Lec 77 PTSD

Question 1

What is diagnostic criteria for trauma?

Answer 1

exposure to actual or threatened death, serious injury, or sexual violence in 1 or more of the ways:

• direct experiencing traumatic event
• witnessing event as it occurred to others
• learning traumatic event occurred to close family or friend
• experiencing repeated or extreme exposure to aversive details of event

Question 2

What are intrusion symptoms of PTSD?

Answer 2

presence of 1 or more of the following

• recurrent + intrusive distressing memories of the event
• recurrent distressing dreams
• dissociative rxns [flashbacks] in which feel as if event recurring
• intense psych distress at exposure to cues that symbolize aspects of the event
• psych reactivity on exposure to cues related to the event

Question 3

What are avoidance systems of PTSD?

Answer 3

persistent avoidance of stimuli associated with trauma such as:

• avoiding distressing memories/thoughts or feelings associated with trauma
• avoiding external reminders [activities/people/places] that arouse distressing memories thoughts or feelings about the trauma

Question 4

What negative alterations in cognition or mood associated with PTSD?

Answer 4

2 or more of the following

• can’t recall important aspect trauma
• negative beliefs about oneself or others
• distorted cognition about the cause or consequences of the trauma leading to blame self or others
• persistent negative emotional state
• decreased interest in activities
• feel detached from others
• can’t experience positive emotions

Question 5

What alterations in arousal or reactivity associated with PTSD?

Answer 5

2 or more of the following

• irritability or outbursts of anger
• reckless or self destructive behavior
• hyper-vigilance
• exaggerated startle response
• difficulty concentrating
• difficulty falling or staying asleep

Question 6

What are diagnostic criteria of PTSD?

Answer 6

• exposure to trauma
• intrusion symptoms
• avoidance of stimuli associated w/ trauma
• negative alterations in cognition or mood
• alterations in arousal or activity
• symptoms last > 1 month
• causes clinically significant distress or impairment in social, occupational functioning

Question 7

What is acute stress disorder?

Answer 7

• exposure to traumatic event
• presence of 9 or more symptoms from any of the following categoreies: intrusion, negative mood, dissociation [altered sense of reality], avoidance, arousal, impaired function, significant distress
• develops within 4 wks of exposure and lasts < 1 month
• considered a precursor to PTSD

Question 8

How do you distinguish acute stress disorder from PTSD?

Answer 8

acute stress disorder [ASD] = dissociative symptoms [altered sense of reality, can’t recall important aspect of trauma]

symptoms last less than 1 month

Question 9

What is course of ASD?

Answer 9

if continues is precursor to PTSD

if psychotherapy may prevent progression

Question 10

What is epidemiology of PTSD?

Answer 10

• ~25% of those exposed to trauma develop PTSD
• 6.8% of US adults have PTSD , women 2x more likely than men
• co-morbid with psych conditions MDD, anxiety disorders, substance use disorders, unexplained somatic complaints, borderline personality disorder

Question 11

Which traumas are most likely to result in PTSD?

Answer 11

• rape - 50%
• combat - 38%
• severephysical assault

Question 12

What is course of PTSD?

Answer 12

• 80% longer than 3 mo
• 75% longer than 6 mo
• 50% at least 2 yrs
• small minority can remain symptomatic for yrs or decades

Question 13

What are predictors of worse outcomes for PTSD?

Answer 13

• more PTSD sx
• comorbid med conditions
• childhood + additional traumas
• psych [mood, anxiety]
• female
• alc abuse

Question 14

What are risk factors for PTSD?

Answer 14

• character of individual more than type of trauma
• trauma type, amount, severity
• young age, women more than men, minority, low SES
• preparedness
• level of social support
• perceived control

Question 15

What is neuro model of PTSD?

Answer 15

• stress-induced changes or inadequate adaptation of neuro systems to exposure to severe stressors
• increase ANS responsiveness [ more NE]
• disinhibition HPA [low cortisol –> hyperactive]
• 5HT modulates synpathetics + HPA
• decreased hippocampal volume, increased amygdala responsiveness, impaired mPFC

net effect –> enhanced encoding of traumatic memories, failures of habituation –> state of perpetual fear

Question 16

What is thought to cause PTSD?

Answer 16

failure to recover from a traumatic event

Question 17

How does HPA axis dysfunction differ in PTSD vs MDD?

Answer 17

MDD: more cortisol, more CRF; less sensitive to negative feedback, HPA glucocorticoid receptors are less sensitive
- DEX suppression test = no suppression

PTSD: less cortisol, more CRF; more sensitive to negative feedback, HPA glucocorticoid receptors are more sensitive
- DEX suppression test = exaggerated suppression

Question 18

What happens to sympathetic in PTSD?

Answer 18

• hyperadrenergic symptoms [anxiety, tachycardia, increased diastolic BP]
• abnormally high NE in both CNS and peripheral –> leads to abnormally strong emotional memory and fear conditioning

Question 19

What happens to HPA axis in PTSD?

Answer 19

less cortisol, more CRF; more sensitive to negative feedback, HPA glucocorticoid receptors are more sensitive
- DEX suppression test = exaggerated suppression

== hyperresponsive to stress and effects of cortisol

Question 20

WHat level of NE in PTSD?

Answer 20

high

Question 21

What level of cortisol in PTSD?

Answer 21

low

Question 22

What happens to 5HT modulation in PTSD?

Answer 22

dysregulated but details not really known

Question 23

What happens to neurocircuitry in PTDS?

Answer 23

brain regions altered: fear response areas –> hippocampus, amygdala, PFC areas including ACC and orbitofrontal cortex

these areas modulate response to stress

Question 24

What is treatment for PTSD?

Answer 24

SSRIs
CBT [prolonged exposure therapy]

adrenergic blockers [propanolol, clonidine], anticonvulsants, atypical antipsychotics