MDCN 470: Course 7 > PTSD > Flashcards

PTSD Flashcards

(16 cards)

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1
Q

course of PTSD:

type I trauma → ___ __ disorder (3-30d) → ___ (1mo+)

A

type I trauma → acute stress disorder (3-30d) → PTSD (1mo+)

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2
Q

2 key subtypes of PTSD

A
  1. with dissociative symptoms (including derealization or depersonalization)
  2. severe/complex PTSD (many symptoms, affecting dysregulation, impaired relationship with others, suicidal thoughts. dissociation, negative belief systems)
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3
Q

Note: Etiologies of PTSD

  • Neuroendocrine systems in PTSD
  • ANS hyperactivity
  • Reduced serotonin
  • Opioid system reduction in endorphins
  • Reduced GABA receptor density
  • Glutaminergic dissociative symptoms
  • Reduced concentration of neuropeptide Y
  • HPA axis hyperexpression.
A
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4
Q

Outline Criteria for PTSD

A. __ to actual or threatened death, __ ___ or __ violence.

  • a. Directly experiencing trauma event
  • b. Witnessing in person
  • c. Learning that the traumatic event occurred to
  • close family member or close friends and was accidental or violent
  • d. Experiencing repeated or extreme exposure to aversive details of trauma (first responders, occupational exposure)

B) __ symptoms and re-experiencing (at least 1)

  • a. Recurrent involuntary and intrusive distressing memories
  • b. Recurrent nightmares
  • c. Dissociative reactions such as flashbacks
  • d. Intense psychological/physiological distress when triggered

C) Persistent __ of trauma stimuli (at least 1)

  • a. Avoidance of, or efforts to avoid memories, thoughts, feelings
  • b. Avoidance of external reminder of trauma that trigger distressing memories

D) Negative alterations in ___ and __ (at least 2)

  • a. Parts of trauma memory absent due to dissociative amnesia
  • b. Persistent negative self-beliefs/distorted cognitions
  • c. Persistent negative emotional state/fear/horror/anger/guilt
  • d. Diminished interest in significant activity
  • e. Emotional numbing/lack of joy or positive emotions

E) ___/__ symptoms (at least 2)

  • a. Irritability/short fuse/impatience/road rage
  • b. Reckless self-destructive behaviour
  • c. Hypervigilance
  • d. Poor concentration
  • e. Insomnia

F) Greater than ____ of duration

G) Symptoms cause ___ ____

H) Not caused by medical illness/EtOH/drugs

A

Outline Criteria for PTSD

A. Exposure to actual or threatened death, serious injury or sexual violence.

  • a. Directly experiencing trauma event
  • b. Witnessing in person
  • c. Learning that the traumatic event occurred to
  • close family member or close friends and was accidental or violent
  • d. Experiencing repeated or extreme exposure to aversive details of trauma (first responders, occupational exposure)

B) Intrusion symptoms and re-experiencing (at least 1)

  • a. Recurrent involuntary and intrusive distressing memories
  • b. Recurrent nightmares
  • c. Dissociative reactions such as flashbacks
  • d. Intense psychological/physiological distress when triggered

C) Persistent avoidance of trauma stimuli (at least 1)

  • a. Avoidance of, or efforts to avoid memories, thoughts, feelings
  • b. Avoidance of external reminder of trauma that trigger distressing memories

D) Negative alterations in cognitions and mood (at least 2)

  • a. Parts of trauma memory absent due to dissociative amnesia
  • b. Persistent negative self-beliefs/distorted cognitions
  • c. Persistent negative emotional state/fear/horror/anger/guilt
  • d. Diminished interest in significant activity
  • e. Emotional numbing/lack of joy or positive emotions

E) Hyperarousal/reactivity symptoms (at least 2)

  • a. Irritability/short fuse/impatience/road rage
  • b. Reckless self-destructive behaviour
  • c. Hypervigilance
  • d. Poor concentration
  • e. Insomnia

F) Greater than 1mo of duration

G) Symptoms cause functional impairment

H) Not caused by medical illness/EtOH/drugs

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5
Q

Development of emotional or behavioural symptoms in reponse to an identifiable stressor, within 3 months of onset of the stressor

Clinical significant symptoms of either

  • Marked distress out of proportion to severity and intensity of the stressor
  • Significant impairment in social, occupational, or other area of function

Not another mental disorder

Not a normal bereavement

No persistence for >6 mo after stressor ends

WHAT IS THIS

A

Adjustment Disorder

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6
Q

timeline for acute stress disorder

A

3 days to 1 month after stressor

9+ symptoms from 5 categories

  • Intrusion (memories, dreams, dissociation, distress)
  • Negative Mood (no positive emotions)
  • Dissociative Symptoms (altered sense of reality, amnesia)
  • Avoidance (thoughts/feelings, external reminders)
  • Arousal (sleep, irritable, hypervigilance, concentration, startle)

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7
Q

5 categories that you need 9+ symptoms from in order to diagnose acute stress disorder

A

9+ symptoms from 5 categories

  • Intrusion (memories, dreams, dissociation, distress)
  • Negative Mood (no positive emotions)
  • Dissociative Symptoms (altered sense of reality, amnesia)
  • Avoidance (thoughts/feelings, external reminders)
  • Arousal (sleep, irritable, hypervigilance, concentration, startle)

20-50% prevalence after a trauma

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8
Q

T/F comorbidities for PTSD is common

A

true

Investigations: comorbidities are very common (80% have 3+ disorders): borderline PD, eating disorder, anxiety ,addiction, somatic symptom disorders, major depression, ADHD

Screen for ACEs

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9
Q

first phase of PTSD managemen

A

Stabilization phase; develop a therapeutic relationship, risk assessment, treatment setting (out/inpatient, day program), PTSD psychoeducation, relaxation skills (meditation, mindfulness), harm reduction (substance use), pharmacotherapy

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10
Q

T/f pharmacotherapy is just as helpful for PTSD as psychotherapy

A

false. unlike depression and anxiety where meds are truly beneficial, psychotherapy is way better for PTSH. Pharmacotherapy is often only indicated if you have a safet risk or comorbid condition (ex/ functionally impaired because of MDD in addition to trauma)

Pharmacotherapy (trauma therapy >>> medications): indicated with safety risk, psychosis, severe symptoms, functional impairment with ADHD

§ 1st line: fluoxetine, paroxetine, sertraline, venlafaxine

§ 2nd line: fluvoxamine, mirtazapine, phenelzine

**insufficient evidence for meds to prevent PTSD

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11
Q

Habituation therapy for PTSD

A

decrease in response to a stimulus after repeated presentations. Each time you stay in the situation, your fear goes down. When you stay in a feared situation for a prolonged period, you learn that it is safe, and your anxiety goes down.

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12
Q

accelerated resolution therapy for ptsds

A

Accelerated Resolution Therapy: good for fear-based trauma. Involves repeated prolonged imaginal exposure to the trauma memories (10-15 sessions). Repeated in vivo exposure to avoided situation in daily living

Dropout rates 30-40%

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13
Q

outline the phases of Eye Movement Desensitization Therapy

A

Eye Movement Desensitization Therapy: good for anger, guilt and shame. Decrease vividness of trauma images and introduce new positive beliefs

Dropout rate 18.9%

Past: maladaptive encoding/incomplete processing

Present: memory activated while using bilateral stimulation; body scanning

Future (goal of therapy): installation of positive beliefs related to target memory

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14
Q

Note; other ezposure-based therapies for PTSD

A
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15
Q

screening process for PTSD

A
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16
Q

PTSD Specifiers:

With ___ __: full criteria not met until 6 months after event

With ___ ___: sudden disruption in the continuity of sense of self or agency (affect, behaviours, consciousness, memory, perception, cognition, sensory motor function), the experience of depersonalization (limbs/voice/ body feel deformed, different or distant feelings of detachment or disconnection, watching self from outside), or the experience of derealization (world has become strange or unreal).

Study These Flashcards
A

PTSD Specifiers:

With delayed expression: full criteria not met until 6 months after event

With dissociative symptoms: sudden disruption in the continuity of sense of self or agency (affect, behaviours, consciousness, memory, perception, cognition, sensory motor function), the experience of depersonalization (limbs/voice/ body feel deformed, different or distant feelings of detachment or disconnection, watching self from outside), or the experience of derealization (world has become strange or unreal).

MDCN 470: Course 7
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