Trauma and Stress-Related Disorders

Question 1

Lifetime prevalence of trauma exposure in North America ranges from _________.

Answer 1

39-74%

Question 2

Who is at major risk for traumatic events?

Answer 2

children/adolescents
women
elderly, military, disaster survivors, and those with mental illness

Question 3

General description of adjustment disorder

Answer 3

development of emotional or behavioral sx’s in response to an identifiable stressor

Question 4

How to diagnose adjustment disorder

Answer 4

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

Question 5

Adjustment disorder associated with elevated risk of what?

Answer 5

suicide

Question 6

Adjustment disorder treatment

Answer 6

• 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

Question 7

Adjustment disorder prognosis

Answer 7

Adjustment disorders in adolescence may develop into major mental disorders, mood, anxiety disorders. Increased risk if suicidality, substance use and impulsive behaviors

Question 8

Timing and duration of post-traumatic stress disorder symptoms?

Answer 8

symptoms develop immediately after event and last greater than 1 month

Question 9

What are intrusion symptoms of PTSD?

Answer 9

• 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

Question 10

PTSD provoking events

Answer 10

actual or threatened death, serious injury, sexual violence (direct experience, witness, close family member)

Question 11

PTSD symptoms

Answer 11

• 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)

Question 12

PTSD treatment

Answer 12

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

Question 13

How is acute stress disorder diagnosed?

Answer 13

Presence of 9 or more in five areas:

• Intrusion symptoms
• Negative mood
• Dissociative symptoms
• Avoidance symptoms
• Arousal symptoms

Question 14

Timing and duration of acute stress disorder

Answer 14

• symptoms develop within 1 month of event

- lasts at least 3 days to max 1 month after event

Question 15

Acute stress disorder treatment

Answer 15

Begin with CBT, progress to SSRIs prn

Question 16

When is reactive attachment disorder diagnosed?

Answer 16

between 9 months to 5 years old

Question 17

Signs of reactive attachment disorder

Answer 17

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

Question 18

Where are Disinhibited Social Engagement and Reactive Attachment Disorders most often seen? Why?

Answer 18

foster care
shared residential facilities

social neglect and frequent changes in caregivers

Question 19

How are Disinhibited Social Engagement and Reactive Attachment disorders similar?

Answer 19

• Childhood disorders dx’d between 9 months and adolescence
• Result from social neglect
• Treated with psychotherapy

Question 20

Signs of Disinhibited Social Engagement Disorder

Answer 20

Child actively approaches and interacts with unfamiliar adults

Question 21

Only FDA-approved drugs for PTSD

Answer 21

Sertraline and fluoxetine