Trauma and Stressor related disorders

Question 1

Classification of the DSM-V trauma and stressor related disorders of adulthood

Answer 1

• PTSD
• acute stress disorder
• adjustment
• other specified
• unspecified

Question 2

What is an Adjustment disorder?

Answer 2

• non life / limb threatening stressor
• triggers marked emotional and/or behavorial sx
• onset within 3 months of stressor
• continues < 6 months
• not due to MMS or bereavement

Question 3

How do you manage Adjustment disorder?

Answer 3

• out pt

Psychoeducation

• adjustment
• high chance sx resolution
• support groups, discussions
• healthy lifestyle

Pharms

• any short acting hypnotic (Zolpidem 5-10 days)
• No SSRIs

Question 4

Name 2 variants of classic adjustment disorder

Answer 4

1. Adjustment like disorder with delayed sx onset (>3 months)
2. Adjustment like disorder with prolonged duration (>6mo) without prolonged stressor duration

Question 5

List the DSM-V criteria for PTSD

Answer 5

• life or limb threatening stressor
• causes intrusive sx > 1 month
  1. persistent avoidance of reminders
  2. negative changes in cognition + mood
  3. marked changes in arousal + reactivity

Specifiers

1. with Dissociative sx (depersonalization/derealization/both)
2. with Delayed expression (6 mo/more to meet full criteria)

Question 6

List the intrusive symptoms of PTSD (5)

Answer 6

• memories - recurr, invol, intrusive
• nightmares - about traumatic event
• dissociative reactions
• psychological distress - intense/prolonged on exposure to reminders
• physiological reactions - on exposure to reminders

Question 7

Name cognitive + mood changes with PTSD

Answer 7

• dissociative amnesia

- inappropriate self blame

Question 8

Name arousal + reactivity changes with PTSD

Answer 8

• irritable

- exaggerated startle response

Question 9

How do you manage PTSD?

Answer 9

• out pt

Psychoeducation

• dx + course
• mobilise support, dont avoid
• avoid substances
• medications

Psychotherapy

• CBT
• EMDR

Pharms
- SSRI

Follow up

• 1wk (SE + progress)
• if fine then 4 wkly
• if problems then 1wk

Question 10

Define Acute Stress Disorder

Answer 10

• stressor/traumatic event
• triggers intrusive sx
• last > 3 days but < 1 month
• cause significant distress/dysfunction

Question 11

List the intrusive sx of Acute Stress Disorder (4)

Answer 11

• persistent avoidance of reminders
• negative changes in cognition + mood
• marked changes in arousal + reactivity
• dissociative sx

Question 12

Describe psychoeducation with Acute stress disorder

Answer 12

• explain the condition
• advice against avoidance -> maintains sx!
• advice against sedatives, alcohol (reduces efficacy of CBT + exposure)
• encourage normalization
• encourage tolerable confrontation of traumatic event (discussion, at scene)
• follow up regularly

Question 13

What drugs will you use for a pt with Acute stress disorder?

Answer 13

• brief hypnotic therapy
• Zolpidem 5-10days
• No SSRI