Trauma Response

Question 1

List some risk factors for heightened responses to trauma

Answer 1

Sudden, unexpected event
Man-made rather than natural
Prolonged exposure
Threat to life, death
Personal factors (family)

Question 2

What is associated with the highest incidence of post-traumatic stress disorder?

Answer 2

Rape

Question 3

What is the freeze response?

Answer 3

Body goes into shutdown with TONIC IMMOBILITY in the presence of “inevitable” danger (think of a deer on the road)

Question 4

List some clinical features of complex PTSD

Answer 4

Low self-esteem, self-blame
Hopelessness
Somatisation
Mood disturbance
Self-harm

Question 5

Give examples of neurobiological changes in PTSD

Answer 5

Increased activity of PAG
Increased activity of amygdala (emotional memory)
Increased activity of limbic system
Hippocampal atrophy (stress response)
Deactivation of Broca’s area when individual access’ trauma memories
Right hemispheric lateralisation (‘timeless’ memory)

Question 6

List the main features of PTSD (FAANDER)

Answer 6

Flashbacks
Nightmares
Avoidance
Arousal (increased)
Emotional numbness
Dissociation
Re-enactment

Question 7

How long after a traumatic event can PTSD be diagnosed?

Answer 7

3 months after

Question 8

If trauma symptoms are mild and present for less than 4 weeks, what is the treatment?

Answer 8

Watchful waiting with support

Question 9

List some psychotherapy that may be used for PTSD

Answer 9

CBT
EMDR (eye movement desentisation and reprocessing sensorimotor psychotherapy)
Media therapy
Mindfulness

Question 10

Which antidepressant is licensed for use in PTSD in primary care?

Answer 10

Paroxetine (SSRI)

Mirtazapine (SNRI)

Question 11

What is post-traumatic stress disorder?

Answer 11

Anxiety developed on the back of exposure to traumatic situations

Question 12

List the medications used for PTSD

Answer 12

SSRI/ SNRI
Amitrypitline, phenelzine
Prazosin
Atypical antipsychotics
Anticonvulsants (carbamazepine)

Question 13

What management is first line in PTSD?

Answer 13

Psychotherapy

Question 14

How do we classify traumatic events?

Answer 14

TYPE 1: Single incident trauma

TYPE 2: Repetitive, ongoing abuse

Question 15

Early life trauma is strongly linked to which mental health disorder?

Answer 15

Depression

Question 16

A history of childhood abuse or deprivation is strongly linked to which mental disorder?

Answer 16

Bipolar disorder

Question 17

Which part of the brain is involved in ‘freeze or flee’ response?

Answer 17

PAG or ventral tegmental area

Question 18

List features of tonic immobility

Answer 18

Reduced vocalisation
Intermittent eye contact
Rigidity and paralysis
Muscle tremors in extremities
Chills
Unresponsive to pain

Question 19

How are risk or resilence factors classified in trauma? Give examples of each

Answer 19

Person-related: history of mental disorder, physical injury, age, history of trauma, coping styles
Trauma-related: man-made, prolonged exposure, perceived threat
Environment-related: lack of support, ongoing life stress, reaction of others, disadvantage

Question 20

List diagnostic criteria for PTSD

Answer 20

Traumatic event
Intrusive symptoms (1 or more)
Avoidance symptoms (3 or more)
Increased arousal (2 or more)
\+/- associated dissociative symptoms (depersonalisation, derealisation, awareness of surroundings, out of body experiences)

Question 21

List classifications of PTSD

Answer 21

Acute
Chronic (>3 months)
Delayed (present after 6 months)

Question 22

List intrusive symptoms in PTSD

Answer 22

Recurrent distressing recollections
Nightmares
Flashbacks
Distress
Psychological reaction (fight or flight)

Question 23

List avoidance symptoms in PTSD

Answer 23

Avoid thinking/ talking about event
Avoid reminders
Amnesia
Loss of interest in activities
Emotional numbing
Sense of shortened future

Question 24

List symptoms of increased arousal in PTSD

Answer 24

Sleep disturbance
Irritability/ anger
Concentration difficulties
Hypervigilance
Exaggerated startled response