Trauma and Stressor Disorders Flashcards
What is Reactive Attachment Disorder?
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.
What is the age diagnostic criteria for Reactive Attachment Disorder
It must be evident before 5 years old and present for >12 months.
They must be developmentally at least 9 months of age
Treatment of Reactive Attachment Disorder
R/O Autism Spectrum Disorder
Remove child from abusive or neglectful environment, educate caregivers, and provide appropriately caring and nurturing environment
What is Disinhibited Social Engagement Disorder
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
Diagnostic Criteria for Disinhibited Social Disorder
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
What is Acute Stress Disorder
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
Does acute stress disorder affect men or women more?
Women > Men
Acute Stress Disorder DDx
PTSD (timeframe)
Brief psychotic disorder
Dissociative disorder
Adjustment disorders
Goal of Acute Stress Disorder Treatment
Prevent progression to PTSD.
—CBT with exposure therapy and anxiety management
—Meds= Brief benzodiazepines and beta blockers
What is Post Traumatic Stress Disorder
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
Does PTSD affect women or men greater
Women > Men
Female PTSD precipitators
Physical assault or rape
Male PTSD precipitators
Combat
Children/Teens PTSD precipitators
Abuse, accidents, disasters, death in immediate family
Do MOST people who experience a traumatic event go on to develop PTSD?
No. Most do not
How do Genes play a role in PTSD?
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
How do brain structures play a role in PTSD?
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.
PTSD treatment
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
PTSD Pharmacological Treatment
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`
What is Adjustment Disorder?
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
What are the 5 subtypes for the predominant symptoms of Adjustment Disorder?
With Depressed mood With anxiety Mixed With disturbance or conduct With mixed disturbance of conduct and emotion
Who is Adjustment disorder more common in?
Women, single, and younger pts
What is the treatment for adjustment disorder
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
