Trauma + Dissociative Flashcards
PTSD criteria (adults)
A) Exposure
B) At least ONE intrusive symptom
C) At least ONE avoidance symptom
D) At least TWO negative alterations in cognition and mood
E) At least TWO alterations in arousal and reactivity
F) More than 1 month
PTSD specifiers
With dissociative symptoms
With delayed expression (criteria met only 6 month after trauma)
PTSD criteria (kids)
< 6 yo
At least ONE intrusive symptom
At least ONE avoidance or negative cognition/mood
At least TWO alteration arousal and reactivity
No reckless/self-destructive behaviour
Traumatic exposure criteria does not include repeated or extreme exposure
What percentage of those experiencing a trauma develop PTSD?
15-25%
What percentage of PTSD have co-morbidities?
80%
66% have at least TWO
PTSD neurobiology
Hippocampal atrophy
Smaller anterior cingulate cortex (proportional to severity)
Increased right-sided changes
Increased amygdala activity
Deactivation of Broca’s in flashbacks
Increased catecholamines
Activated opioid system
Low cortisol = ENHANCED SUPPRESSION OF CORTISOL ON DEXAMETHASONE CHALLENGE
Hyperregulated HPA
PTSD risk factors
Childhood trauma Personality disorder Poor support Female Family hx psych disorder Recent stressful life changes External locus of control Recent ++ EtOH
Acute stress disorder
3 DAYS TO 1 MONTH
AT LEAST NINE (9) SYMPTOMS
- all intrusive
- can’t experience positive emotions
- can’t remember details of trauma
- dissociative symptoms
- all avoidance
- all arousal except reckless/self-destructive
50% of PTSD patients had ASD
Conversion rate from ASD to PTSD?
25-30%
EMDR also used for what anxiety disorder?
PHOBIAS
SSRIs may not be as effective for which PTSD population?
Combat veterans
Adjustment disorder
Development of emotional or behavioural symptoms in response to an identifiable stressor occurring WITHIN 3 MONTHS of the onset of the stressor (which can be of any severity)
At least ONE
- marked distress out of proportion
AND/OR
- impaired function
NOT exacerbation of pre-existing mental condition
Once stressor/consequences have terminated, symptoms don’t persist for more than an additional 6 MONTHS
Most return to normal within 3 months
Adolescents on average take longer
Most common diagnosis in a hospital psychiatric consultation setting?
Adjustment disorder (50%)
Adjustment disorder specifiers
with depressed mood with anxiety with mixed anxiety and depressed mood with disturbance of conduct with mixed disturbance of emotions and conduct unspecified
Other specified trauma-related disorder
Persistent complex bereavement disorder
PTSD treatment
Rx > Psychotherapy
1st line
Paxil, Effexor XR > Prozac, Sertraline
Adjunctive
2nd line - Zyprexa, Risperdal, Zopiclone
Not recommended Celexa Clonazepam/Xanax Desipramine Epival Zyprexa (mono) Tiagabine
Propranolol not helpful in treatment or prevention
Therapy vs. Rx in anxiety disorders
PTSD
Rx > psychotherapy
TF-CBT = EMDR (faster with EMDR + can do multiple traumas at once)
OCD
Combo > Rx
Combo = CBT
Individual = group
Panic d/o Combo > Rx or CBT alone (acute) Combo = CBT alone (maintenance) Less relapse with CBT when Rx stopped 6 sessions as good as 12 sessions
Social anxiety d/o
CBT = Rx
CBT gains last longer
GAD
CBT = Rx = relaxation technique
Individual = group (but faster with individual)
Specific phobia
Rx NOT recommended
Gradual = flooding
PTSD - nightmare treatment
Prazosin
Nabilone
PTSD - flashback treatment
NALTREXONE
3 stages of trauma therapy
- Stabilisation
- Trauma integration (live in the present)
- Reconnection
Reactive attachment disorder criteria
BOTH:
- rarely seeks comfort when distressed
- rarely responds to comfort
At least 2:
- minimal responsiveness to others
- limited positive affect
- unexplained irritability/sadness/fearfulness
Experienced pattern of extremes of insufficient care (at least 1):
- social neglect
- repeated change of primary caregiver
- rearing in unusual setting severely limit opportunities
RULE OUT AUTISM
Symptoms present between 9 months and 5 years old
Specify:
- persistent
- severe (if have all symptoms)
Reactive attachment disorder types
Inhibited (RAD): tends to normalize over time in good environment
Disinhibited (social engagement disorder): behavioural patterns persist even when newly attached
Recovery:
PHYSICAL > emotional
Disinhibited social engagement disorder
At least 9 months old
Not limited to impulsivity
Can be diagnosed concurrently with ADHD
DID gold standard scale?
SCID - dissociative disorder revised
Both diagnosis and severity
Average # of identities in DID?
15 for women
8 for men
Depersonalization/derealization disorder
Reality testing remains intact during episode
LOW co-morbidity with PTSD
Avoidant, borderline, OCPD
