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NEUROPSYCH & CLINICAL NEURO > Week 10: Stress and trauma > Flashcards

Week 10: Stress and trauma Flashcards

1
Q

PTSD used to be considered what in the DSM5?

A

Anxiety disorder

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2
Q

What characterizes PTSD?

A

Re-experiencing, avoidance, negative changes in thoughts and mood, and hyperarousal following exposure to a traumatic event

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3
Q

What is the first line of treatment for PTSD?

A

Trauma focussed therapy

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4
Q

What can you treat PTSD with if not trauma-focused therapy?

A

Non-trauma focussed therapies
Medications

ECT - triggers a brief seizure

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5
Q

What medication is used for PTSD?

A

SSRIs

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6
Q

What is focal brain stimulation?

A

It is a potential stand-alone treatment for PTSD

Involves applying energy to specific brain regions to alter the activity of a brain site as well as its connections

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7
Q

What are the 3 focal brain stimulation techniques and how invasive are they?

A

Deep brain stimulation (DBS) - most focal but the most intensive
Transcranial magnetic stimulation (TMS): less focussed than DBS but also not as invasive
Transcranial direct current stimulation (tDCS): this is non-focal and non-invasive

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8
Q

What is vagus nerve stimulation used for?

A

to indirectly stimulate neural targets via this nerve

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9
Q

What two brain structures are involved in PTSD but are hard to stimulate because of their location in the brain?

A
  • Amygdala

- Hippocampus

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10
Q

How can you reach the amygdala to stimulate it?

A

You can target indirectly via prefrontal structures through TMS or through DBS (however for DBS it requires surgery and has risks)

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11
Q

What do we see in the brain when first-line treatments to PTSD don’t work?

A

Hyperactivation of the amygdala

Reduced hippocampal volume

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12
Q

DBS to stimulate the amygdala has found…

A

a clinical improvement in PTSD symptoms

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13
Q

Trauma can result from…..

A

One or multiple threatening and stressful events

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14
Q

What does trauma result in?

A

Persistent negative effect and activation of the threat system

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15
Q

What is the basic route of the threat system?

A

Sensory information coming into the system that is centred around the amygdala and output from the autonomic nervous system and the HPA axis

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16
Q

What are some persistent negative effects that may result from trauma?

A 
Intense fear 
Terror 
Loss of hope 
Anxiety 
Guilt 
Shame 
Hyperarousal
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17
Q

What are the specific trauma and stress-related disorders in the DSM5

A 
PTSD 
Acute stress disorder (ASD) 
Adjustment disorder 
Reactive adjustment disorder 
Disinhibited social engagement disorder 
Unclassified or unspecified trauma disorders
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18
Q

What might stress and trauma disorders be comorbid with?

A 
Depression 
Substance abuse 
Eating disorders 
Self-harming behaviors 
Dissociative behaviors 
Personality disorders
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19
Q

For adults and children over the age of 6, what are the PTSD symptoms?

A 
Upsetting memories 
Feeling on edge 
Having trouble sleeping 
World feels unsafe 
May try and avoid things that remind them of the trauma
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20
Q

Who can develop PTSD?

A

Anyone at any age

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21
Q

What increases the likelihood of PTSD?

A

Very intense or very long-lasting traumatic events

Also getting injured

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22
Q

What kind of traumatic events is PTSD more common following?

A

Combat

Sexual assault

23
Q

What are the categorical symptoms of PTSD according to the DSM5? (see notes for in depth)

A
  • Exposure to the actual or threatened, death, serious injury or sexual violence
  • presence of one or more of the following intrusive symptoms associated with the event after it has occured
  • avoidance of stimuli associated with the event
  • marked alterations in arousal and reactivity with two of the following
24
Q

For PTSD diagnoses, the symptoms have to last for ……… and cause……….. but not be due to……..

A
  1. One month
  2. Distress or impairment in social, occupational, or other important areas of functioning
  3. Physiological effects of a substance or another medical condition
25
Q

What is the acute phase of ASD?

A

It is where the diagnosis of ASD can be made

3 days - 1 month

26
Q

What if ASD symptoms last for longer than a month?

A

The clinician would assess for PTSD and ASD diagnosis would no longer apply

27
Q

What is the debate around ASD and PTSD?

A

Debated whether or not ASD is a predictor of PTSD

28
Q

How many PTSD symptoms does ASD have to meet?

A

At least 9 of the 14

29
Q

What are the categorical symptoms of ASD according to the DSM5? (see notes for in-depth)

A
  • Exposure to the actual or threatened death, serious illness, or sexual violence
  • Negative mood
  • Dissociative symptoms (altered sense of reality or inability to remember important aspects of the event)
  • Avoidance symptoms
  • Arousal symptoms (sleep disturbance, anger, hypervigilance, cant concentrate)
30
Q

How do ASD and PTSD differ in how they meet criteria and are diagnosed?

A

PTSD required meeting a certain number of symptoms from established clusters, ASD are not clustered, just need to meet a certain amount overall

PTSD includes non-fear based symptoms, ASD does not

31
Q

Trauma focussed psychotherapies with the most evidence are?

A
  1. Prolonged exposure
  2. Cognitive processing therapy
  3. Eye movement desensitization and reprocessing
32
Q

What is prolonged exposure?

A

Teaches you how to gain control by facing your negative feelings.
It involves talking about your trauma and doing some of the things you have avoided since

33
Q

What is cognitive processing therapy?

A

Teaches you to reframe your negative thoughts about the trauma
It involves talking with your provided about your negative thoughts and doing short writing assignments

34
Q

What is eye-movement desensitisation and tracking

A

Helps you to make sense of your trauma, calling it to mind while paying attention to a back and forth movement or sound such as a finger waving or a light/tone

35
Q

Fear is…

A

A subjective state
Physiological responses elicited by threatening stimuli through activation of the HPA axis and ANS, also behavioral responses

36
Q

What is threat detection?

A

A protective bodily response vital for survival

37
Q

What is the evolutionary perspective of threat detection?

A

The brain has prewired circuits that respond to ancestral threats

38
Q

How do we learn to respond to new threats?

A

Neural plasticity in fear circuits

39
Q

What is considered fear pathology?

A

Fear response is inappropriate to the stimulus or in magnitude

40
Q

What is the james-lange theory of emotion?

A

Emotion inducing stimulus triggers specific physiological and behavioural responses in the person

The person then interprets these responses which is the emotion

41
Q

What is the cannon-bard theory of emotion?

A

There is a stimulus that promotes physiological and behavioural responses as well as an emotional experience simultaneously.

42
Q

What is the fear center model?

A

Threat into sensory system

Into the fear circuit

Leads to a fear response - defensive behaviour and physiological responses

43
Q

What is the two-systems model of fear?

A

One system is for generating conscious feelings of fear (cognitive circuit)
One system is for controlling behavioural and physiological reactions (defensive survival circuit)

They both do have some interaction with each other

44
Q

What does the hypothalamus do

A

Regulates many functions such as the HPA axis through the pituitary gland

45
Q

What was Papez’ argument?

A

Emotional states are expressed through the effect of the limbic system on the hypothalamus

Emotion is experienced through the effect of the limbic system on the cortex

46
Q

How does sensory information travel to the amygdala

A

It comes into the thalamus and travels to the amygdala in the temporal lobe it goes down to the body to trigger the physiological responses there are two ways of this information gets here

The low road and the highroad

47
Q

What is the Low Road in relation to sensory information travelling to the amygdala

A

The low road is a direct route straight from the thalamus to the amygdala

48
Q

What is the highroad in relation to sensory information travelling to the amygdala

A

The highroad is indirect it goes from the thalamus to the sensory cortex then to the amygdala

49
Q

When the sympathetic nervous system is activated what kind of physiological symptoms do we see

A

Increased heart rate, inhibited saliva, dilated bronchial, inhibited digestion, dilated pupils

50
Q

What drugs dampen down the sympathetic nervous system

A

Beta-blockers

51
Q

The HPA axis enables what

A

Fight or flight

52
Q

Explain the HPA axis

A

It involves the hypothalamus, pituitary gland and adrenal gland

The hypothalamus controls the secretion of hormones from the Pituitary gland by secreting CRH

The pituitary releases ACTH

These hormones released travel down to the kidneys the adrenal glands that secrete the hormone cortisol

Cortisol will eventually affect all cells in the body and feeds into the brain infection hippocampus and the pre-frontal cortex that are particularly sensitive

this corresponds with memory deficits under extreme stress cortisol also increases the amygdala response

53
Q

What does the adrenal cortex release?

A

Glucocorticoids (including cortisol)

54
Q

What does the adrenal medulla release?

A

Catecholamines

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