Lectures 82, 83: PTSD and Anxiety Flashcards Preview

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Flashcards in Lectures 82, 83: PTSD and Anxiety Deck (54):
1

Define trauma

Exposure to actual or threatened death, serious injury, or sexual violence in 1+ these ways... 1) direct experiencing the traumatic event; 2) Witnessing the event as it occurred to others; 3) Learning the traumatic event occurred to close family member or friend; 4) Experiencing repeated or extreme exposure to aversive details of the event

2

Four symptom classes required for PTSD

Intrusion symptoms, avoidance symptoms (+ general numbness), negative alterations in cognitions and mood, alterations in arousal or activity

3

Negative alterations in cognitions & mood includes what "classic" memory symptom

Not being able to recall important aspect of the trauma

4

How long must symptoms exist? What is the final criteria for a PTSD diagnosis?

1 month; impaired functioning

5

How is acute stress disorder different from PTSD? Can it become PTSD?

3 days - 1 month after a trauma; yes

6

About how common is trauma disorder(%)? About how common is PTSD (lifetime, %)?

~50% for 1 traumatic event; ~10%

7

What is a significant predictor of a worse outcome for PTSD? Describe

Childhood trauma; early trauma --> dysrupted limbic-HPA axis --> negative impact on development --> lifelong psych/behavioral, etc problems

8

What can keep a traumatized kid from developing LT psych/non-psych consequences?

Lifestyle factors: access to care, community support, etc.

9

Is PTSD the only disorder related to tramau exposure?

Nope: lots of psych problems are correlated

10

Risk factors for PTSD (3)

1. Amount of trauma; 2. Type of trauma (rape is very high); 3. Lack of preparedness

11

Describe an example of differential trauma responses b/t women and men

Women are more likely to experience PTSD after threat/physical attack

12

T/F: Is it possible for a person to develop PTSD from stressors w/in range of usual human experiences?

Yes

13

Women/men more at risk for PTSD?

Women

14

One pathophysiological model of PTSD describes it as...How is this related to the stress response? Findings in ER?

A failure to recover; fundamentally different stress response to trauma that can be distinguished early; elevated HR in those who develop PTSD

15

What NT system is implicated in PTSD?

Noradrenergic: hyperactive sympathetic system

16

What evidence exists demonstrating abnormal noradrenergic system in PTSD? Test?

Increased plasma levels and urinary excretion of NE, elevated HR, BP; alpha-2 receptor antagonist --> flashbacks due to increased NE

17

What are a medication class effective at treating PTSD? Therefore...

SSRIs; serotonin likely involved in PTSD

18

What happens if you give dexamethasone to PTSD pt?

Hyper suppression of HPA axis due to excessive sensitivity of glucocorticoid receptors

19

PTSD patients have higher/lower cortisol levels. Comparison to MDD?

Lower; higher levels in MDD

20

If you have low cortisol you cannot...How could this effect memory? The final step in this pathway would be?

Shutdown fight/flight response (increased NE); "overconsolidation" of memories of distress --> state of perpetual fear

21

Research examining what related to the HPA axis?

Giving steroids (cortisol) at the time of trauma

22

Describe the cognitive model of PTSD and what are some negative ways of thinking?

People respond to traumatic events based on their interpretation; perceived controllability, feelings of shame/guilt, feeling that it could have been prevented

23

How do we treat PTSD

Medications (SSRIs and adrenergic blockers) and psychotherapy (CBTs: exposure therapy, relaxation techniques, stress management)

24

What is an important part of psychotherapy for PTSD?

Education!

25

Anxiety disorders (general def, and prevalence [gender, %])

Excessive, severe, prolonged anxiety that compromises functioning; females > males; about ~30%

26

Anxiety disorders share these features...(2 categories)

Subjective features: apprehension, worry, fear, hypervigilance; Physiological symptoms: tension, fatigue, GI, hyperventilation, palpitations

27

Physiological symptoms of anxiety often lead to...

Presentation in medical settings

28

Panic disorder (two major criteria). Can or cannot have what associated symptom?

Recurrent unexpected panic attacks and anticipatory anxiety (> 1 month); agoraphobia

29

Describe a panic attack

Abrupt onset of fear (5 - 30 min), out of the blue, physical symptoms, emotional symptoms (fear of dying/losing control)

30

Cardinal symptom of panic attacks

Hyperventilation

31

Agoraphobia (def)

Fear/avoidance of situations from which escape might be difficult

32

Is panic disorder common?

Fairly: ~5%

33

The first panic attack might be...the subsequent ones are?

Triggered; "out of the blue"

34

There is a strong association b/t panic disorder and...

Suicide

35

Generalized Anxiety Disorder (def)

Excessive anxiety and worry, most days, for > 6 months that cannot be controlled with some other symptoms (mostly physical/mental), impairs function

36

GAD tends to be.. (course of illness) and strongly co-morbid with what other anxiety disorder?

Chronic: once a worrier, always a worrier; panic disorder

37

Social Phobia (def)

Fear of 1 or more social/performance situation

38

Basis of fear in social phobia (two examples)...

Humiliation/embarrassment

39

T/F: Gender difference in social phobia

False: men and women get it the same amount

40

When does social phobia generally hit?

Late childhood/early adolescence

41

What is the course of social phobia

Chronic

42

How disabling is social phobia?

Depends on how many social fears someone has

43

What are the cognitive-behavioral theories of anxiety? (3)

Learned response from parental behavior; classical conditioning; faulty (catastrophic) thinking patterns --> maladaptive behaviors

44

Cognitive theory about panic disorder

Somatic sensation --> catastrophic thought about meaning --> autonomic arousal (cycle) --> PANIC

45

Describe fear network's role in anxiety disorders

"Short route" of senosry thalamus to amygdala that does NOT involve inhibitory control of frontal regions sends; amygdala signals to lower brain regions that causes physiological changes (e.g. hypothalamus --> sympa NS and cortisol)

46

A person with anxiety might do what with sensory information?

Misperceive it! --> arousal

47

Serotonergic dysfunction in panic disorder based mostly on the fact that...Might also be related to these sites of inhibition?

SSRIs treat panic disorder; 5-HT inhibits response at PAG, LC, and hypothalamus

48

Describe noradrenergic dysregulation in panic disorder

Panic disorder associated with increased activity and sensitivity of noradrenergic system

49

GABA's relationship to anxiety

Lower GABA levels/lower number of GABA receptors possible

50

T/F: Environmental contribution is more significant for anxiety disorders than others

True

51

What heritable trait is related to anxiety disorders?

Behavioral inhibition

52

What kids of environmental contributions are related to the development of anxiety disorders?

Disruptions of early attachment and childhood trauma

53

Three classes of pharm treatment for anxiety

Antidepressants, benzos (short-term while SSRIs kick in), anticonvulsants

54

What type of therapy is very effective for anxiety disorders? How might it work?

CBT; increases frontal inhibition over amygdala

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