wamss notes trauma and stress related disorders Flashcards
post-traumatic stress disorder
Severe psychological disturbance following a traumatic event characterised by involuntary re-experiences of elements of the event
features of post traumatic stress disorder
- Trauma (exposure)
- Re-Experience (involuntary distressing memories, dreams, flashbacks) at least 1
- Avoidance of stimuli associated with event
- Unable to function
- Month or more of Sx
- Arousal Increased (irritable, hypervigilance, concentration/sleep problem)
- Negative alterations in mood or cognition
Intrusions, Avoidance, Negative alterations in mood & cognition, alterations in arousal or reactivity
acronym for remembering features of post traumatic stress disorder
TRAUMAN
according. to the DSM-5, PTSD is characterised into 4 types of symptoms groups
intrusive symptoms
avoidance
negative alterations in cognition or mood
alterations in arousal or hyperactivity
intrusive symptoms of PTSD
- Most characteristic symptom
- Involuntary re-experiencing aspects of the traumatic event in a vivid & distressing way
- Flashbacks, intrusive images & sensory impressions, dreams, emotional &
psychological reactivity to internal or external cues
avoidance symptoms of PTSD
- Avoidance of reminders, people, situations, circumstances associated with the trauma
negative alterations in cognition or mood
- May include amnesia to parts of the event, negative beliefs about self or world,
distorted idea of blame, fear, anger, guilt, shame - May have inability to experience positive feelings
Alterations in Arousal or Hyperreactivity symptoms of PTSD
- Hypervigilance, exaggerated startle response, irritability, difficulty concentrating,
sleep problems
theory of pathophysiology of PTSD
Failure of the medial prefontal-anterior cingulate networks to mediate amygdala activity resulting in hyper-reactivity to thread
Oversensitive negative feedback system whereby low levels of cortisol inhibit the production
of ACTH by the anterior pituitary leading to a failure to contain the sympathetic response
leading to the consolidation of traumatic memories
risk factors for PTSD
Exposure to trauma
Serious accident, domestic violence (witness), natural disaster, terrorism, torture, combat
exposure, TBI, death of a loved one, abuse, multiple major life stressors, work exposure to
trauma police, ambulance…
Other mental disorders
Low social support
Drug & ETOH abuse
screening for PTSD
Impact of Event Scale
Post-Traumatic Diagnosis Scale
DDx for PTSD
Other Mental disorders (adjustment disorder) or Substance Abuse disorders
treatment for PTSD
Some may recover with no or limited intervention
Psychological interventions
CBT & Trauma-focused CBT
Relaxation techniques & coping mechanisms
Group therapy, Individual & Family Therapy
Eye movement desensitization and reprocessing
how do you treat moderate/severe PTSD or those who have failed non-pharmacological treatment
First Line:
- SSRI – Paroxetine strongest evidence available
Second Line:
- Other SSRIs
- Antipsychotics, MAOI, TCA – limited evidence for efficacy
symptomatic management of PTSD
Benzodiazepines- anxiety Sx
B-blockers- hyperarousal Sx
