Post-Traumatic Stress Disorder

Question 1

Name the 3 main symptom clusters of PTSD

Answer 1

Re-experiencing, hyperarousal, avoidance

Question 2

State some PTSD symptoms in the hyperarousal cluster

Answer 2

Difficulty falling asleep, irritability, angry outbursts, difficulty concentrating, exaggerated startle response

Question 3

State some PTSD symptoms in the avoidance cluster

Answer 3

Avoiding thoughts and feelings associated with the trauma; avoiding activities, places, and people which produce recollection of the trauma; feeling detached from others; reduced interest and participation in activities

Question 4

Describe the difference between type I and type II trauma

Answer 4

Type I is a single traumatic event, whereas type II is prolonged and repeated trauma

Question 5

What percentage of PTSD susceptibility is heritable? (Goldberg et al, 1990)

Answer 5

30%

Question 6

State some brain changes associated with PTSD susceptibility

Answer 6

Impaired HPA axis sensitivity and reduced hippocampal volume

Question 7

What is the lifetime prevalence of PTSD in the general population? (Kessler et al, 1995)

Answer 7

8%

Question 8

State some differential diagnoses for PTSD

Answer 8

Depression, borderline personality disorder, substance abuse

Question 9

State the most common comorbidities of PTSD

Answer 9

Alcohol misuse, drug misuse, major depressive disorder, stomach ulcers

Question 10

What is the first-line treatment for severe PTSD?

Answer 10

Pharmacotherapy - SSRIs, mirtazapine, or antipsychotics (olanzapine)

Question 11

Name some psychological interventions for PTSD

Answer 11

Trauma-focused CBT, eye movement desensitisation and reprocessing (EMDR)

Question 12

Describe the evidence for single session debriefing after a traumatic event

Answer 12

There is no evidence of benefit and it may even be harmful

Question 13

What percentage of patients no longer meet the diagnostic criteria for PTSD after psychotherapy?

Answer 13

56%

Question 14

Describe the main features of ‘enduring personality change after catastrophic experience’ (EPCACE) in ICD-10

Answer 14

Permanent hostile and distrustful attitude, social withdrawal, constant feelings of emptiness or hopelessness, feeling on-edge or threatened, permanent feeling of being changed, feeling different to others

Question 15

According to Munjiza et al’s 2017 case-control study, what percentage of patients with personality change meet criteria for EPCACE?

Answer 15

35.7%

Question 16

What were the problems with the EPCACE diagnosis? (Munijza et al, 2019)

Answer 16

More than 50% of patients who met the diagnostic criteria described symptoms not included in the ICD-10 criteria, including frequent mood changes, anger control problems, persistent feelings of eccentricity, over-sensitivity to criticism, loss of libido, perfectionsism, and suicidal ideation or self-harm

Question 17

Define complex PTSD, as introduced in ICD-11

Answer 17

Meeting the criteria for PTSD, with the addition of severe and persistent problems with affect regulation, feelings of worthlessness, shame, and guilt, and difficulties with sustaining relationships

Question 18

State some problems with the ICD-11 criteria for complex PTSD

Answer 18

Significant overlap with personality disorder (diagnostic confusion), significant overlap with personality disorder risk factors, stigma attached to personality disorder leading to preference for complex PTSD, treatment for personality disorder and PTSD being very different (unclear which would be more efficacious)