Trauma

Question 1

Trauma may result from witnessed events resulting in emotional or psychological impact, such as _____.

Answer 1

witnessing abuse

Question 2

Psychological trauma may result from experiencing physical trauma, such as ______ (2).

Answer 2

1. Traumatic brain injury
2. Vehicle accidents

Question 3

Psychological trauma may result from a single episode or be continuous and complex, for example _____ (2).

Answer 3

1. Refugees
2. Lengthy hospitalization

Question 4

Examples of global traumatic events (6)

Answer 4

1. War
2. Economic upheaval
3. Mass murder
4. Natural disaster
5. Epidemics
6. Assassination

Question 5

Health effects of adverse childhood experiences (4)

Answer 5

1. Obesity
2. Early onset smoking→COPD
3. IV drug use
4. Suicide attempts

Question 6

List the trauma and stressor Related Disorders (5)

Answer 6

1. Acute Stress
2. Adjustment
3. Disinhibited Social Engagement
4. Posttraumatic Stress
5. Reactive Attachment

Question 7

Reactive attachment disorder: diagnostic criteria symptom clusters (3)

(“Sullen Girl”)

Answer 7

1. Consistent pattern of inhibited, emotionally withdrawn Behavior toward adult caregivers (x2)
2. Social and emotional disturbance (x2)
3. Extremes of insufficient care (x1)

Question 8

Criteria for reactive attachment disorder: requires both of these _____.

Answer 8

Child rarely or minimally seeks or responds to comfort when distressed

Question 9

Children with reactive attachment disorder must have two of these persistant social and emotional disturbances (3)

Answer 9

1. Minimal social and emotional responsiveness others
2. Limited positive affect
3. Episodes of unexplained irritability, sadness or fearfulness in non-threatening interactions with adult caregivers

Question 10

Children with reactive attachment disorder will experience at least one of the following patterns of extremes of insufficient care (3):

Answer 10

1. Lack of having basic emotional needs for comfort, simulation and affection met by adult caregivers
2. Repeated changes of primary caregivers (foster kids or lots of Nannies)
3. Rearing in unusual settings that severely limit opportunities to form selective attachments

Question 11

Reactive attachment disorder signs are evident between the age of _____ & _____.

Answer 11

• 9 months
• 5 years old

(10% of severely neglected children)

Question 12

Reactive attachment disorder treatment (4)

Answer 12

1. Medical & psychiatric Care
2. Parent education/adequate caretaking
3. Parents psychiatric treatment
4. Legal intervention

Question 13

What is a major difference between Disinhibited Social Engagement Disorder and Reactive Attachment disorder?

Answer 13

• Disinhibited Social Engagement Disorder: Child approaches and interacts with unfamiliar adults
• Reactive Attachment Disorder: Child is unable to seek or respond to comfort of caregivers

(Both must be at least 9 months (developmentally) and have an extreme of insufficient care)

Question 14

Disinhibited Social Engagement Disorder: pattern of behavior in which the child actively approaches and interacts with unfamiliar adults will exhibit two of the following 3 behaviors:

Answer 14

1. approaches unfamiliar adults without reserve
2. overly familiar verbal or physical behavior with unfamiliar adult
3. willingness to go with unfamiliar adults or wander off w/out checking back

Question 15

Disinhibited social engagement disorder is not limited to ______ and reactive attachment disorder must be differentiated from _______.

Answer 15

• impulsivity
• autism

Question 16

How is the treatment of Disinhibited Social Engagement Disorder different from Reactive Attachment Disorder?

Answer 16

• same as RAD, except w/o legal or medical care

1. Psychiatric Care: child & parent
2. Parent education
3. Adequate caretaking

Question 17

PTSD: men is usually ______-related; women is usually ______-related.

Answer 17

• combat
• rape or assault

Question 18

PTSD co-morbid disorders:

Answer 18

1. Anxiety
2. MDD
3. SUD

Question 19

PTSD crieria: for more than 1 month, the following cluster of symptoms are exhibited (associated w/traumatic event):

Answer 19

1. Intrusion sx (x1)
2. Avoidance of stimuli (x1)
3. Negative alterations in cognition & mood (x2)
4. Altered arousal or reactivity (x2)

Question 20

PTSD may result from exposure to actual or threatened death, serious injury or sexual violence in one or more of the following ways: (4)

Answer 20

1. Direct experience
2. Repeated exposure to events
3. Witnessing event in person
4. Learning of event that happened to loved one

Question 21

List the 5 intrusion sx that may be experienced in PTSD

(dx criteria x1)

Answer 21

1. recurrent, involuntary, intrusive memories
2. recurrent dreams
3. Dissociative flashbacks
4. Intense psychological stress when cued
5. Physiological reactivity when cued

(cues are external or internal stimuli that resemble an aspect of the traumatic event)

Question 22

List the 2 examples of persistent avoidance of stimuli associated w/the traumatic event in PTSD.

(dx criteria x1)

Answer 22

1. avoid memories, thoughts, feelings associated
2. avoid external reminders (people, places, conversations, acvities, objects)

Question 23

List the 6 alterations in arousal & reactivity sx that may be experienced in PTSD

(dx criteria x2)

Answer 23

1. Irritable behavior & angry outbursts (little to no provocation)
2. reckless, self-destructive behavior
3. hypervigilance
4. exaggerated startle response
5. difficulty concentrating
6. sleep disturbance

Question 24

List the 7 negative alterations in cognitions & mood sx that may be experienced in PTSD

(dx criteria x2)

Answer 24

1. Inability to remember an aspect of the event
2. cognitive distortions → self-blame
3. exaggerated negative belief or expectation about the world, oneself or others
4. negative emotional state
5. inabilty to experience positive emotions
6. feel detached or estranged from others
7. decreased interest or participation in significant activities

Question 25

PTSD: 1st line trmt

Answer 25

1. SSRI & SNRI 2. Therapy: group, family, CBT, imaginal

Question 26

PTSD: 2nd line trmt

Answer 26

1. **Prazosin (nightmares & hypervigilance)** 2. BZD (experimental: stellate ganglion block for military PTSD)

Question 27

Describe Imaginal Therapy (used to treat PTSD).

Answer 27

1. Patient writes a narrative of what happened to them 2. Desensitize them gradually by using relaxation techniques before and after reading the narrative

Question 28

EMDR

Answer 28

Eye movment desensitization & reprocessing (experimental, but "strongly recommended" per VA & DOD)

Question 29

Acute Stress Disorder may result from exposure to threat, serious injury or sexual violence in one or more of the following ways: (4)

Answer 29

the same as PTSD; the ***_difference is timeline - this is dx within the 1st month_*** (direct experience, repeated exposure, learning of a loved one's trauma, witnessing a traumatic event)

Question 30

Acute Stress Disorder Dx Criteria: 9 sx from 5 categories. What are the 5 categories?

Answer 30

1. intrusion 2. negative mood 3. dissociation 4. avoidance 5. arousal (begins or worsens after the traumatic event occured)

Question 31

List the 5 intrusion sx that may be experienced in Acute Stress Disorder (dx criteria 9 of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)

Answer 31

the same intrusion sx as PTSD (memories, dreams, flashback, psychological distress & physiological rxns to cues)

Question 32

How are the negative mood sx in Acute Stress Disorder different than those seen in PTSD? (dx criteria req. 9 out of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)

Answer 32

* Both have the **inability to experience positive emotions**, but PTSD also has an *exaggerated negative belief or expectation about the world, oneself or others & negative emotional state*

Question 33

2 dissociative sx in Acute Stress Disorder (dx criteria req. 9 out of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)

Answer 33

1. altered sense of reality of surroundings or self 2. inability to remember aspect of event

Question 34

2 avoidance sx in Acute Stress Disorder (dx criteria req. 9 out of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)

Answer 34

Same as PTSD (avoids memories, thougths, feelings & external reminders that trigger them)

Question 35

5 arousal sx of Acute Distress Disorder (dx criteria req. 9 out of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)

Answer 35

* Same as PTSD, but ***_without reckless or self-destructive behavior_***... (Irritable behavior and angry outbursts, Hypervigiliance, Exaggerated startle response, Problems w/ concentration & sleep)

Question 36

In addition to impairment in important areas of a patients life, Acute Distress Disorder also prevents them from _______ (2).

Answer 36

1. pursue necessary tasks (i.e. obtaining assistance) 2. mobilizing personal resources by telling their support system (family/friends) about it

Question 37

Acute Stress Disorder: causes (5)

Answer 37

1. Assault, rape, witnessing mass shooting (50%) 2. MVA (20%) 3. Assault (20%) 4. TBI (14%) 5. Industrial accident (12%) 6. Severe burns (10%) (less than 20% if event is not involving physical assault)

Question 38

Acute Stress Disorder: Treatment (2)

Answer 38

1. Relxation training 2. BZD (short-course) (beta-blockers may help)

Question 39

\_\_\_% of Acute Stress Disorder Cases progress to PTSD

Answer 39

80%