Trauma and stressor related disorders

Question 1

What is a general description of post-traumatic stress disorder?

Answer 1

Long-lasting and debilitating anxiety in response to an extreme stressor

Question 2

What is a general description of acute stress disorder?

Answer 2

Short-lasting debilitating anxiety in response to an extreme stressor

Question 3

What are some examples of extreme stressors which may give rise to acute stress disorder or PTSD?

Answer 3

Serious motor accident

Natural disaster

Significant assault (inc. childhood abuse)

Active military service

Displacement as a refugee

Witnessing or learning about the sudden death of a loved one

Question 4

What is the length of time for acute stress disorder?

Answer 4

1 month

Question 5

What is the length of time for acute post-traumatic stress disorder

Answer 5

1-3 months

Question 6

What is the length of time for chronic post traumatic stress disorder?

Answer 6

> 3 months

Question 7

What is delayed post-traumatic stress disorder?

Answer 7

PTSD where the symptom onset is delayed by 6-months or longer from the initial stress exposure

Question 8

What factors increase the risk of developing PTSD?

Answer 8

Intensity, frequency and duration of the traumatic event.
Proximity to the traumatic event
The nature of the trauma (physical injury, interpersonal violence)
Gender (female)
Previous exposure to trauma
Prior psychiatric illness
Ability to receive support

Question 9

What is the presentation of PTSD?

Answer 9

Re-experiencing the traumatic event
Triggered by minor stimuli
Avoidance of triggers
Increased arousal
Emotional numbing

Survivor guilt (war veterans)
Self-disruptive behaviour (rape survivor)

Question 10

What are some screening questions for PTSD?

Answer 10

What is the worst thing that has ever happened to you
Have you ever experienced or witnessed an event in which you were, or thought you were seriously injured or your life was in danger?
Do you think or dream about those events?

Question 11

What are the three cluster symptoms of PTSD?

Answer 11

Re-experiencing
Hyperarousal
Avoidance and numbing

Question 12

What is the early intervention (first few days) after a traumatic experience?

Answer 12

Practical and emotional support

Structured interventions and psychological debriefing should not take place on a routine basis

No pharmacotherapy

Question 13

What is the first line treatment for acute stress disorder and PTSD?

Answer 13

Specialist administered trauma-focussed psychotherapy.

No medication for acute stress disorder

No medication for first 4-8 weeks of PTSD

Question 14

What are the trauma focussed psychotherapies used in acute stress disorder and PTSD?

Answer 14

Trauma focussed CBT

Eye movement desensitisation and reprocessing

Counselling on emotional regulation (anger, anxiety, stress, sleep)

Question 15

What is the pharmacotherapy for PTSD?

Answer 15

1. SSRI
2. Mirtazapine (15mg) or Amitriptyline (50-75mg)
3. Phenelzine (45-60mg) +low tyramine diet

Question 16

What is a general description of adjustment disorder?

Answer 16

when a persons psychological distress response to one or more stressors becomes severe enough to impair social and other functioning.

Question 17

What are common stressors which may trigger an adjustment disorder?

Answer 17

Workplace problem
Legal difficulty
Health crisis
Interpersonal problems
Leaving home
Retirement

Question 18

What are the classifications of adjustment disorder?

Answer 18

…with depressed mood
…with anxiety
…with mixed anxiety and depression (most common)
…with disturbance of conduct
…with mixed disturbance of emotions and conduct
…unspecified

Question 19

What is the treatment for adjustment disorder with anxiety?

Answer 19

WHERE SEVERE

Diazepam 2-5mg for a maximum of 2 weeks