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Reasoning in mental health 2 > Class 6 > Flashcards

Class 6 Flashcards

(53 cards)

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1
Q

Psychologically, the bottom line of trauma is a feeling of

A

utter helplessness.

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2
Q

Women prevalence vs men PTSD

A

women 2: Men 1

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3
Q

What type of trauma do men usually have

A

violent perpetrated by non-significant other; physical

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4
Q

What type of trauma do women usually have

A

violence perpetrated by significant other; sexual

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5
Q

x% of Canadian adults report some form of abuse before age 16

A

32%

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6
Q

Most prevalent form of childhood abuse

A

neglect

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7
Q

Prevalance of child abuse in mental health patients

A

70%

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8
Q

Automatic Response to Threat

A

12 msec: cortisol adrenaline =BP/ HR, blood flow, oxygenation, glucose

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9
Q

Cascade of survival responses

A

attach cry, flight, fight, freeze, feigned death

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10
Q

If the body has used an immobilizing defense,

A

, the nervous system does not get a cue to turn off
Amygdala keeps firing to signal persistence of threat
Catecholamines continue to be secreted, long after the threat has passed

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11
Q

3 main parts of brain

A

Humain brain: cortex, rational thinking
Mammal brain: limbic system, emotions
Reptile brain: brainstem, automatic response

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12
Q

Under threat, in the brain

A

limited access to prefrontal cortex, the reptile brain is running the show. The link between the amygdala and the hippocampus is broken. The memory gets stored in the implicit memory system by the amygdala where they’re encoded as sensations, smells, sounds, images, tastes, emotions, fragments of events
instead of in the explicit memory system in the hippocampus.

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13
Q

Usually brain encodes memory:

A

sensory input= thalamus= amygdala=hippocampus= prefrontal cortex

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14
Q

Amygdala has direct connection to

A

reptilian brain through hpa axis

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15
Q

After the encoded of the memory in the implicit memory system, the amygdalae acts like

A

a smoke detector, it sounds the alarm whenever it detects anything resembling the trauma

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16
Q

Truncated mobilizing defenses

A

Catecholamines
Hyper-responsive catecholamine system
↓ Cortisol
Hypo-responsive HPA axis

Hypervigilance
Increased startle
Hyperarousal

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17
Q

PTSD fMRI Findings

A 
Smaller hippocampus
Reversible with treatment
Hyper-responsive amygdala
During Flashbacks:
R brain > L brain
↑ amygdala
↑ visual cortex
↓ Broca’s area
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18
Q

PTSD name all symptoms + number needed + specifiers

A 
Intrusion: 1
Memories
Flashbacks
Nightmares
Distress with triggers

Avoidance: 1
Internal (memories, thoughts, feelings)
External (people, places, situations)

Mood/ cognition:2
Amnesia
Neg. beliefs (“I’m bad,” “World dangerous,” “Trust no-one”)
Self-blame
Persistent negative emotions (fear, anger, guilt, shame)
Difficulty experiencing positive emotions
Diminished interest
Detachment from others

Arousal: 2 
Hypervigilance
Startle reflex
Irritability / aggression
Reckless / self-destructive behavior
Poor concentration
Poor sleep

Specifiers
with dissociative symptoms
with delayed onset

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19
Q

Scales

A

PCL-5 - PTSD Checklist :20 items, self report, cut-off > 33
IES – Impact of Events Scale - DSM-IV : 22 items, self-report, cut-off > 24
CAPS – Clinician-Administered PTSD Scale :30 items, clinician rated, cut-off > 20

For dissociation:
DES: self-report 28 items
MDI:L self-report 30 items, need to request it

ACE Questionnaire for childhood aversity

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20
Q

Complex PTSD, what kind of trauma

A

Child abuse, neglect, combat, urban violence, concentration camps, battering relationships, forced dislocation, and enduring deprivation.

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21
Q

Complex PTSD symptoms

A 
Core symptoms of PTSD and: 
Emotion regulation issues: Self-harm
Substance abuse
Eating disorders
Shoplifting, hoarding, gambling
Picking, trichotillomania
Outbursts

Relational difficulties: Reenactments
Isolation / mistrust
Abusive relationships / revictimization
Therapeutic ruptures
Parenting difficulties

Alteration in consciousness:DID

Adverse belief system:Negative core beliefs (“I’m bad/damaged/worthless”)

Somatic distress: Functional syndromes
Fibromyalgia, chronic pain
Non-epileptic seizures, headaches

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22
Q

Most important risk factors PTSD

Study These Flashcards
A

Severity
Duration
Proximity

23
Q

Pre trauma risk factors

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A 
Childhood trauma
History of trauma
Low SES
Low education
Low IQ
Ethnic minority
Past psych issues
Past SUD
Family psych history
Low cortisol: Low cortisol: cortisol is what’s responsible for shutting off feedback loop of catecholamines, hpa axis is less active. high levels of catecholamines in the brain = the connection between amygdala and hippocampus gets blocked.
24
Q

During trauma risk factors

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A 
Nature of trauma:
Violent
Sexual
Death
Personal
Degrading
External locus control: external locus of control: when we face events do we feel like we have power over them or feel like things just happen to us. internal: i have power and agency over the world
Dissociation during trauma
25
Post trauma risk factors
ASD (50% progress) Little support or services Shame/guilt/doubt Ongoing stressors
26
Adverse childhood experience mental health outcomes
``` Suicide (12 x more) Depression (5x) Addictions (5x) Alcohol use disorder (7x) Injecting drugs (10x) Linked to most psych illnesses: ALL anxiety disorders BAD Eating disorders ADHD & LD ```
27
Adverse childhood experience physical health outcomes
``` Heart disease COPD Cancer Liver disease Sexually transmitted diseases Obesity Autoimmune diseases Pelvic pain Migraines, headaches Unexplained symptoms ```
28
Course - PTSD
``` Onset mid-late 20’s Onset can be delayed by years Chronic, waxing & waning 60% respond to treatment 40% have residual symptoms Suicide (6x attempts), violence Associated with poor quality of life ```
29
Poor Prognostic Factors
``` Delayed onset of sympt. Delayed intervention Poor premorbid function Poor social support Severe sympt. Comorbidities Veterans Elderly / children ```
30
Comorbidity
``` 60% of patients have > 3 Major depression in 50% Anxiety disorders Substance use disorders Personality disorders Somatization General Medical Conditions: pain, TBI, sexual dysfcn, IBS Children: ODD, ADHD, separation anxiety ```
31
Non pharmacological treatment
``` Therapy is the treatment of choice! Combo Therapy > Meds Combo not routinely recommended Individual & group are effective Positive literature for: VRE and I-CBT rTMS (L1) ```
32
Pharmacology
60% response rate Poorer response in veterans May take up to 12 wks Maintenance 1-2 yrs
33
1st line
Sertraline Fluoxetine Venlafaxine Paroxetine
34
2nd line
Fluvoxamine Mirtazapine Phenelzine
35
Adj 2nd line
Eszopiclone Olanzapine Risperidone
36
Nightmares
Prazosin for nightmares | Nabilone off-label
37
3 stages of stage based model
1)Safety & Stabilization Building the foundation below your feet 2)Trauma Processing Taking the sting out of the memories 3) Integration & Reconnection Moving beyond
38
Stage 1 , 3 types of safety,
Physical safety: Substance use, self-injury, eating disorders Environmental safety: Stable living situation, non-abusive relationships Emotional safety: Ability to calm the body, modulate intense emotions, set boundaries
39
freeze gateway to
dissociation
40
Why do we need to assure safety in phase 1
While launching a survival response, we cannot integrate new information Our first priority is to help the nervous system find its way back to safety
41
Contraindications to Trauma Therapy
Unstable housing Recent psychiatric admission (within 3-6 months) Active acute suicidality or homicidality Severe unstable substance use, eating disorder, medical condition Current ongoing abusive relationships
42
Goal of stage 1
Help people rediscover the resources & resilience they already have inside through Psychoeducation Skills No trauma details
43
Stage 2 – Trauma Processing, goal
Exposure to the narrative & desensitization | Goal: Remember the trauma without getting dysregulated; integrate it into explicit memory
44
Why avoid benzos
right after trauma can increase the risk of PTSD because block capacity to consolidate memories = interfering with natural process
45
Evidence-Based Therapies
Eye-Movement Desensitization Reprocessing (L1): Processing with BLS: bls: bilateral stimulation: stay in the present, innately soothing, in dreams where in REM, recreating processing memories Resourcing Trauma-Focused Cognitive Behaviour Therapy (L1): In vivo exposure Imaginal exposure Cognitive restructuring Narrative Exposure Therapy (L1): Lifeline Exposure Transcript Prolonged Exposure Cognitive Processing Therapy
46
Therapies that aren't recommended
Supportive, dynamic, hypnotherapy
47
Stage 3 – Integration & Reconnection
``` Addressing grief, attachment wounds Re-investing in community, purpose, meaning Transition out of therapy Relapse-prevention plan Goal: Thriving ```
48
Kids below age 6:
Repetitive play in which themes of trauma are expressed Less flashbacks, more reenactments in play Nightmares not specific to trauma – frightening dreams Withdrawn Irritability is expressed with tantrums
49
Acute stress disorder criteria
Intrusion: Memories Flashbacks Nightmares Distress with triggers Avoidance:Internal (memories, thoughts, feelings) External (people, places, situations) Mood : Difficulty experiencing positive emotions ``` Arousal: Hypervigilance Startle reflex Irritability / aggression Poor concentration Poor sleep ``` Dissociation: Amnesia Derealization / depersonalization > 9 criteria 3 days – 1 month
50
Differences between PTSD and GAD
Dissociation is not a specifier No negative cognitions Timeline
51
Treatment ASD
Mass screening & debriefing is not recommended Psychological First Aid Model Ensure basic needs & maintain daily routine Recruit social support Psychoeducation about normal reactions to trauma Monitor & identify vulnerable individuals No pharmacological treatment is indicated Early use of BZD can increase risk of PTSD Some evidence for EMDR prior to 1 month
52
Adjustment disorder
“the presence of emotional or behavioral symptoms in response to an identifiable stressor/s, which occurred within three months of the beginning of the stressor/s. In addition, one or both of the following criteria must exist: Distress that’s out of proportion with the expected reactions to the stressor. Symptoms must be clinically significant. They cause severe distress and impairment in functioning. In addition, the following criteria must be present: The distress and impairment are related to the stressor and not because of an intensification of existing mental health disorders. The reaction isn’t part of normal bereavement. When the stressor is removed or the individual has begun to adjust and cope, the symptoms subside within six months.
53
Specifiers adjustment disorder
with depressed mood: low mood, tearfulness, hopelessness with anxiety: nervousness, worry, jitteriness, separation anxiety with mixed anxiety and depressed mood with disturbance of conduct: violation of rights of others/ age appropriate societal norms, rules with mixed disturbance of emotions and conduct unspecified: physical complaints, withdrawal form relationships, impaired work, academic performance

Reasoning in mental health 2 (6 decks)

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