5. Psychiatry > 2- PTSD > Flashcards

2- PTSD Flashcards

(40 cards)

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1
Q

What is psychological trauma?

A

Injury or shock to body, mind spirit to which the brain creates coping mechanism to avoid future trauma
Results in emotional, psychological and social consequences

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2
Q

What determines if acute stress will become an acute stress disorder?

A

Risk/protective factors

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3
Q

If acute stress disorder persists for 1 month what does it become?

A

Acute PTSD

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4
Q

If acute PTSD persists for 3 months what does it become?

A

Chronic PTSD

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5
Q

What is the physiological response to long term trauma?

A

Body sensitized to threat (flight or fight trigged unnecessarily)

heightened physical responses to triggers/cures

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6
Q

What is the emotional response to long term trauma?

A

Intense feelings that are difficult to contain (numbing of emotions)

Tendency towards all or nothing reactions

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7
Q

What is the cognitive response to long term trauma?

A

Disrupts what we previously thought to be true about ourselves, others, and the world

Memory and cognitive impairments

Tendency towards all or nothing thinking

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8
Q

What 5 areas are commonly disrupted by trauma?

A
  1. Safety
  2. Trust
  3. Power and control
  4. Esteem
  5. Intimacy
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9
Q

Sexual trauma is considered what kind of trauma?

A

Interpersonal

  • Frequently perpetrated by trusted individual
  • Violation of boundaries/integrity
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10
Q

Sexual trauma (experience) can result in what dx?

A 
PTSD
Depression
Substance abuse/dependence
Eating d/o
Physical health manifestations
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11
Q

What are protective factors against PTDS? (6)

A

Close relationships (family, school, community, peers/social)
Emotional regulation skills/amount of positive emotions
Spirituality/religion
Achievement/self-regard
Cognitive strategies
Mobilization after threat

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12
Q

What are risk factors for PTSD? (9)

A 
Severe trauma/injury
Chronic life stress
Lack of social support
Young age/F gender
Psych comorbidities (anxiety, mood d/o)
Low SES/edu
Bereavement/grief
Poor coping skills
Shame/blaming
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13
Q

What area of the brain encodes fear w/ trauma and pairs stress w/ sensory cues?

A

Amygdala

*Scan the environment for threats

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14
Q

What area of the brain learns fear environment/context?

A

Hippocampus

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15
Q

What area of the brain will release NE during trauma?

A

LC

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16
Q

What area of the brain associates visceral/autonomic sensation w/ fear?

A

Insula/anterior cingulate cortex

*I feel afraid

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17
Q

What area of the brain controls the amygdala and regulates emotion?

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A

Pre-frontal cortex

18
Q

What assessment can be used in PCP setting to evaluate PTSD?

19
Q

What is the DSM5 criteria for PTSD? (7)

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A
  1. Exposure to traumatic stressor
  2. Re-experiencing sx
  3. Avoidance of memories or external reminders
  4. Negative alteration in cognition/mood
  5. Alteration in arousal, reactivity (irritable, reckless, sleep problems)
  6. Duration for ≥ 1 month
  7. Cause impairment, not due to substance or GMC
20
Q

What is the DREAMS mnemonic for PTDS?

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A 
Detachment
Re-experiencing the event
Event had emotional effects
Avoidance
Month in duration
Sympathetic hyperactivity/hypervigilance
21
Q

What is Criteria A for PTSD?

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A

Direct exposure to actual or threatened death, injury, sexual violence

22
Q

What is Criteria B for PTSD?

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A

1+ intrusive sx (nightmares, flashbacks, strong emotions or physical reactions when reminded of event)

23
Q

What is Criteria C for PTSD?

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A

Avoidance sx (avoiding memories, thoughts, or feelings OR external reminders of event)

24
Q

What is Criteria D for PTSD?

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A

2+ Cognitions or moods (negative beliefs about self/world, self blame, feeling numb/disconnected, difficult w/ positive feelings)

25
What is Criteria E for PTSD?
2+ Arousal/Reactivity (irritable, aggressive, trouble concentrating, easily startled, sleep troubles)
26
When evaluating pt w/ PTSD. What 2 questions should you ask to assess psych comorbidities?
1. Did you experience these sx PRIOR TO your traumatic incident? 2. Do you ever experience these sx separate from a trauma trigger or cure?
27
What screening tools can you use to assess psych comorbidities?
PHQ9 - Depression GAD7 - Generalized anxiety MDQ - Bipolar
28
What are common clinical comorbidities associated w/ PTSD?
``` Heart disease AI disease Hyperlipidemia Interstitial cystitis Dementia Fibro Chronic pain ```
29
How might sx of pts w/ PTSD present in clinical setting?
Avoidance (no showing appointments, not completing therapy assignment) "Forgetting" medication regimen or refusing to take meds Resistance to therapy/change Labile mood
30
As a PR how should you approach your pts w/ PTSD?
1. Validate sx 2. Ask permission before touching 3. DON'T ask for trauma details 4. Know community resources
31
What are the tx steps for pt w/ PTSD?
1. Education 2. Tx options 3. Develop common goals/rapport 4. Develop tx plan
32
What are the tx goals for pt w/ PTSD? (6)
1. Reduce severity of sx 2. Prevent or tx trauma-related comorbid conditions 3. Improve adaptive functions (social, occupational) 4. Restore sense of safety/trust 5. Prevent relapse 6. Limit generalization of danger experienced
33
What are the tx options for PTSD? (6)
1. Trauma focused CBT (or regular CBT if not ready for trauma based work) 2. EMDR 3. Stress management 4. Group therapy 5. Sleep hygiene 6. Anger management training
34
Are antipsychotics and BZs recommended for pts w/ PTSD?
NO
35
What meds are FDA approved for PTSD?
Sertraline Paroxetine *SSRI/SNRIs, Trazodone and mood stabilizers also given
36
What med can be given if nightmares?
Prazosin (a-blocker)
37
What med can be given for hyperarousal?
B-blocker
38
What must a pt have if you are going to refer them for trauma therapy?
Appropriate coping skills (therapy w/ exacerbate intrusive sx)
39
Should you increase a pt's meds w/ PTSD during trauma therapy?
No, unless clinically necessary (can make therapy less effective)
40
What do you need to tx before a pt is eligible for trauma therapy? (3)
Substance abuse Cognitive impairment (TBI) Intrusive/untx psychosis
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