Trauma and Stressor Disorders

Question 1

What is Reactive Attachment Disorder?

Answer 1

A rare disorder of childhood that results from parental abuse or neglect. The child has minimal responsiveness to others- no smiles, does not play interactive games, does not reach out to be picked up, and minimally responds to comfort when distressed etc. They show physical and psychological signs of neglect; poor hygiene, developmental delays, and mood changes.

Question 2

What is the age diagnostic criteria for Reactive Attachment Disorder

Answer 2

It must be evident before 5 years old and present for >12 months.
They must be developmentally at least 9 months of age

Question 3

Treatment of Reactive Attachment Disorder

Answer 3

R/O Autism Spectrum Disorder

Remove child from abusive or neglectful environment, educate caregivers, and provide appropriately caring and nurturing environment

Question 4

What is Disinhibited Social Engagement Disorder

Answer 4

When a child’s behavior is inappropriately familiar with relative strangers, violating social norms. A product of parental neglect or abuse. 20% of those in group homes, foster care, or resident facilities have this

Question 5

Diagnostic Criteria for Disinhibited Social Disorder

Answer 5

Child actively approaches and interacts with unfamiliar adults and exhibits at least 2 of the following:
— reduced or no reticence in approaching and interacting with unfamiliar adults
—overly familiar verbal or physical behavior not consistent with cultural or age appropriate social boundaries
—diminished or absent checking back with adult caregivers after venturing away
—willingness to go off with an unfamiliar adult with little or no hesitation

This is associated with cognitive and language delays, and signs of poor care like malnutrition and poor hygiene
The child must be at least 9 months developmental age to make diagnosis

Question 6

What is Acute Stress Disorder

Answer 6

The precursor to PTSD. Occurs 3 days to 1 month after traumatic event. Occurs in less than 20% of traumatic experiences with higher rates coming after interpersonal events like assault or rape

Question 7

Does acute stress disorder affect men or women more?

Answer 7

Women > Men

Question 8

Acute Stress Disorder DDx

Answer 8

PTSD (timeframe)
Brief psychotic disorder
Dissociative disorder
Adjustment disorders

Question 9

Goal of Acute Stress Disorder Treatment

Answer 9

Prevent progression to PTSD.
—CBT with exposure therapy and anxiety management
—Meds= Brief benzodiazepines and beta blockers

Question 10

What is Post Traumatic Stress Disorder

Answer 10

Exposure to life-threatening trauma with a clinical presentation of (for GREATER THAN 1 MONTH) with significant impairment;

—Re experiencing the event with nightmares, intrusive memories, or flashbacks
—Avoidance of reminders to the event or dissociation
—Emotional detachment, negative thoughts, depressed mood, numbing, avoidance of others, and inability to experience positive emotions
—alterations in sleep, hypervigilance, irritability, startle reflex, poor concentration, and reckless behavior

Question 11

Does PTSD affect women or men greater

Answer 11

Women > Men

Question 12

Female PTSD precipitators

Answer 12

Physical assault or rape

Question 13

Male PTSD precipitators

Answer 13

Combat

Question 14

Children/Teens PTSD precipitators

Answer 14

Abuse, accidents, disasters, death in immediate family

Question 15

Do MOST people who experience a traumatic event go on to develop PTSD?

Answer 15

No. Most do not

Question 16

How do Genes play a role in PTSD?

Answer 16

Strathmin is the protein needed to form fear memories.

Gastrin releasing peptide (GRP) is a signaling chemical in the brain that is released during emotional events and plays a role in fear response.

5-HTTLPR controls serotonin levels

Question 17

How do brain structures play a role in PTSD?

Answer 17

Dysregulation of the hypothalamic pituitary adrenal axis prolongs the stress response.

The amygdala plays a role in emotion, learning, and memory.

The prefrontal cortex plays a role.

Decreased hippocampus volume can prolong stressors.

Question 18

PTSD treatment

Answer 18

Multidisciplinary approach

—psychological intervention before pharmacological; the most robust factors for determining outcome after trauma were 1. Availability and quality of social supports and 2. Intensity of psychological pressure on person during recovery period
—early CBT

Question 19

PTSD Pharmacological Treatment

Answer 19

SSRIs approved for PTSD
— Sertraline, paroxetine, and fluoxetine
—Trials have shown benefit from SNRI Venlafaxine
—No evidence for using benzodiazepines for PTSD may worsen sx + abuse potential
—Prazosin alpha adrenergic antagonist has good efficacy in treatment of PTSD nightmares. About 10% of pts have dizziness or lightheaded ness due to orthostatic hypotension`

Question 20

What is Adjustment Disorder?

Answer 20

Depression and or anxiety symptoms that develop within 3 months of an identifiable stressor. Does not meet DSM5 criteria for MDD or GAD and does not extend beyond 6 months of stressor.

Stressor is non life threatening but still causes significant impairment in usual activity

Question 21

What are the 5 subtypes for the predominant symptoms of Adjustment Disorder?

Answer 21

With Depressed mood
With anxiety
Mixed
With disturbance or conduct
With mixed disturbance of conduct and emotion

Question 22

Who is Adjustment disorder more common in?

Answer 22

Women, single, and younger pts

Question 23

What is the treatment for adjustment disorder

Answer 23

Goal of treatment is to prevent progression to more chronic condition like major depression
—supportive psychotherapy is primary
—meds can be used briefly for anxiety or insomnia