Posttraumatic Stress Disorder Flashcards
10,000 feet view of PTSD
Syndrome that develops after exposure to a traumatic event
Ongoing symptoms for at least 1 month
Symptoms include re-experiencing, avoidance of reminders, negative alterations of thoughts and mood, symptoms of increased arousal
Diagnostic criteria for PTSD
Exposure to trauma: directly, witnessed, learning of event to a significant other/family member, experiencing repeated exposure to aversive details of a traumatic event
At least one of: recurrent and intrusive memories of the event, recurrent distressing dreams related to the event, dissociative reactions (flashbacks), psychological distress at exposure cues, marked physiologic reactions to exposure cues
Persistent avoidance of or efforts to avoid distressing memories, thoughts, feelings of the event AND/OR avoidance of reminders of the event
Negative alterations in thinking and mood associated with the event including at lesat two of: inability to remember aspects of the event. persistent/exaggerated negative beliefs about onself/others/the world, persistent negative emotional state, anhedonia, feelings of detachment from others, persistent inability to experience positive emotions
Alterations in arousal associated with the event, with at least two of: irritability or angry outbursts, reckless or self-destructive behavior, hypervigilance, pronounced startle response, problems concentrating, or sleep disturbance
Categories of PTSD symptoms
- Intrusive (flashbacks, response to cues)
- Avoidance
- Mood symptoms
- Arousal symptoms
How do the diagnostic criteria for PTSD in those < 6 years of age differ from those for adults?
Often involve events occuring to a parent or caregiver
Otherwise mostly the same, though manifestations in the four domains may be different in a small child
TBI as a Ddx for military PTSD
TBI may cause mood and hyperarousal symptoms, similar to PTSD
However, intrusive symptoms and avoidance symptoms are not seen.
Treatment of PTSD
- Usually multimodal and involving pharmacotherapy, psychotherapy, and social intervention
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SSRIs (sertraline and paroxetine), SNRIs (venlafaxine) are effective in reducing symptoms
- TCAs and MAOis may be an option if other medications have not been proven helpful
- Note that full response to these medications in PTSD may take up to 24 months
- Prazosin (a1 antagonist) is effective in treating PTSD sx, especially nightmares
- Atypical antipsychotics may augment treatment with antidepressants
- No role for benzodiazepines – not shown helpful
- Various forms of CBT are effective in PTSD, especially individual trama-focused and EMDR therapy
- Social interventions (providing shelter, food, cothing, housing) to restore safety and security is crucial
Individual trauma-focused CBT
Involves prolonged exposure, which fcuses on re-experiencing traumatic events through repeatedly engaging with the memories and everyday reminers and REFRAMING them rather than avoiding them
Eye movement desensitization and reprocessing (EMDR) therapy
Repeatedly recalling traumatic memories while receiving neutral sensory input
Present-centered therapy
Focuses on current relationships and work challenges
In childhood PTSD, flashbacks are expressed as. . .
. . re-enactment, as with toys
What is a good option to prevent the possible development of PTSD after trauma?
CBT
Especially if early signs of PTSD are present (nightmares, mood changes, hypervigilance)
Stress symptoms that persist for __ after a traumatic event are unlikely to resolve on their own
Stress symptoms that persist for 3 months after a traumatic event are unlikely to resolve on their own
The first intervention in the treatment of trauma-reated disorders should always be . . .
. . . establishing safety
If a patient appears to have PTSD-like symptoms, but does not meet the PTSD diagnostic criteria, the diagnosis is often ___
If a patient appears to have PTSD-like symptoms, but does not meet the PTSD diagnostic criteria, the diagnosis is often adjustment disorder
Acute stress disorder
May appear identical to PTSD, but duration is 3 days - 1 month
If it persists beyond 1 month, the diagnosis becomes PTSD
