Trauma and stressor related disorders Flashcards
Which disorder describes a stressor triggering marked/disprop emotional and or behavioural symptoms?
Adjustment disorder
Time period of adjustment Disorder?
Starts within 3 months of stressor and continues no longer than 6 months.
What is criteria a of ptsd? ( triggering events) (4)
Exposure to actual or threatened death, serious injury, or sexual violence in one or more of following ways:
- Direct expenience
- Witnessing in person
- Learning that event occurred to close family member or friend . In cases of actual or threatened death, the event must have been violent or accidental.
- Experiencing related or extreme exposure to aversive details of traumatic event eg police constantly swing child abuse.
What is criteria B of ptsd? ( symptoms) (5)
Presence of one or more of following intrusion symptoms: RIMIND
- Recurrent, involuntary, Intrusive distressing memories. In children older than 6 , may manifest as repetitive play with themes of event
- Marked physiological reactions to internal or external cues that sympbolise or resemble aspect of event.
- Intense or prolonged psych distress at exposure to internal or external caes that symbolise or resemble an aspect of the event
- nightmares: Recurrent distressing dreams about event
- Dissociative reactions eg flashbacks in which individual feels/acts as of the event were recurring.
What is criteria c of ptsd? ( symptoms) (2)
Persistent avoidance of stimuli :
- Avoidance of or efforts to avoid distressing memories, thoughts, feelings
- Avoid external reminders eg people, conversations, activities etc that arouse distressing memonies, thoughts, feelings
What is criteria D of ptsd? ( symptoms) (7)
Negative alterations in cognitions and mood as evidenced by 2 or more:
- Inability to remember important aspect typically due to dissociative amnesia
- Persistent and exaggerated negative beliefs or expectations about self, others or world
- Persistent, distorted cognitions about cause or consequences of event that lead individual to blame self or others.
- Persistent negative emotional state eg horror, shame
- Markedly diminished interest or participation in significant activities
- Feel detached or estranged from others
- Persistent inability to experience positive emotions
What is criteria E of ptsd? ( symptoms) (6)
Marked alterations in arousal and reactivity evidence by 2 or more:
- Irritable and angry outbursts with little or no provocation, typically expressed as verbal or physical aggression
- Reckless or self-destructive behaviour
- Hypervigilance
- Exaggerated startle response
- Problems concentration
- Sleep disturbance
What is criteria F of ptsd? ( time period)
Critenia b, cd, E more than 1 month
Which 4 groups Of symptoms are necessary to diagnose Ptsd?
AN AID
- Avoidance (at least one)
- Negative alterations cognition and mood (at least 2)
- arousal and reactivity (at least 2)
- Intrusion symptoms (at least one)
(Dissociation part of intrusion syndrome)
How Often should a ptsd patient be followed up?
After 1 week
If fine, 4 weekly until at psychiatrist etc
if problems, after 1 week
Duration of acute stress disorder?
More than 3 days but less than 1 month
symptoms similar to ptsd
Which disorder has similar symptoms to ptsd but has a shorter duration?
Acute stress disorder
Which categories and number of symptoms are present in acute stress disorder? (5)
Nine or more symptoms from any of the following categories: Intrusion symptoms (same as ptsd except no physiological symptoms) Negative mood (cognitions not included as in ptsd) Dissociative symptoms (part of intrusion symptoms in ptsd and includes altered sense of reality of surroundings or self ) Avoidance symptoms Arousal symptoms (reactivity not included as in ptsd- same as ptsd but excludes reckless or self destructive behaviour )
Treatment of acute stress disorder?
No big role for medication, mostly cbt and psychoeducation
Can only give ssri if turn into ptsd as it takes too long to have effect.
Which sedative should never be given to a ptsd patient?
Benzodiazepines- risk factor for ptsd. Feed into avoidance
Which drug can be given for ptsd nightmares?
Prazosin- alpha 1 blocker
Define stressor
Any situation/event that requires individual to make adjustment
Stress response definition
Total sum of all adjustments to stressors (physiological, behavioural, psychological)
Name 2 specifiers PTSD
- With dissociative symptoms: depersonalization or derealisation
- with delayed expression: full diagnostic criteria not met until 6 months after event
Treatment PTSD? (6)
Psychological
- trauma therapy
- CBT
- EMDR (eye movement desensitisation and reprocessing)
Biological
- first line: ssri - fluoxetine, sertraline, venlafaxine (snri)
- nightmares: Prazosin (alpha 1 blocker)
- acute anxiety: benzo
(Adjunctive atypical antipsychotic - risperidone, Olanzapine)
Name 6 specifiers adjustment disorder
- With depressed mood
- with anxiety
- with mixed anxiety/ depression
- with conduct disturbance
- with mixed disturbance of conduct/emotions
- unspecified
Name 5 other specified trauma and stressor related disorder
- Adjustment-like disorders with delayed onset of symptoms that occur more than 3 months after the stressor
- adjustment - like disorders with prolonged duration of more than 6 months without prolonged duration of stressor
- ataque de nervios
- other cultural syndromes
- persistent complex bereavement disorder
Name 7 diagnostic criteria of reactive attachment disorder
*Paeds.
- A. Inhibited, emotionally withdrawn behaviour from adult caregivers manifested by rarely/minimally seeking comfort when distress and rarely / minimally responds to distress
- B. social + emotional disturbance, at least 2:
→ minimal social + emotional responsiveness
→ limited positive affect
→ episodes of unexplained irritability / sadness / fearfulness even during northreatening interaction with caregivers - C. Child has experienced pattern of extremes of insufficient care by caregivers, at least 1:
→ social neglect/deprivation with lack of basic emotional needs met for comfort, stimulation, affection
→ repeated changes of caregivers that limit opportunities to form stable attachments
→ rearing in unusual settings that limit opportunities to form selective attachments eg institutions with high child-to- caregiver ratios - D. Care in C causes behaviour in A
- E. Not autism
- F. Disturbance evident < 5 years
- G. Child has developmental age of at least 9 months
Name 5 criteria of disinhibited social engagement disorder
*Paeds trauma + related disorder
- A child actively approaches+ interacts with unfamiliar adults, at least 2:
→ low/absence reticence (reserve) in approaching + interacting with unfamiliar adults
→ overly familiar verbal /physical behaviour
→ low/absent checking back with adult caregiver after venturing away, even in unfamiliar settings
→ willingness to go off with an unfamiliar adult with min/no hesitation - B. Behaviours in criteria A not limited to impulsivity as in ADHD, but include socially disinhibited behaviour
- C. Child experienced pattern of extremes of sufficient care
- D. Care in criteria c responsible for behaviour in criteria A
- E. Child has developmental age of at least 9 months
