Trauma and Stress-Related Disorders Flashcards
Lifetime prevalence of trauma exposure in North America ranges from _________.
39-74%
Who is at major risk for traumatic events?
children/adolescents
women
elderly, military, disaster survivors, and those with mental illness
General description of adjustment disorder
development of emotional or behavioral sx’s in response to an identifiable stressor
How to diagnose adjustment disorder
Onset occurs within 3 months of onset of stressor
- Marked distress out of proportion to the situation (may see depression, anxiety, mixed mood, mixed conduct)
- Significant impairment
Symptoms resolve within 6 months after stressor removed
Adjustment disorder associated with elevated risk of what?
suicide
Adjustment disorder treatment
- Brief therapies (psych intervention like cognitive, behavioral interpersonal, couples/family, mindfulness-based, exercise, problem-solving, etc.)
- Antidepressants equally as effective, benzos avoided but still effective, so was placebo
Adjustment disorder prognosis
Adjustment disorders in adolescence may develop into major mental disorders, mood, anxiety disorders. Increased risk if suicidality, substance use and impulsive behaviors
Timing and duration of post-traumatic stress disorder symptoms?
symptoms develop immediately after event and last greater than 1 month
What are intrusion symptoms of PTSD?
- Recurrent, involuntary, intrusive memories
- Recurrent distressing dreams
- Dissociative reactions (flashbacks)
- Intense/prolonged psychological distress with exposure to cues/triggers
- Marked physiological reactions with exposure to cues/triggers
PTSD provoking events
actual or threatened death, serious injury, sexual violence (direct experience, witness, close family member)
PTSD symptoms
- intrusion symptoms
- persistent avoidance of stimuli
- negative alterations in cognition/mood (fear, horror, detachment)
- marked alteration in arousal and reactivity (sleep, concentration, self-destructive behaviors)
PTSD treatment
SSRI or SNRI
- must weigh benefits vs risks for suicide and QT prolongation
- start low and go slow
Benzos NOT recommended!
- increase PTSD development
- interfere with psychotherapies
How is acute stress disorder diagnosed?
Presence of 9 or more in five areas:
- Intrusion symptoms
- Negative mood
- Dissociative symptoms
- Avoidance symptoms
- Arousal symptoms
Timing and duration of acute stress disorder
- symptoms develop within 1 month of event
- lasts at least 3 days to max 1 month after event
Acute stress disorder treatment
Begin with CBT, progress to SSRIs prn
When is reactive attachment disorder diagnosed?
between 9 months to 5 years old
Signs of reactive attachment disorder
lack of or incompletely formed attachment to caregiving adults
absence of comfort-seeking behaviors, no response to comforting
Diminished or absent expression of positive emotions
Where are Disinhibited Social Engagement and Reactive Attachment Disorders most often seen? Why?
foster care
shared residential facilities
social neglect and frequent changes in caregivers
How are Disinhibited Social Engagement and Reactive Attachment disorders similar?
- Childhood disorders dx’d between 9 months and adolescence
- Result from social neglect
- Treated with psychotherapy
Signs of Disinhibited Social Engagement Disorder
Child actively approaches and interacts with unfamiliar adults
Only FDA-approved drugs for PTSD
Sertraline and fluoxetine
