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MHAWB > PTSD > Flashcards

PTSD Flashcards

1
Q

Main Symptoms

Increased Arousal, Negative Emotions and Guilt

A

exaggerated startle response (Shalev et al, 2000)

difficulty sleeping

hyper vigelance

difficulty concentrating

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2
Q

Main Symptoms

Avoidance

A

Avoids all situations/events which may trigger memories.

Lack of feelings of positive emotion.

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3
Q

Main Symptoms

Re-experiencing

A

Regularly recalls vivid flashback of events experienced during the trauma.

Recurrent nightmares.

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4
Q

Main Symptoms

Reduced Responsiveness

A

Feeling detached from others.

Deperonalisation.

Derealisation.

(Ruzek et al, 2011)

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5
Q

Comorbid Problems and Symptoms

A

Depression, guilt, shame, anger, marital problems, sexual dysfunction, substance abuse, suicidal thoughts, stress related violence.

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6
Q

DSM Criteria

Criterion A

A

Stressor.

Person was exposed to; death, threatened death, actual/threatened serios injury or sexual violence.

  1. Direct exposure.
  2. Witnessing in person.
  3. Indirectly (learning about relative/friend exposed to trauma).
  4. Repeated or extreme indirect exposure to adverse details of the event (usually in professional duties. Does not include non-pro exposure like TV, movies or pictures).
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7
Q

DSM Criteria

Criterion B

A

Intrusion symptoms (1/5 needed)

  1. Reccurent, ivoluntary and intrusice recollections (children may use repetitive play).
  2. Traumatic nightmares (children may have disturbing dreams not content related to the trauma).
  3. Dissociative reactions (e.g. flashbacks). May be brief episodes or loss of conciousness (children may re-enact in play).
  4. Intense and prolonged distress after traumatic reminders.
  5. Marked physiological reactivity after exposure to trauma related stimuli.
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8
Q

DSM Criteria

Criterion C

A

Persistent avoidance of stimuli associated with the trauma (1/2 needed).

  1. Trauma related throughts or feelings.
  2. Trauma related external reminders (e.g. people, places, conversations, activities, objects or situations).
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9
Q

DSM Criteria

Criterion D

A

Negative alterations in cognitions and mood that are associated with the traumatic event (2/7 needed).

  1. Inability to recall key features of traumativ event (dissociative amnesia usually, not due to head injury, alcohol or drugs).
  2. Negative beliefs and expectations about self and world (e.g. I am bad, the world is dangerous).
  3. Blame self or others for causing traumatice event or consequences.
  4. Negative trauma related emotions (e.g. fear, horror, anger, guilt, shame).
  5. Diminished interest in (pre-trauma) significant activities.
  6. Feeling alienated from others (e.g. detatchment/estrangement).
  7. Constricted affect. Persistent inability to experience positive emotions.
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10
Q

DSM Criteria

Criterion E

A

Alterations in arousal and reactivity that are associated with trauma (2/6).

  1. Irritable or aggressive.
  2. Self-destructive or reckless.
  3. Hypervigilance.
  4. Exaggerated startle response.
  5. Problems concentrating.
  6. Sleep disturbance.
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11
Q

DSM Criteria

Criterion F, G, H

A

F. Persistence of symptoms for more than one month.

G. Significant symptom related distress or functional impairment.

H. Not due to medication, substance or illness.

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12
Q

DSM Issues in Timing

A

If symptoms begin immediately/ soon after trauma and last less than a month DSM diagnosis is Acuter Stress Disorder.

Longer than one month - PTSD.

80% of ASD develops into PTSD (Bryant et al, 2005).

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13
Q

Controversies

Specific Aetiology

A

Category A issues.

Can develop after “non life threatening events” (Scott and Stradling, 1994).

Pre incident vulnerability and post incident social support also contribute to post trauma (Ozer et al, 2003).

May downplay/ ignore broader context features (e.g. personality, personal situation).

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14
Q

Controversies

Symptom Overlap

A

Galatzer et al (2013)

Combination of symptoms of major depression and specific phobia.

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15
Q

Controversies

Medicalisation

A

McNally (2003)

Individuals no longer have to experience the event directly.

New diagnostic sub categories proposed.

Medicalisation of normal human emotions?

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16
Q

Controversy

A

Research must be reterospective (compromised by memory lapses/ mis recollections).

Continual changes to DSM criteria - impacts relevance of previous literature.

Persists over years/variability of onset makes baseline difficult to identify (also impacted by uncertainty of cause/delayed trials).

Self reporting not sufficient.

Impact of previous trauma must be considered.

17
Q

Prevelance of PTSD

A

Lifetime rate - 1-3%.

Estimated 40-70% of population will experience traumatic event during their life (Ozer and Weiss, 2004).

Woman more likely than men (2.4:1) (Tollin and Foa, 2006).

Cultural variations - caucasianss lower prevelance than Latinos/ African Americans (Perilla, Norris and Lavizzo, 2002).

Development of PTSD depends on nature and severity of the event.

More severely exposed = more likely to develop a disorder.

18
Q

Natural Course of PTSD

9/11

A

US population after 9/11; >2 months (17%) >3 months (6%) (Neria et al, 2006).

9/11 rescue workers (higher exposure); 2-3 years (12.1%) 5-6 years (19.5%) (BrackBill et al, 2009).

9/11 responders 11-13 years after; PTSD (9.7%) remitted (7.9%) partial (5.9%) (Bromet et al, 2016).

19
Q

Natural Course of PTSD

A

Dam collapse; baseline PTSD (60%) 14 years (25%) (Green, 1990, 2010).

Meta analysis, 42 studies. Remission after 40 months (44%). Worse prognosis if no diagnosis in first 5 months (Morina et al, 2014).

469 fire fighters at 4, 11 and 29 months. Some had delayed onset while others immediate. Not linear. Linked to intrversion, neuroticism, history/family history of psychological disorders (McFarlane, 1988).

20
Q

Vulnerability Factors

A

Tendency to take personal responsibility for traumatics event and misfortune of others (Solomon et al, 1988).

Developmental factors - early separation from parents/ unstable family life (King et al, 1996).

Family history of PTSD (Foy et al, 1987, Lehner et al, 2014).

Maternal PTSD - high glutocorticoid sensitivity in offspring (Lehner et al, 2014).

Previous high anxiety or psychological disorder (Breslau et al, 2000).

Low intelligence (Duke et al, 2002).

High IQ best predictor of resistance (Silva et al, 2000).

How individual responds to event leads to poorer health (Irish et al, 2012).

21
Q

Theory of Shattered Assumptions

Janoff-Bulman (1992)

A

Severe trauma shatters belief world is safe/ benign causing disbelief/shock/conflict.

Challanges core beliefs causing state of unreality.

Trauma survivor has to update schema in negative way. How they cope can effect LT adjustment to trauma (Bolton and Hill, 1996).

However, if already experienced world as unsafe more likely to develop PTSD (Resnick, 2001).

22
Q

Conditioning Theory

A

Many symptoms of PTSD may be due to conditioning.

Trauma (UCS) become associated with situational cues of the time and place (CS).

When cues are encountered in future the trigger the arousal/fear response.

Conditioned fear responses don’t extinguish due to development of cognitive and physical avoidance response.

Still fails to explain why some people develop PTSD and others don’t.

Doesn’t explain range of symptoms unique to PTSD.

23
Q

“Mental Defeat”

Ehlers and Clark (2000)

A

Specific psychological characteristics that make people vulnerable.

Individual see self as “victim” - process all info about trauma negatively and see self as unable to act effectively.

Increases distress, influences recall, may give rise to maladaptive behaviour/cognitive strategies that maintain disorder.

Only partially process the memory of trauma so event isn’t integrated fully into autobiographical knowledge.

24
Q

Dual Representation Theory

Brewin (2001)

A

Hybrid disorder involving two seperate memory systems (Brewin, 2001).

Verbally accessible memory (VAM).

  • Registers memories of trauma that are conciously processed at the time.
  • Narrative in nature, info about event, context, personal evaluations.
  • Integrated, readily retrieved.

Situational accessible memory (SAM).

  • Records info from trauma too breif to take in consciously.
  • Sights, sounds, extreme bodily reactions.
  • Vivid uncontrollable flashbacks difficult to communicate (not narrative form).

MHAWB (2 decks)

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