Response to Trauma - PTSD

Question 1

How are traumatic events broken up?

Answer 1

Type 1

Type 2

Question 2

Describe Type 1 traumatic events

Answer 2

Single sudden event

Question 3

Describe Type 2 traumatic events

Answer 3

Repetitive trauma

Ongoing abuse

Question 4

Which type of trauma is most likely to develop into PTSD?

Answer 4

Type 2 is 3x more likely to develop into

Question 5

Where in the brain does Fear and anxiety arise from?

Answer 5

Peri-aqueductal Region

Ventral Tegmental area

Question 6

What is fear?

Answer 6

Genetically ingrained function that promotes survival

Question 7

Freeze - focus of fear is distant

Answer 7

Stop Watch Listen - voluntary

Question 8

Freeze - focus of fear is inescapable

Answer 8

Tonic immobility

Involuntary but reversible motor inhibition

Question 9

Activity in the Periaqueductal Grey Matter relates to what?

Answer 9

Dread

Question 10

What can result in right sided hippocampal volume reduction?

Answer 10

Adult trauma

Question 11

What can result in left sided hippocampal volume reduction?

Answer 11

Childhood trauma

Question 12

What region of the brain relates to Desire and seeking?

Answer 12

Ventral tegmental

Question 13

What region of the brain is related to Rage and Anger?

Answer 13

Dorsal PAG

Question 14

What region of the brain is related to Lust?

Answer 14

Ventral and Dorsal PAG

Question 15

Where does neuroception occur?

Answer 15

Within the primitive brain

Midbrain Medulla Pons

Question 16

What is Neuroception?

Answer 16

Unconscious system that determines whether situations are safe or dangerous.
Activates prosocial or defensive behaviours
Means when we become consciously aware i.e we hear see or feel it we are able to react to it faster.

Question 17

What is the job of the superior colliculi?

Answer 17

Orientates us towards or away from the stimuli

Question 18

What is the job of the PAG?

Answer 18

Generation of an emotional response to the information supplied by the Superior Colliculi

Question 19

Based on the regions of the brain associated to stimuli and emotional response which area is focused on when healing?

Answer 19

PAG and Superior colliculi likely best area to try and “rewire” as this is the basis of underlying fear.
Conscious awareness only occurs when at cortical level

Question 20

What region of the brain is deactivated when exposed to current or the memory of trauma?

Answer 20

Brocas Area

Question 21

Which protein is known to be protective against PTSD?

Answer 21

Neuropeptide Y - Gamma

Question 22

What are some trauma related Risk factors for developing PTSD?

Answer 22

Man made
Prolonged exposure
Perceived threat to life
Grotesque scenes
Proximity to course
Personally relevant i.e children involved

Question 23

What are some patient related Risk Factors for developing PTSD?

Answer 23

Serious physical injury

FH or PH of mental disorders

Question 24

What some environmental risk factors for developing PTSD?

Answer 24

Lack of support network

Ongoing life stresses

Question 25

What percentage of patients recover psychosocial from their experience with no need of specialist care?

Answer 25

50%

Question 26

What is the normal acute response to a traumatic event?

Answer 26

``` Numbness Shock Fear Depression Guilt Anger Impaired sleep Helplessness Aviodance ```

Question 27

What makes it a pathological response to a traumatic event?

Answer 27

Severity and duration is beyond what is expected | >4 weeks

Question 28

How long does acute stress disorder last for?

Answer 28

Less than 4 weeks

Question 29

What are main symptoms of PTSD?

Answer 29

Depression Panic attacks Phobias

Question 30

What are the five categories of PTSD symptoms

Answer 30

``` Intrusive Avoidance Negative Alterations Increased Arousal and reactivity Functional impairment ```

Question 31

In order to be diagnosed with PTSD what intrusive symptoms do you need?

Answer 31

``` More then 1 of the 5 Recurrent recollections Nightmares Flashbacks Distress from reminders Physiological reactions ```

Question 32

In order to be diagnosed with PTSD what avoidance symptoms do you need?

Answer 32

One or both of Thoughts and feelings External reminders i.e locations people

Question 33

In order to be diagnosed with PTSD what Negative alterations do you need?

Answer 33

More than 1 of the 7 | Negative alterations in cognition and mood

Question 34

In order to be diagnosed with PTSD what increased arousal and reactivity symptoms do you need?

Answer 34

``` More than 2 of the 6 Sleep Irritable Concentration Vigilance Startled Destructive ```

Question 35

How long does the functional impairment have to last to get a diagnosis of PTSD?

Answer 35

Over 1 month

Question 36

What are some Negative alterations?

Answer 36

Amnesia for key aspects Loss in interest in activities Negative affect Overly negative thoughts and assumptions about self and world Exaggerated blame to self and others Feeling isolated Difficulty experiencing positive emotions

Question 37

Alongside the usual symptoms what is required for a diagnosis of Complex PTSD?

Answer 37

Negative self concept - low self esteem, hopelessness, pervasive shame and/ or guilt Emotional dysregulation - violent or emotional outbursts, reckless behaviour

Question 38

What are some tension reducing activities seen in complex PTSD cases?

Answer 38

Binging then purging Self mutilation Substance misuse

Question 39

Why is there a decreased focus on Top down therapies such as CBT for the treatment of PTSD?

Answer 39

CBT focuses on the conscious cortex regions of the brain, these regions are not the source of the issue they simply interpret it. The mammalian brain is the driver behind fear.

Question 40

What therapies focus on rewiring the mammalian brain i.e superior colliculus and the PAG?

Answer 40

Eye Movement Desensitisation and Reprogramming EMDR

Question 41

What is the role of pharmacotherapy in PTSD?

Answer 41

Symptomatic treatment for acute | 2nd line or augmenting Therapy

Question 42

What antidepressants are used?

Answer 42

Venlafaxine | SSRIs i.e sertraline

Question 43

What Antipsychotics are used?

Answer 43

Risperidone ( severe hyperarousal )

Question 44

What are some alternative medications used?

Answer 44

Mood stabilisers e.g. carbezamapine | Prozosin Alpha 1 Antagonists