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Flashcards in PTSD Deck (35):
1

DSM 5 criteria for PTSD

Exposure to actual or threatened death,serious injury, or sexual violence (1 or more)

Directly experiencing the traumatic event

Witnessing in person, the event(s) as it occurred to others

Learning that it occurred to close family member or close friend (event must be violent or accidental)

Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) 

2

Traumatic event is persistently reexperienced
1) recurrent and intrusive distressing recollections

2) recurrent distressing dreams

3) Dissociative reactions: acting or feeling as if reliving the event. Continuum: to complete loss of awareness of the present

4) intense psychological distress at exposure to internal or external cues

5) physiological reactivity to exposure to cues 

Intrusions 

3

How does Avoidance have a role in PTSD

Persistent avoidance of stimuli associated with the trauma

1) efforts to avoid distressing memories, thoughts, feelings, about the
traumatic event

2) avoid external reminders activities, places or people, conversations, objects, situations that arouse recollections 

4

Ways in which Avoidance leads to numbing

Negative alterations in cognitions and mood

1) inability to recall important aspects of the trauma

2) Persistent and exaggerated negative beliefs or expectations about self, others or world

3) Persistent, distorted cognitions about the cause or consequences of the event

4) Persistent negative emotional state (fear, guilt, shame, anger)

5) markedly diminished interest or participation in activities

6) feeling of detachment or estrangement from others

7) Persistent inability to experience positive emotions 

5

1) Sleep Disturbance, difficulty falling or staying asleep

2) Irritability or outbursts of anger

3) Difficulty concentrating
4) Hypervigilance
5) Exaggerated startle response

6) Reckless or self-destructive behaviors 

Hyperarousal seen in PTSD

6

Explain Horowitz Theory of Integration

It's being on a continuim: 

Over control: numbing/denial/dissociation leading to negative alterations in mood

to 

Under-control: flashbacks/nightmares/hyperarousal which are intrusive

7

PTSD:

• Duration of symptoms is more than ____

• Disturbance causes significant distress or impairment in :

1 month

social, occupational, or other important areas of functioning 

8

How prevalent are traumatic events

80% of population exposed to traumatic event 

Disasters may create significant impairment in 40% to 50% of those exposed 

Up to 45% of those exposed to natural disastermay develop PTSD or major depression or other psychiatric symptomotology 

9

How prevelant is PTSD in population; what about veterans

• Adults 18 and older – 6.8%

• Men – 3.6%
• Women – 9.7% 

vs Veterans

• Men – 30.9%
• Women – 26.9% 

10

What are crisis related synmptoms

Anxiety, Panic, Elevated Startle Response, Insomnia, Anger, Helplessness, Depression
Suicidal Ideation, Impulsivity, Violence, Self-Medication 

 

11

What are the Three Key brain areas involved in PTSD and how are they affected?

Amygdala: activation

Hippocampus: reduced volume

Prefrontal cortex:Less activation

12

Set of nuclei at the center of each temporal lobe; – dozen distinct areas, two involved in fear conditioning

 

Amygdala

13

Amygdala Receive inputs from ___and____;

has_____and____ outputs 

senses and memory

 physiologic and behavioral

14

What routes do the amygdala take when processing information

Quick and dirty route” vs. cortical route makes processing implicit (no conscious effort required) 

15

What part of the amygdala receives inputs from the autidory coretx and auditory thalamus

16

What part of Amygdala gives output to the Central gray, Lateral hypothalamus, adn Paraventricular hypothalamus

Central Amygdala

17

The following areas receive input from Central Amygdala and are responsible for what fnx?

Central Gray:

Lathera Hypothalamus:

Paraventriclar Hypothalamus:

Central Grey: freezing

Latheral Hypothalamus: Blood Pressure

Paraventricular Hypothalamus: Hormones

18

The_____ contextualizes fear and regulates it on the basis of the situation we are in (i.e. a lion in the zoo fascinates; a lion on the street invokes fear)

• Context is a psychological construction...a memory created on the spot about the various factors involved in a situation 

hippocampus

19

What is the difference between a health and unhealthy hippocampus

Reduced hippocampal volume may be related to memory dysfunction in PTSD: 

debate is do people have premorbid hippocampus, thus are predisposed to PTSD

20

What is the relationship between the Prefrontal cortex and the Amygdala

PFC and Amygdala are RECIPROCALLY related...when PFC is activated, the Amygdala is inhibited, making it harder to express fear. 

(behavior of animals with PFC damage is similar to humans with PTSD: they develop fear reactions that are highly unregulated)

21

How is the Amygdala connected to the PFC

Amygdala is only connected to the Medial part of PFC

while Lateral and medial are connected, only Medial goes to amygdala

22

Describe three main brain areas that are related to PTSD

Dysfunction in 3 main brain areas related to PTSD

•Hyperactivity of the A has been shown in neutral conditions

•PFC and A activation are inversely related

•H decreased volume 

23

Traumatic memories are stored in a state of high physiologic arousal.

Traumatic events are state dependent thus how do we access them?

Traumatic memories must be accessed in a state of similar emotional arousal. 

24

Describe behavioral treatment for PTSD

• Anxiety attempts to avoid fear-evoking stimuli

• PTSD (avoidance) blocks exposure that promotes extinction

• Focus on exposure treatments to facilitate extinction 

25

What method is this:

Flooding (implosive therapy) 

balanced with:

Systematic Desensitization

Behavioral Deconditioning

26

What is the structure of Cognitive Behavioral Therapy

Look at the Fear structure:

Physiological responses + Ascribed meaning

27

What brain pathways are involved in Talk therapy?

PFC-Lateral: not directly connected to the AMygdala

28

What brain pathways are involved in CBT?

PFC-Medial; directly connected to amygdala

29

What brainpathways are invovled in drug therapy:

Drug (directly connected to A and other brain areas) 

30

What types of Cognitive Behavioral Therapies are the most effective?

Stress Innoculation Training

Imagery Rescripting and Reprocessing Therapy

Cognitive Restructuring Within Reliving

Imaginal/In Vivo Exposure

Prolonged Imaginal Exposure

Cognitive Processing Therapy 

31

Physician Screen tool for Type I trauma

• Have you experienced any vivid thoughts about the accident/injury?

• What do you believe is the cause of the accident/injury?

• Are you able to return to the place of the accident/injury?

• What do you think could be done to prevent the accident/injury? 

32

What types of changes do we look for when screening individual who experienced a traumatic event?

• Problems with concentration
• Sleep disturbances
• Hypervigilance/increased startle response

• Increased irritability
• Changes in mood
• Changes in appetite 

33

What changes are suggesting and used in the Physician Screening tool for Type II trauma (multpile/prlonged)

• Somatic complaints; all diagnostic testing is negative

• Chronic depression and/or anxiety

• Difficulty sleeping
• Difficulty concentrating

• Memory problems: chunks of time during childhood that are not remembered 

34

Flashback, nightmares or images of the past that continually intrude

Startle response greater than witnessed in others

Difficultwithappetite/foodortexturesthatare unappealing

Difficultyidentifying,experiencing,toleratingor expressing anger

Problems knowing who to trust 

suggestive of Type II trauma

35

Comorbidities associated with PTSD

• Panic Disorder
• Agoraphobia
• OCD
• Social Phobia
• Specific Phobia
• Major Depressive Disorder • Somatization Disorder

• Substance-Related Disorders