Naming and verbal repetition
Verbal comprehension
Writing
Copying
