Flashcards in PTSD Deck (43):
Which areas of the brain are affected in PTs with PTSD?
medial prefrontal cortex, amygdala, pituitary, hypothalamus
What is the PTSD Checklist for DSM-5?
list of 20 questions relating to symptoms of PTSD scored from 0 to 4 - score of 38 out of 80 is associated with a diagnosis of PTSD
What is Criterion A for PTSD in the DSM-V?
exposure to actual or threatened death, serious injury, or sexual violence: directly, witnessing in person, learning about a close family member/friend, exposure to aversive details of traumatic events (does not include exposure through electronic media/TV/movies/pictures)
What is Criterion B for PTSD in the DSM-V?
presence of one or more intrusion symptoms associated with the traumatic event: recurrent memories, recurrent dreams, flashbacks, intense psychological distress at exposure, marks physiological reactions to cues
What is Criterion C for PTSD in the DSM-V?
persistent avoidance of stimuli associated with the traumatic event: avoidance of memories/thoughts/feelings and avoidance of external reminders that arouse distressing memories
What is Criterion D for PTSD in the DSM-V?
negative alterations in cognitions and mood associated with the traumatic event: dissociative amnesia, persistent and exaggerated negative beliefs about oneself, distorted cognitions about the cause or consequence of the traumatic event, markedly diminished interest in significant activities, detachment/estrangement from others, inability to experience positive emotions
What is Criterion E for PTSD in the DSM-V?
marked alterations in arousal and reactivity associated with the traumatic event: irritability, reckless/self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, sleep disturbance
What is Criterion F for PTSD in the DSM-V?
duration of the disturbance (criteria B, C, D, E) is more than one month
What is Criterion G for PTSD in the DSM-V?
disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
What is Criterion H for PTSD in the DSM-V?
disturbance is not attributable to the physiological effects of a substance or another medical condition
What are the two subtypes of PTSD?
(1) with dissociative symptoms - individual experiences depersonalization (perception of being outside observer of one's mental processes or body) or derealization (unreality of surroundings) and (2) with delayed expression - full diagnostic criteria not met until at least 6 months after the event
What is the first line medication treatment for PTSD?
6 to 8 week trial of selective serotonin reuptake inhibitors (SSRIs)
What are the usual and therapeutic doses of paroxetine (Paxil) for treatment of PTSD?
20 mg starting and 20-60 mg therapeutic
What are the usual and therapeutic doses of sertraline (Zoloft) for treatment of PTSD?
50 mg starting and 50-200 mg therapeutic
What are the usual and therapeutic doses of fluvoxamine (Luvox) for treatment of PTSD?
50 mg starting and 100-300 mg therapeutic
What are the usual and therapeutic doses of fluoxetine (Prozac) for treatment of PTSD?
20 mg starting and 20-60 mg therapeutic
What are the usual and therapeutic doses of citalopram (Celexa) for treatment of PTSD?
20 mg starting and 20-40 therapeutic
What are the usual and therapeutic doses of escitalopram (Lexapro) for treatment of PTSD?
10 mg starting and 20-30 therapeutic
What are the usual and therapeutic doses of venlafaxine (Effexor) for treatment of PTSD?
37.5 mg starting and 37.5-300 mg therapeutic
What have been the major changes in the definition of Criterion A of PTSD between DSM-III and DSM-V?
"outside the range of usual human experience ... markedly distressing to almost anyone" (DSM-III) deemed too vague; "response involved intense fear, helplessness, or horror" (DSM-IV) removed - not the emotions most highly associated with PTSD; limited vicarious trauma to individuals interpersonally close to the trauma victim
What are the common pathways to the development of acute stress disorder and PTSD?
peritraumatic panic (panic occurring at the time of the trauma), anxiety sensitivity, negative cognitions about oneself
What is acute stress disorder?
describes acute posttraumatic symptoms 2 days to 1 month following traumatic exposure - includes symptoms of intrusion/re-experiencing, avoidance, arousal and requires dissociative symptoms
What is accelerated resolution therapy?
brief exposure-based therapy for PTSD delivered in 1-5 sessions over a 2-week time frame - includes a narrative component (imagery rescripting), in vivo and/or imaginal exposure, cognitive restructuring, and relaxation/stress modulation
What are the best evidence-based, trauma-focused psychotherapy approaches for addressing PTSD?
cognitive processing therapy, prolonged exposure, eye movement desensitization and reprocessing (EMDR)
What is prolonged exposure therapy for PTSD?
asking patients to repeatedly recount the trauma to extinguish fear associated with the memory (imaginal exposure) or practice facing trauma reminders and triggers in the real world (in vivo exposure) - 9-12 weeks of 90 minute sessions
What is cognitive processing therapy?
changing maladaptive beliefs related to the trauma - with an option of writing an account of the trauma
What is EMDR?
comprises exposure and cognitive restructuring but asks patients to maintain dual focus on an external stimulus (eye movement tracking of therapist hand movements) while thinking about the trauma
What are common pretrauma risk factors for developing PTSD?
gender, age at trauma, ethnicity, lower education, lower SES, previous trauma, general childhood adversity, personal/family psychiatric history, reported childhood abuse, poor social support, initial severity of reaction to the traumatic event
What are the four core clusters of symptoms of PTSD in children?
intrusion, avoidance, negative alterations in cognition/mood, hyperarousal - marked difference from child's behavior prior to the traumatic event and cause significant distress or impairments in role functioning
What is dissociation?
disruption of the usually integrated functions of consciousness, memory, identity, awareness of body/self/environment
What are common dissociative symptoms seen in PTSD?
decreased responsiveness to external stimuli (emotionally/physically numb, blunted affect, robotic movements), memory impairment, disturbance of identify and awareness
How does CBT work?
cognitive approaches help patients correct erroneous cognitions while behavioral approaches aim to decrease symptoms through exposure to reminders of the traumatic event
How does avoidance perpetuate PTSD?
avoiding triggers can interfere with the extinction of fear by limiting the amount of exposure to realistically safe reminders of the traumatic event
What is the basis of psychotherapy for PTSD as described in emotional processing theory?
PTSD emerges due to the development of a fear network that fails to be disrupted due to escape and avoidance behaviors - extinguishing the fear requires (1) activation of the fear memory and (2) replacement of the fear response with corrective information about the trigger (e.g., that it cannot harm the patient)
What is cognitive therapy?
meanings we impose on events contribute to emotional states - changing how we think about them can reduce PTSD symptoms and improve well being (uses Socratic questioning)
What is cognitive processing therapy?
PTs writes a detailed account of the trauma and reads it in the presence of the therapist and at home - helps challenge faulty assumptions and self-statements and modifies maladaptive thoughts and over-generalized beliefs
Which types of psychotherapy are recommended in PTs with PTSD?
exposure therapy - PTs with extreme fear and avoidance; cognitive therapy - PTs with extreme guilt and trust issues; virtual reality - PTs who are highly avoidant
What is the role of D-cycloserine in PTSD?
has shown promise in augmenting extinguishing of fear through exposure therapy for patients with several types of anxiety orders (has not yet been proven effective in PTSD)
Which drugs can be used to treat insomnia/sleep disturbance in PTSD?
mirtazapine (Remeron) and trazodone (Desyrel)
Which drugs can be used to treat irritability, aggression, and impulsiveness in PTSD?
carbamazepine (Tegretol) and valproic acid (Depakote)
Which drugs can be used to treat hyperarousal in PTSD?
clonidine (Catapres) and propranolol (Inderal)
Why should benzodiazepines be used cautiously in the treatment of PTSD?
many PTs with PTSD suffer from comorbid substance abuse disorder