Stress Disorders Flashcards
What age is PTSD most prevalent?
Young adulthood, when trauma is most likely
5 key components to PTSD
Trauma, intrusive / dissociative sxs, neg mood, avoidance, and hyperarousal
Common hyperarousal sxs in PTSD
Insomnia, irritability, and hypervigilance
Risk factors for PTSD
Female gender, history of previous trauma, family history of PTSD or depression, lack of social supports, use of benzos or alcohol, low SES, very old / young at time of trauma, small hippocampi
DSM Criteria for PTSD
A) Exposure to trauma
B) 1+ intrusion sxs associated w/ traumatic event: distressing memories, distressing dreams, flashbacks, psychological / physiological distress caused by exposure to internal / external cues that symbolize traumatic event
C) Persistent avoidance of stimuli associated w/ trauma
D) Neg alterations in cognitions and mood, indicated by 2+ of the following:
• Inability to remember an important aspect of the traumatic event
• Exaggerated neg beliefs about oneself or others such as “I am bad” or “No one can be trusted”
• Distorted cognitions about event that cause person to blame himself
• Persistent negative emotional state
• Anhedonia
• Feelings of detachment / estrangement from others
• Inability to experience positive emotions
E) Alterations in arousal and reactivity associated w/ trauma w/ 2+ of the following:
• Irritable behavior / angry outbursts w/ little or no provocation
• Reckless / self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems w/ concentration
• Sleep disturbance
F) sxs last more than 1 month
What occurs biologically w/ PTSD?
Overactivity of NE system. Many pas have low plasma cortisol, possibly due to enhanced neg feedback in HPA axis.
Prognosis for PTSD
50% of pxs go into remission w/in 3 months.
Good prognosis factors for PTSD
Sxs develop quickly, good pre-morbid functioning, strong social support, absence of other co-morbidities.
Acute stress disorder
Similar sxs to PTSD but sxs arise immediately after trauma and do not last more than 1 month. Large majority of pxs w/ ASD go on to develop PTSD.
Treating stress disorders
- SSRI’s are 1st line, especially sertraline and paroxetine. Helps w/ co-morbid depression as well. Not effective for combat PTSD.
- Alpha-1 agonist prazosin is good for nightmares and insomnia.
- Atypical antipsychotics may help in PTSD
- Benzos are avoided due to risk of worsening sxs
- Do NOT debrief people after traumatic event until psychiatric disorder is evident.
- Prolonged exposure therapy - Change how px reacts to stressful stimuli
- Cognitive Processing Therapy (CPT) – type of CBT. Pxs write about impact of trauma and how they think differently about safety, trust, esteem, power, and intimacy. Therapist challenges px’s interpretations of traumatic events and helps him identify “cognitive distortions” and replace them w/ more accurate interpretations.
What percentage of pas w/ PTSD have at least one other psychiatric diagnosis?
More than 75%
6x increase in depression and 4x increase in panic disorder
