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Behavioral Medicine > Trauma > Flashcards

Trauma Flashcards

1
Q

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

A

witnessing abuse

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2
Q

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

A
  1. Traumatic brain injury
  2. Vehicle accidents
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3
Q

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

A
  1. Refugees
  2. Lengthy hospitalization
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4
Q

Examples of global traumatic events (6)

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

Health effects of adverse childhood experiences (4)

A
  1. Obesity
  2. Early onset smoking→COPD
  3. IV drug use
  4. Suicide attempts
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6
Q

List the trauma and stressor Related Disorders (5)

A
  1. Acute Stress
  2. Adjustment
  3. Disinhibited Social Engagement
  4. Posttraumatic Stress
  5. Reactive Attachment
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7
Q

Reactive attachment disorder: diagnostic criteria symptom clusters (3)

(“Sullen Girl”)

A
  1. Consistent pattern of inhibited, emotionally withdrawn Behavior toward adult caregivers (x2)
  2. Social and emotional disturbance (x2)
  3. Extremes of insufficient care (x1)
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8
Q

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

A

Child rarely or minimally seeks or responds to comfort when distressed

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9
Q

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

A
  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
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10
Q

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

A
  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
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11
Q

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

A
  • 9 months
  • 5 years old

(10% of severely neglected children)

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12
Q

Reactive attachment disorder treatment (4)

A
  1. Medical & psychiatric Care
  2. Parent education/adequate caretaking
  3. Parents psychiatric treatment
  4. Legal intervention
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13
Q

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

A
  • 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)

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14
Q

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:

A
  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
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15
Q

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

A
  • impulsivity
  • autism
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16
Q

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

A
  • same as RAD, except w/o legal or medical care
  1. Psychiatric Care: child & parent
  2. Parent education
  3. Adequate caretaking
17
Q

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

A
  • combat
  • rape or assault
18
Q

PTSD co-morbid disorders:

A
  1. Anxiety
  2. MDD
  3. SUD
19
Q

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

A
  1. Intrusion sx (x1)
  2. Avoidance of stimuli (x1)
  3. Negative alterations in cognition & mood (x2)
  4. Altered arousal or reactivity (x2)
20
Q

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

A
  1. Direct experience
  2. Repeated exposure to events
  3. Witnessing event in person
  4. Learning of event that happened to loved one
21
Q

List the 5 intrusion sx that may be experienced in PTSD

(dx criteria x1)

A
  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)

22
Q

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

(dx criteria x1)

A
  1. avoid memories, thoughts, feelings associated
  2. avoid external reminders (people, places, conversations, acvities, objects)
23
Q

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

(dx criteria x2)

A
  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
24
Q

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

(dx criteria x2)

A
  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
25
Q

PTSD: 1st line trmt

A
  1. SSRI & SNRI
  2. Therapy: group, family, CBT, imaginal
26
Q

PTSD: 2nd line trmt

A
  1. Prazosin (nightmares & hypervigilance)
  2. BZD

(experimental: stellate ganglion block for military PTSD)

27
Q

Describe Imaginal Therapy (used to treat PTSD).

A
  1. Patient writes a narrative of what happened to them
  2. Desensitize them gradually by using relaxation techniques before and after reading the narrative
28
Q

EMDR

A

Eye movment desensitization & reprocessing

(experimental, but “strongly recommended” per VA & DOD)

29
Q

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

A

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)

30
Q

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

A
  1. intrusion
  2. negative mood
  3. dissociation
  4. avoidance
  5. arousal

(begins or worsens after the traumatic event occured)

31
Q

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)

A

the same intrusion sx as PTSD

(memories, dreams, flashback, psychological distress & physiological rxns to cues)

32
Q

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)

A
  • 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
33
Q

2 dissociative sx in Acute Stress Disorder

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

A
  1. altered sense of reality of surroundings or self
  2. inability to remember aspect of event
34
Q

2 avoidance sx in Acute Stress Disorder

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

A

Same as PTSD

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

35
Q

5 arousal sx of Acute Distress Disorder

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

A
  • Same as PTSD, but without reckless or self-destructive behavior…

(Irritable behavior and angry outbursts, Hypervigiliance, Exaggerated startle response, Problems w/ concentration & sleep)

36
Q

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

A
  1. pursue necessary tasks (i.e. obtaining assistance)
  2. mobilizing personal resources by telling their support system (family/friends) about it
37
Q

Acute Stress Disorder: causes (5)

A
  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)

38
Q

Acute Stress Disorder: Treatment (2)

A
  1. Relxation training
  2. BZD (short-course)

(beta-blockers may help)

39
Q

___% of Acute Stress Disorder Cases progress to PTSD

A

80%

Behavioral Medicine (35 decks)

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