Group- Stress Disorders Flashcards
- List the diagnostic criteria for post-traumatic stress disorder.
I) Exposure to actual or threatened death, serious injury, or sexual violence
II) Presence of one or more of the following INTRUSION SYMPTOMS associated with the traumatic events (after the event occurred) →symtoms for @least 1mo
(1. Recurrent, involuntary or intrusive distressing memories of event
2. Recurrent distressing dreams in which the context or affect of dream are related to the event
3. Dissociative reactions in which the individual feels or acts as if the event were recurring (continuum), can be triggered
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize an aspect of the traumatic events
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the event
III) Negative alterations in COGNITIONS AND MOOD associated with the event
(1. Inability to remember an important aspect of the event
2. Persistent and exaggerated negative beliefs or expectations
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event, blame of self or others
4. Persistent negative emotional state
5. Markedly diminished interest or participation in significant activities
6. Feelings of detachment or estrangement from others
7. Persistent inability to experience positive emotions)
IV) Marked alterations in AROUSAL AND REACTIVITY associated with event
(1. Irritable behavior and angry outbursts, expressed as verbal or physical aggression toward people or objects
2. Reckless or self-destructive behavior
3. Hypervigilance
4. Exaggerated startle response
5. Problems with concentration
6. Sleep disturbance)
- Recognize the symptoms and course of acute stress disorder.
.
- Describe the epidemiology of traumatic events, including violence, sexual assault and abuse, war, and natural disasters.
assertive violence (17%) military combat (0.8%) rape or sexual assault (0.9%) shot or stabbed (1.8%) mugged or threatened with weapon (9.8%) badly beaten up (3.5%)
other injury or shocking event (36.5%) serious car accident (9.1%) natural disaster (5.0%) Life threatening illness (1.4%) witnessed killing, serious injury or discovered dead body (15.5%) other serious accident (5.4%)
- Describe the epidemiology, pathophysiology, and risk factors for PTSD.
life prevalence 8%, high in veterans or during young adulthood
stress disorders arise when vulnerable individuals are exposed to a severe stressor(s), risk is proportional to the severity and type of stressor and the vulnerability of the individual
evidence of hyperactivity of noradrenergic system and low cortisol levels due to enhanced negative feedback
- Describe the clinical presentation, and prognosis of acute stress disorder and post-traumatic stress disorder
presentation: intrusive/dissociative symptoms, negative mood, avoidance symptoms and hyperarousal
½ cases remission of symptoms within 3mo, man over a year to remission
Contrast the clinical presentation of Acute Stress disorder with PTSD.
ASD is similar to PTSD, with the distinction being time frame, symptoms arise immediately after the trauma and do not last more than one month
List the treatments available for acute stress disorder and post-traumatic stress disorder, including psychotropic medications and psychotherapy.
somatic tx: SSRI (sertraline and paroxetine)
alpha 1 adrenergic (parson) for nightmares and insomnia; some use of atypical antipsychotics, avoid BZD
psychotherapy: “debrief” event with prolonged exposure thearpy (change reaction to stressful memories) and cognitive processing therapy (reflection on how they think and react to trauma memories and identify cognitive distortions
social support is important
tx. of co-morbid depression and anxiety
Discuss the d/dx for patients with stress disorders.
schizophrenia (more concrete flashbacks), depression (only negative symptoms), somatoform disorders (tx of psych issues will address physical symptoms)
