Responses to Trauma Flashcards
(97 cards)
1
Q
Trauma can be either?
A
Intentional or Unintentional
2
Q
Give 3 examples of intentional trauma.
A
- Assult
- Robery
- Rape
3
Q
Give 2 examples of unintentional trauma.
A
- RTA
* Industrial accident
4
Q
In the context of a disaster, what is meant by ‘centrifugal’?
A
People are together only at the moment of the accident e.g plane crash
5
Q
In the context of a disaster, what is meant by ‘centripetal’?
A
An existing community e.g hurricane, earthquake, tornado, flood
6
Q
What is type 1 trauma?
A
A single incident trauma, unexpected
7
Q
What is type 2 trauma?
A
Complex trauma
8
Q
Type 2 trauma is _________
A
REPETITIVE
9
Q
Give 3 examples of type 2 trauma.
A
- Ongoing abuse
- Hostage taking (piracy)
- Genocide
10
Q
How many people are affected by type 2 trauma?
A
1 in 10 adults
1 in 7 children
11
Q
How much higher is the risk of PTSD in people with type 2 trauma compared to type 1 trauma?
A
3x
12
Q
“Any situation associated with multiple casualties and fatalities, and damage to property, due to natural or unnatural causes, that is beyond what can be coped with ordinarily by the deployment of the emergency services” this is the definition of?
A
A major accident
13
Q
Is panic rare or common in trauma?
A
Surprisingly it is rare
14
Q
Activism is much more common than fatalism in a traumatic event
A
TRUE
15
Q
In patients with chronic depression, what predicts the need for psychotherapy as well as pharmacotherapy?
A
A history of early life trauma
16
Q
What do a high percentage of patients with bipolar disorder have?
A
Childhood deprivation or abuse
17
Q
In what ways does PTSD often affect physical health?
A
- Excess all-cause mortality.
- Chronic diseases such as cardiovascular, digestive (incl. liver disease), MSK, endocrine, resp
- Stands up even when control for other factors (incl alcohol and drugs)
18
Q
What 2 things are genetically ingrained functions of the NS?
A
Anxiety and fear
19
Q
Anxiety and fear arise from neural processes that prompt us to do what?
A
FREEZE or FLEE
20
Q
What do people FREEZE in response to?
A
Distant or inescapable threat
21
Q
What do people FLEE in response to?
A
Threat which is nearby and escapable
22
Q
Where does fight or flee originate?
A
In the PAG or Ventral Tegmental Area
23
Q
What occurs in inescapable threat?
A
Tonic immobility
24
Q
What is tonic immobility?
A
An involuntary state of profound (but reversible) motor inhibition
25
When, especially, does tonic immobility occur?
There is direct physical contact with predator/aggressor.
26
What type of case does tonic immobility often occur in'?
Sexual assault cases
27
Outline some features of tonic immobility.
* Decreased vocalisation.
* Intermittent EC.
* Rigidity and paralysis.
* Muscle tremors and extremities.
* Chills.
* Unresponsive to pain.
28
What may tonic immobility be associated with?
Peri-traumatic dissociation
29
What is the benefit of tonic immobility?
It enhances survival
30
How does tonic immobility enhance survival?
* predators less likely to attack immobile prey.
* if attack, immobility may cause them to loosen grip, increasing chances of escape.
* decreased risk of extreme violence which fighting back can cause.
* some attackers lose interest if victim is immobile and unresponsive.
31
What does the orientating response vary according to?
* Nature of the stimulus
* Internal state of the person
* The persons previous experience
32
What happens in the brain as a predator gets closer?
Brain activity shifts from the ventromedial prefrontal cortex to the periaqueductal grey
33
It has been suggested that PTSD is due to a deficiency of ?
The top-down modulation of amygdala activation in the prefrontal cortex
The ability to regulate emotional responses to negative stimuli may be a PROTECTIVE FACTOR when exposed to trauma – a RESILIENCE FACTOR
34
What is defence activation composed of?
3 looping systems
35
Name the 3 loops in defence activation?
1. Midbrain/brainstem origin - peri-aqueductal gray (PAG) and superior colliculi (SC)
2. Mesolimbic-dopamine system
3. Mesolimbic-dopamine system
36
What does acute stress lead to a dose dependant increase in?
Catecholamines and cortisol
37
What does cortisol act to mediate and shut down?
The stress response
38
How does cortisol work?
Through negative feedback, this acts on the pituitary, hypothalamus, hippocampus and amygdala.
These sites are responsible for the stimulation of cortisol release.
Acute stress therefore increases cortisol release.
39
What is the biological paradox of cortisol?
CORTISOL LEVELS ARE LOW IN PTSD
40
In what condition, are cortisol levels low?
PTSD
41
What does acute stress do to cortisol levels?
INCREASES it
42
According to DSM, what is required for something to be described as a 'traumatic event'?
* Experienced, witnessed or confronted
* Threat of death or serious injury (self or others)
* [intense fear, helplessness or horror]
43
According to ICD, what is required for something to be described a 'traumatic event'?
* delayed &/or protracted response
* exceptionally threatening or catastrophic
* likely to cause pervasive distress in almost anyone
44
For both DSM and ICD, what is a traumatic event?
The primary and overriding casual factor
45
What are the 3 categories of pre-traumatic risk factors?
* Personal capabilities and attributes.
* Past personal experiences.
* Environment.
46
List some personal capabilities and attributes.
* Attachment capacity.
* Current attachments.
* Locus of control (ie. in charge of own destiny compared with feeling reliant on others).
* Gender (males cope better).
* Extremes of age and development (children and older people).
* Behavioural problems (<15yrs).
47
List some past personal experiences which act asa a risk factor for pre-traumatic events.
* Childhood experience of trauma (can be + or -)
* Substance misuse
* Previous psychiatric history
* (Dis)advantage (social, educational or economic)
48
List some environmental factors which can predispose someone to pre-traumatic events.
* Concurrent life stressors or strengths.
| * Social capital.
49
List some normal signs and symptoms of trauma
* numbness, shock, denial
* fear
* depression or elation
* anger, irritability
* guilt
* impaired sleep
* hopelessness, helplessness
* perceptual changes
* avoidance
* intrusive experiences (e.g flashbacks)
* hyperarousal, hypervigilance
50
What is agoraphobia?
Feeling like your environment is unsafe and you cannot escape
51
List some physiological reactions after trauma.
* Depression
* Grief Reactions
* Panic Attacks +/- agoraphobia
* Alcohol/Drug Dependence
* Brief Hypomania
* Specific Phobias (e.g., travel)
* PTSD
52
What type of trauma causes the most PTSD?
Rape and sexual assault
53
Is there a risk between PTSD and suicide?
Yes – PTSD has a stronger association with suicide than any other anxiety disorder
54
By how much is the risk of suicide increased in those with PTSD compared to controls?
6x
55
What do ~60% of men, and 40% of women with PTSD meet criteria for?
Greater than or equal to 3 other psychiatric diagnoses
56
Approximately 80% of patients with PTSD will have at least one co-morbid psychiatric condition. What are the most common of these?
Depression
Drug/alcohol abuse
Anxiety disorder
57
Describe the burden of PTSD on patients.
Severe impairment of social functioning, resulting in unemployment and relationship problems
58
Rates of PTSD rise with age in....
MEN, but not women
59
How much more common is PTSD in women?
2.5x
60
Outline the DSM IV criteria for PTSD.
* traumatic event(s)
* intrusive symptoms: 1 or more
* avoidance symptoms: 3 or more
* increased arousal: 2 or more
* duration 1 month
* distress and impairment in social or occupational functioning
* acute / chronic / delayed onset
61
Give examples of intrusive phenomenon.
* Recurrent distressing recollections.
* Nightmares.
* Flashbacks, in any modality.
* Distress accompanies reminders.
* Physiological reactions (fight or flight).
62
Outline avoidance and emotional numbing symptoms.
* avoidance of thinking or talking about the event
* avoidance of reminders such as activities, places or people
* amnesia for important aspect of trauma
* loss of interest in activities
* detachment
* emotional numbing
* sense of foreshortened future
63
Outline hyperarousal symptoms.
* sleep disturbance
* irritability / anger
* concentration difficulties
* hypervigilance
* exaggerated startle response
64
Outline the DSM V criteria for PTSD.
* traumatic event(s) – no longer need emotional response at time of trauma (now criterion D)
* intrusive symptoms: 1 or more (of 5)
* avoidance symptoms: 1 or both (…of 2)
* negative alterations in cognitions & mood 1 or more (of 7)
* increased arousal & reactivity: 2 or more (of 6)
* specify whether with dissociative symptoms
* duration 1 month
* distress and impairment in social or occupational functioning
65
What is criterion D for DSM V criteria for PTSD?
Negative alterations in cognitions and mood, associated with the traumatic event(s), beginning or worsening after the TE.
66
Give 2 examples of criterion D for DSM V criteria for PTSD?
* Persistent & exaggerated negative beliefs or expectations about oneself, others or the world (e.g., I am bad; the world is completely dangerous)
* Persistent, distorted cognitions about the cause or consequences of the TE(s) that lead the individual to blame himself/herself or others
Persistent negative emotional state (e.g fear, horror, anger, guilt or shame)
67
What is criterion E for PTSD in DSM V?
Marked alterations in arousal and reactivity associated with the TE . . .reckless or self-destructive behaviour
68
TE
traumatic event
69
Where are defence and orienting responses, like basic emotional systems, generated?
In the midbrain
70
What is the brainstem, including the midbrain, the major influencer of?
The autonomic nervous system
71
What type of processing is the mammalian brain responsible for?
'Top-down'
72
What type of processing is the reptilian brain responsible for?
'Down-up'
73
What does the hippocampus have a role in?
Declarative or explicit memory, and the stress response
74
What does the amygdala have a role in?
Fear, both during the trauma and its recollection
75
Where do changes to the hippocampus appear in adult trauma?
RIGHT
76
Where do changes to the hippocampus appear in childhood trauma?
LEFT
77
There is an apparent paradox at the heart of neurobiological and imaging studies in PTSD. What is this?
High cortisol levels damage the hippocampus BUT cortisol levels are low in PTSD
78
Suggest an explanation from why there is high cortisol levels in acute stress but low in PTSD?
Receptors for cortisol are more sensitive in people with PTSD – at the level of the pituitary gland
79
What condition is decreased hippocampal volume associated with?
Bipolar disorder
80
What area of the brain gives people such vivid memories of traumatic events in that 'it feels like yesterday'?
Brocca's area
81
Impairment of what is related to amygdala damage?
Emotional event memory
82
In what condition will damage to amygdala be seen?
Alzheimers
83
When a person is under threat, what shifts in brain activity occur?
Activity shifts to PAG
84
What happens to the brain when someone accesses personal traumatic memories?
Deactivation of Brocca's area occurs
85
What may explain the 'timeless' quality of traumatic memory?
Right hemispheric lateralisation
86
What are 2 trauma focussed treatments?
* CBT
| * EMDR
87
What type of approach is generally accepted for the treatment of complex PTSD?
A phased approach.
| although evidence base is not strong
88
Outline the structure of a phase approach in the treatment of complex PTSD.
* Stabilisation and resourcing (incl ‘safety’).
* Reprocessing of trauma memories/material.
* Reintegration.
89
When should medication be considered in PTSD?
In the acute stage if patients are symptomatic
90
Give examples of medications for PTSD that non specialists can prescribe.
* Paroxetine
| * Mirtazapine
91
Give examples of medications that specialists can prescribe for PTSD.
* Amitriptyline
| * Phenelzine
92
Suggest alternative medications that can be used in the treatment of PTSD.
Prazosin, atypical antipsychotics or mood stabilizers (carbamazepine).
93
PTSD is NOT.....
A normal adaptation to severe, traumatic stress
A normal response to trauma
The inevitable response to trauma
94
Most trauma exposed patients do NOT develop PTSD
TRUE
95
Outline the psychological treatment for PTSD.
– CBT / EMDR for single event PTSD / more straightforward presentations
– neither are sufficient for complex PTSD
– sadly, guidelines don’t always guide
96
'Disasters' can be?
Individual or collective
97
Many people can recover quickly from PTSD or only have brief stress
TRUE
