Trauma y trastornos por estres Flashcards
10.1.
A patient was just diagnosed with breast cancer and seeks
help from a psychiatrist after experiencing 2 months of
depressed mood and anxiety. She has missed many days of
work and has stopped going to her favorite weekly art class.
She reports still eating and sleeping well and denied any
suicidal thoughts. Which of the following is her most likely
diagnosis?
A. Acute stress disorder
B. Adjustment disorder
C. Major depressive disorder
D. Posttraumatic stress disorder (PTSD)
E. Unspecified anxiety disorder
10.1. B. Adjustment disorder
Adjustment disorders are in response to a stressful life event, such as
a medical diagnosis, financial difficulties, relationship problems, etc.
It can occur within 3 months of the stressor and can result in
depressive symptoms and/or anxiety, resulting in a disturbance in
functioning and possibly a disturbance in conduct. A PTSD would be
more likely to occur with traumatic events such as assault, crimes,
physical or sexual abuse, war, etc. The patient would experience
nightmares or flashbacks and avoidance symptoms. An acute stress
disorder differs from PTSD in that the symptoms occur within 1 day
to 1 month of the trauma. A major depressive disorder would likely
include other symptoms such as changes in appetite, sleeping,
energy, suicidal thoughts, etc.
10.2.
In addition to negative mood, two symptoms from which of
the following criteria must be met for a diagnosis of
posttraumatic stress disorder (PTSD)?
A. Arousal alterations
B. Avoidance
C. Different traumas
D. Dissociative
E. Intrusions
10.2. A. Arousal alterations
In addition to a history of exposure to trauma, a PTSD diagnosis
requires one symptom of intrusion (i.e., reenactment, nightmares,
dissociative responses, etc.), one of avoidance (i.e., avoiding
memories or external reminders of the trauma), two symptoms of
negative mood/cognition (i.e., negative perceptions of self, cognitive
distortions, excessive guilt, decreased interest in activities, etc.), and
two in arousal alterations (i.e., irritability, anger, hypervigilance, risk
taking, sleep disturbances, etc.)
10.3.
A lack of specificity in which criteria is a potential challenge
in diagnosing someone with an adjustment disorder?
A. Age of onset
B. Avoidance and hyperstartle symptoms
C. Psychosocial consequence descriptions
D. Symptom presentation time frame
E. The stressor and severity descriptions
10.3. E. The stressor and severity descriptions
One of the challenges in diagnosing an adjustment disorder is that
there are no clear criteria that define the stressors that are required
to make this diagnosis and specific affective, cognitive, and
autonomic descriptions are not specified. Another challenge is that
the symptoms can be of any severity. It is defined that the symptoms
need to occur within 3 months of the stressor. The disorder can occur
at any age. Specific criteria are included for avoidance and
hyperarousal symptoms for a posttraumatic stress disorder (PTSD)
diagnosis. The symptoms for both PTSD and an adjustment disorder
should result in some impairment in functioning.
10.4.
A diagnosis of posttraumatic stress disorder (PTSD) can only
be made if which of the following criterion is met?
A. Anxiety and depression are present
B. Constant symptoms exist without fluctuations
C. Symptom presentation arises rapidly
D. Persistent symptoms exist for at least 1 month
E. Two avoidance symptoms are met
10.4. E. Persistent symptoms exist for at least 1 month
Many people experience PTSD symptoms including shock,
nightmares, and flashbacks after a traumatic event. However, most
resolve on their own and some will meet criteria for an acute stress
disorder. A diagnosis of PTSD can only be made if the symptoms
persist for at least 1 month. It is normal for symptoms to fluctuate
with various degrees of intensity over time. PTSD may or may not be
associated with comorbid anxiety or depression. Two negative
mood/cognition and two arousal alteration symptoms are required
to make a diagnosis of PTSD though only one symptom of intrusion
and one of avoidance are required. A rapid presentation of symptoms
is not required. There is a modifier criterion for delayed expression
with symptoms not presenting until at least 6 months after the
trauma.
10.5.
A patient was robbed getting into her car. Three months later
she presents with ongoing nightmares, flashbacks, trouble
sleeping and focusing. She is overwhelmed with fear and anger
and can no longer bring herself to drive. Which medication has
the most robust evidence to help with this diagnosis?
A. Topiramate
B. Paroxetine
C. Prazosin
D. Risperidone
E. Venlafaxine
10.5. B. Paroxetine
The patient described has a diagnosis of posttraumatic stress
disorder (PTSD). The selective serotonin reuptake inhibitors
(SSRIs), particularly sertraline and paroxetine have the most robust
evidence for efficacy. There is some supportive evidence that the
serotonin and norepinephrine reuptake inhibitors (SNRIs), such as
venlafaxine and the atypical antipsychotics, such as risperidone,
along with anticonvulsants, such as topiramate could be helpful.
Prazosin can help with nightmares found in posttraumatic stress
disorder.
10.6.
Which type of evidence-based therapy for posttraumatic
stress disorder (PTSD) focuses on correcting faulty
attributions from the trauma, such as viewing the world as a
dangerous place?
A. Cognitive processing therapy (CPT)
B. Eye movement desensitization and reprocessing therapy
(EMDR)
C. Present-centered therapy (PCT)
D. Prolonged exposure therapy (PE)
E. Trauma-focused cognitive behavioral therapy (TFCBT).
10.6. A. Cognitive processing therapy (CPT)
CPT involves correcting faulty attributions as mentioned above such
as views of the world being uncontrollable and unpredictable. EMDR
involves recalling distressing images of the trauma while receiving
sensory inputs. Patient-centered therapy focuses on the current
relationship and work challenges and does not directly address the
trauma. TFCBT includes prolonged exposure therapy and involves
reexperiencing the traumatic event through imaginal and in vivo
exposures.
10.7.
Of the factors listed, which of the following is the most
important risk factor for developing posttraumatic stress
disorder (PTSD)?
A. Being single or divorced
B. Being very young or very old
C. Having good financial means, being labeled in a high
socioeconomic class
D. Participating in the Vietnam war
E. Severity of or proximity to the trauma
10.7. E. Severity of or proximity to the trauma
While certain factors increase the risk of PTSD such as being a young
adult, single, divorced, widowed, socially withdrawn, or of low
socioeconomic class, the most important risk factors include the
severity, duration, and proximity of a person’s exposure to the
trauma. While one survey showed approximately 30% of males
developed PTSD from the Vietnam war, other trauma aside from war
can also lead to the development of PTSD
