Chapter 11: PTSD Flashcards

1
Q

Definition of PTSD

A
  1. Expsoure to actual or threatened death, injury, sexual violence
  2. Recurrent intrustive recollections or re-experienceing of a traumatic event
  3. Avoidance of external or internal trauma reminders
  4. Negative changes in cognitions & mood
  5. changes in arousal and reactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Exercise and PTSD

A
  • Aerobic exercise and walking are beneficial
  • Types of aerobic exercise needs to be studied (cycling was not beneficial)
  • The exercise needs to be maintained for benefits to be ongoing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Categories of Meditation Practices

A
  1. Attentional (foster self-regulation)
  2. Deconstructive (thoughts/ emotions are mental events rather than reflections of reality)
  3. Constructive (strengthen positive psychological patterns)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Transcendental / Mantram Repition & PTSD

A
  • Mainly attentional type of meditation
  • Both are beneficial for PTSD
  • TM typically eyes closed 15-20 min, BID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mindfulness Meditation & PTSD

A
  • Has both attentional and deconstructive elements
  • MBSR and MBCT are two of the most widely available programs
  • pay attention to your experience with curiosity
  • can be a form of exposure therapy in PTSD
  • RCTs comparing meditation practices showed no benefit of one vs the other (MBSR, yoga, mantram)
  • The longer the intervention, the more reduction in PTSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Compassion & Loving Kindness Meditation

A
  • Constructive category of meditation
  • addresses emotional numbing, moral injury, trauma-related shame, social disconnectedness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Yoga and PTSD

A
  • Fosters upregulation of PANS, downregulation of SANS, decreased cortisol and catecholamine levels
  • Trials demonstrate significant benefit

Tai Chi and Qigong have not been studied

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Visualization / Guided Imagery and PTSD

A
  • focus on chronic nightmares
  • Imaginal confrontation with nightmare contents (ICNC)
  • Imagery rescripting and rehearsal (IRR)
  • Imargery rehearsal therapy (IRT)
  • Imagery rescripting and exposure therapy (IRET)

Evidence is too underdeveloped to determine it’s value! May be a supplement to other care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Emotional Freedom Technique and Thought Filed Therapy

A

Combination of exposure through visualization plus acupoint tapping on energy meridians to release energy blockages that create the negative emotions.

Study shows that the tapping on acupoints is an active component!

Evidence is encouraging, but lack of active controls and other methodoligcal shortcomings preclude firm conclusions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hypnotherapy and PTSD

A
  • Guided, controlled access to traumatic memories that may be kept out of normal consciousness
  • Hypnotherapetic Olfactory Conditioning - resistant olfactory induced flashbacks
  • Abreactive Ego State Therapy - views personality as several ego states, and PTSD results from memory being tied to a particular ego state and being treated with emotional cathatrsis. Used more in other countries.
  • Hypnosis has large effect size, but need more research
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Acupuncture and PTSD

A
  • Large effect size in short term, medium effect size in follow up
  • Low quality evidence. But studies are encouraging.
  • May be appropraite for patients who prefer not to engage in more conventional therapies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Trauma Focused Therapies

A
  • CPT: cognitive processing therapy.
  • PE Therapy: prolonged exposure
  • EMDR: recount trauma memory while doing eye movements
  • Narrative Exposure Therapy: create a story about their life and tell another person

Exposure treatments have stronger longer term outcomes than other forms

Trauma focused therapies do marginally better than non-trauma focused

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Non-trauma Focused THerapies

A

Emphasize strength-based activation of existing coping skills

  • PCT: Present Centered Therapy. uses patient’s own coping skills. Inferior results to trauma-focused CBT but has better retention.
  • SIT: stress inoculation training. Teaches new skills. Reasonable second line, effective in short term. Not as longer lasting effects as trauma-focused options.
  • Psychodynamic therapies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Psychotherapy after trauma to prevent PTSD

A
  • debriefing sessions may increase risk of PTSD
  • brief trauma-focused CBT may reduce acute traumatic stress (rather than post-traumatic stress, occuring within one month after trauma)
  • modified trauma-focused interventions (very brief ones within a few wks of trauma) may help prevent PTSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SSRIs for PTSD

A
  • Sertraline and Paroxetine are FDA approved for PTSD
  • Paroxetine has better evidence than sertraline (which doesnt always do better than placebo)
  • Fluoxetine and venlafaxine have some benefit too
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Antipsychotics for PTSD

A

Risperidone and Olanzapine have some evidence

17
Q

What pharmacologic agent is contraindicated for people with PTSD

A

Benzos!

Worse outcomes.

18
Q

Prazosin for PTSD

A
  • alpha-1 agonist
  • meta analysis showed solid support
  • one VA trial showed little benefit over placebo for nightmares or sleep
19
Q

What is the first-line treatment for PTSD

A
  • trauma focused psychotherapy

Endorsed as first line by the APA and VA.

Effects are more likely to endure once medications are discontinued.

20
Q

Pharmacology to prevent PTSD after trauma

A
  • preliminary support for hydrocortisone

No support for propranolol, escitalopram, temazepam, gabapentin.

21
Q

Therapies to consider for PTSD

A
  • Biofeedback. Especially HRV.
  • ECT. Especially for those with comorbid depression.
  • TMS (adverse = seizures, headache, pain, sleepiness, facial twitch, altered cognition during sessions)
  • Inositol - no improvement in sx
  • Ginkgo biloba - improved sx
  • MDMA
  • Cannabis - mixed evidence (not recommended)
  • Ketamine - promising