Trauma/Stress Related Disorders

Question 1

DSM-5 Criteria for PTSD

Answer 1

this is probably the longest DSM5 yet, I don’t think it will even fit on a NC! Review!!

Question 2

DSM-5 Criteria for acute stress disorder

Answer 2

Exposure to actual or threatened death, serious injury, or sexual violation in 1 (or more) of the following ways

• directly experiencing the traumatic events
• witnessing, in person, the event as it occurred to others
• learning that the event occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event must have been violent or accidental
• experiencing repeated or extreme exposure to aversive details of the traumatic event

Presence of 9 (or more) of the following sx from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event occurred
**review all sx

Question 3

DSM5 criteria for adjustment disorder

Answer 3

The development of emotional or behavioral sx in response to an identifiable stressor occurring w/i 3 months of the onset of the stressor
The sx of behaviors are clinically significant, as evidenced by one or both of the following:
-marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence sx severity and presentation
-significant impairment in social, occupational, or other important areas of functioning

• The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder
• The sx do not represent normal bereavement
• Once the stressor or its consequences have terminated, the sx do not persist for more than an additional 6 months

Question 4

intrusion symptoms associated with traumatic events

Answer 4

• Recurrent, involuntary, intrusive distressing memories of traumatic events
• Recurrent distressing dreams where content and/or affect of ream related to event
• Dissociative reactions in which individual feels/acts as if traumatic events are recurring
• intense or prolonged psychological distress at exposure to internal or external cues (triggers) that symbolize or resemble an aspect of the traumatic events
• marked physiological reactions to internal or external cues (triggers) that symbolize or resemble an aspect of the traumatic events

Question 5

State the therapeutic approaches and their intent in managing a patient with post traumatic stress disorder

Answer 5

• Cognitive therapy: helps patient process traumatic memories and automatic negative expectations
• Behavioral therapy: deconditions PTSD patient by pairing relaxation techniques with systematic desensitization

Question 6

Identify the pharmacologic agents used in treatment of a patient with PTSD

Answer 6

• Antidepressants:
  i. SSRIs: sertraline, paroxetine, fluoxetine
  ii. SNRIs: venlafaxine
  iii. MAOIs
  iv. TCAs
• Adrenergic blockers: clonidine, β-blockers
• Mood stabilizers: lithium
• Anticonvulsants: carbamazepine, valproate, lamotrigine
• Anxiolytics: benzodiazepines (cautious), buspirone
• Antihistamines: cyproheptadine (for nightmares)
• Atypical antipsychotics: adjunctive meds

Question 7

Identify therapy for acute stress disorder

Answer 7

• Cognitive behavioral therapy: most supported approach
• Pharmacotherapy: SSRIs, TCAs, β-blockers (propranolol), high dose glucocorticoids (prevention of sx), morphine (when administered immediately after trauma)

Question 8

goal of therapy and the therapeutic approaches for an adjustment disorder

Answer 8

Relieve sx and help patient establish level of functioning comparable to that before stressful event

Question 9

Identify the major psychological response to a medical disorder

Answer 9

Adjustment disorders are common accompaniments of mental illness and may be the major physiologic response to a medical disorder