Week 2 - A - Response to trauma, Trauma 1 and 2, Freeze v flee, PTSD diagnosis criteria and treatment Flashcards
Traumatic events can be classified as type 1 and type 2 trauma What is the difference between type 1and2 trauma?
Type 1 trauma - this is where there is a single incident of truama and is unexpected
Type 2 trauma - also known as complex trauma is repetitive and includes ongoing abuse and hostage taking
Is type 1 or type 2 trauma more likely to result in PTSD?
Type 2 trauma is 3 times more likely to result in PTSD than type 1 trauma
Is trauma more likely to affect higher or lower socioeconomic classes?
Trauma is much more likely yo affect lower socioeconomic clases
What percentage of patients with bipolar disorder have a history of childhood deprivation or abuse?
According to a study, childhood deprivation or abuse is linked to 50% of cases of bipolar disorder
The two responses to threat are freeze or flee What do these mean? • Fight, flight, freeze, hide, avoid, attach, submit, despair & uncontrolled activation states all originate from what area of the brain? This area is the area of the brain that is also very much involved in analgesia modulation
Freeze is what happens when there is a distant or inescapable threat
Flee is when the threat is nearby and escapable
The area where all the freeze/flee and others airse in response to a threat is the periaqueductal grey (PAG) area - this is the area in the mdibrain around where the cerebral aqueduct lies
“Freeze” responses To distant threat can be voluntary – i.e., “stop, watch and listen” pattern of vigilance When ‘inescapable’ threat – “Tonic immobility” occurs When does tonic immobility occur and what is it?
Tonic immobility occurs especially in direct physical contact with a predator/aggressor
It is an involuntary state of profound (but reversible) motor inhibition
What are some features of tonic immobility?
There is decreased vocalisation
There is rigidity and paralysis
Muscle tremors in extremities
Chills
And unresponsiveness to pain
Why is it thought that tonic immobility may enhance survival?
It is less likely that predators are going to attack immobile prey and if they do they, immobility may cause them to loosen grip increasing chances of escape
There is also a decreased risk of violence in those who do not fight back and some predators may lose interest if victim immobile and unresponsive
How does increased proximity to a predator shift the brain activity?
Increased proximity to a predator shifts the brain activity from the prefrontal cortex to the midbrain superior colliculi and periaqueductal
• PTSD – suggested that it is associated with a deficiency in top-down modulation of amygdala activation by the prefrontal cortex It is thought that are three looping mechanisms in response to trauma What are these three looping mechanisms?
First loop - midbrain / brainstem origin - PAG and superior colliculi
Second loop - mesolimbin dopamine system
Third loop - Stimulus response learning system ie the structures that hold learning
Name the 3 looping defence systems again? What happens to the cortisol levels in PTSD?
The 3 looping defence sytems are
The midbrain / brainstem loop - PAG and superior colliculus
The mesolimbic doapmine response
The stimulus response learning system
In PTSD the cortsiol levels are low - this is a biological paradox in response to acute stress
What is the criteria for PTSD? How many of each type of symptom? What is the duration of the symptoms that allows for distinguishing between PTSD and Acute stress reaction?
There has to have been a traumatic event in which there are intrusive symptoms - 1+
avoidance sympotms - 3+
increased arousal - 2+
and the duration of these symptoms is at least one month after the event
What is the intrusive phenomena? (need at least 1)
Recurrent distressing recollections
Nightmares
Flashbacks
Pshyiological reactions fight or flight
Distress accompanies reminders
What are the avoidance symptoms that can happen in PTSD? (need at least 3)
Avodiance of thinking or talking about the event
Avoidance of reminders such as activities, places or people
Amnesia for important aspects such as trauma
Loss of interest in activities
Detachment
What are the hyperarosual symptoms that may be present in a patient with PTSD? (Need at least 2)
Sleep disturabcne
Irritability/anger
Concentration difficulties
Hypervigilance
Exaggerated startle response
A number of sufferers with PTSD may recover with no or limited interventions. However, without effective treatment, many people may develop chronic problems over many years. The severity of the initial traumatic response is a reasonable indicator of the need for early intervention, and treatment should not be withheld in such circumstances. IF someone presents where symptoms are mild and have been present for less than 4 weeks after the trauma
Watchful waiting if the symptoms have been present for less than 4 weeks and then follow up one month later
If someone presents with severe symptoms for less than 3 months, what is the management? If someone presents with symptoms for greater than 3 months, what is the management?
If someone preents with severe symptoms for less than 3 months or symptoms for greater than three months
1st line is - trauma focussed psycotherpay - CBT or eye movement desensitization and reprocessing (EMDR)
For PTSD sufferers who have no or only limited improvement with a specific trauma-focused psychological treatment, healthcare professionals should consider the following : * an alternative form of trauma-focused psychological treatment * the augmentation of trauma-focused psychological treatment with a course of pharmacological treatment. What drugs are shown to possibly have effect in PTSD patients? (limited evidence exists)
For non specialists Mirtazapine (Atypical NaSSA) or paroxetine (SSRI)
Specialists - amitriptyline (TCA) or phenelzine (MAOI) PTSD is not a normal adaptation to severe (traumatic) stress.
- * • PTSD is not an inevitable response to trauma
- * • PTSD is not the only response to trauma
- * • most trauma-exposed people do not develop PTSD
- * • many individuals will recover quickly from PTSD or only ever have brief distress
