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Psychiatry > Responses to Traumatic stress > Flashcards

Responses to Traumatic stress Flashcards

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1
Q

what are centrifugal and centripetal disasters

A

centrifugal= when individuals are only together at the moment of the disaster (train/ plane crash)

centripetal- affects an existing community (hurricane, tornado, earthquake, flood)

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2
Q

what are type 1 and 2 trauma

A

type 1 trauma
-single incident, enexpected

type 2 (complex) trauma

  • repetitive
  • ongion abuse, hostage taking (piracy), genocide
  • betrayal of trust in primary care giving relationship
  • developmental trauma
  • attachment/ attunement disruption
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3
Q

how common is type 2 trauma

A

may affect as many as 1 in 7 children

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4
Q

which type of trauma is more likely to cause PTSD

A

type 2

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5
Q

what are the types of traumatic event

A

individuals exposed:

  • intentional (assault, robbery, rape)
  • unintentional (RTA, industrial accident)

communities/ populations exposed

  • human made (technological, train/ plain crash)
  • natural disasters
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6
Q

define a major incident

A

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

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7
Q

is trauma/ disasters exceptional events

A

no part of daily life and in some areas/ for some people a repetitive event

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8
Q

who is more likely to be victims (and die) from trauma

A

poor and marginalised people

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9
Q

is panic a common response to a traumatic event

A

no most people behave rationally

panic is rare

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10
Q

are survivors of traumatic events left dazed and apathetic

A

activism is much more common that fatalism
only 15-20% of victims show passive or dazed reactions
after disasters most start reconstruction quickly

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11
Q

what impact can trauma have in later life

A

chronic depression
bipolar disorder
PTSD
can affect physical health (infections, pain disorders, hypertension, diabetes, asthma, allergies)

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12
Q

what physical health effects is PTSD associated with

A

increased mortality

chronic cardio, GI (inc liver disease), MSK, endocrine and resp diseases increased

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13
Q

what does anxiety and fear make us do

A

freeze (distant or inescapable threat)

or to flee (threat nearby and escapable)

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14
Q

what part of brain do decisions such as: Fight, flight, freeze, hide, avoid, attach, submit, despair & uncontrolled activation states
in response to fear originate from

A

PAG (periaqueductal grey) or ventral tegmental area

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15
Q

what is the purpose of the freeze response to fear

A

in distant threats: stop, watch, listen- pattern of vigilance

in inescapable threat: tonic immobility occurs (involuntary state of profound, reversible, motor inhibition), especially when direct physical contact with predator/ aggressor

predators less likely to attack immobile prey
if still may loosen grip increasing chances of escape
decreased risk of extreme fighting with fighting back
some attackers loose interest if victim immobile and unresponsive

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16
Q

what response is seen in 1/3-2/3 of all sexual assault causes

A

tonic immobility

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17
Q

what are the features of tonic immobility

A 
decreased vocalisation 
intermittent eye contact 
rigidity and paralysis 
muscle tremor in extremities 
chills 
unresponsiveness in pain

may be associated with peri-traumatic dissociation

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18
Q

what are the types of freeze response

A 
Frozen fight
Frozen flight
Frozen attach
Frozen hide
Attentive freeze (broad field)
Attention freeze (narrow field)
Tonic immobility
Low arousal freeze
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19
Q

what are the orienting responses

A

Arousal -unfamiliar stimulus registers in nervous system
Arrest -pause in or slowing of movement and activity
Alert -all senses heightened (to take in more information)
Muscular change -both flexion & extension
Orient/scan -search for the location (“where is it”)
Locate -source of the stimulus is found
Identify -novelty is recognised &/or identified
Evaluate -what is it? Is it dangerous/friendly? Do I pay attention?
Take action -not dangerous, normal activity resumed
-dangerous- defensive or emergency sequence activated
Reorganise-the nervous system re-equilibrates

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20
Q

what causes the orienting response to vary

A

the nature of the stimulus: abrupt/ gradual, familiar/ unfamiliar

internal state of the person: existing arousal level, level of consciousness, configuration of mental/ emotional/ physical components

the persons previous experience
-esp past traumatic experience

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21
Q

where in brain is active when dread of capture is felt

Study These Flashcards
A

periaqueductal gray (PAG)

22
Q

what does increased proximity to a predator do to brain activity

Study These Flashcards
A

shifts brain activation from prefrontal cortex to the midbrain Superior Colliculi & periaqueductal gray (PAG)
region responsible for active & passive defence responses

23
Q

PSTD is associated with a deficiency where

Study These Flashcards
A

deficiency in top-down modulation of amygdala activation by the prefrontal cortex

24
Q

what can act as a protective/ resilience factor when exposed to trauma

Study These Flashcards
A

an ability to regulate emotional responses to negative stimuli

25
what are the three looping systems of defence activation
First loop – midbrain/brainstem origin Peri-aqueductal Gray (PAG) & Superior Colliculi (SC) Second loop – Mesolimbic- Dopamine System Third loop – Stimulus-response learning system
26
what can activate the mesolimbic dopamine system (ML-DA)
``` PAG Inputs: FEAR RAGE PANIC/ Grief Shame (dtnorphins, CRF) ``` CARE/Nurturing Play/Joy Sexual Desire (oxytocin, prolactin, opiods)
27
what does the acute stress response lead to
dose-dependent increase in catecholamines and cortisol cortisol acts as to mediate (& shut down) the stress response through negative feedback it acts on the pituitary, hypothalamus, hippocampus and amygdala
28
are cortisol levels high or low in PTSD
low
29
how many people recover from a traumatic event with psychosocial intervention
50%
30
what are the risk factors for PTSD
in trauma: sudden. unexpected events, man made disaster, prolonged exposure, perceived threat to life, multiple deaths/ mutilation (the grotesque), dose response (proximity), personally relevant factors patient: severe actute stress reaction, FHx of mental health, physical injury (patients perception), loss of function, extremes of age, genetic predisposition, past trauma experience, coping styles, hopelessness/ powerlessness, personality traits (anxious), aldolescent behavioural problems, lower education/ intelligence/ socioeconomic status, life style, female, substance missuse environment: lack of support, ongoing life stresses, reactions of others, economic resources, disadvantage, displacement
31
what are the normal reactions to 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 ```
32
what are the psychological reactions to trauma
``` Depression Grief Reactions Panic Attacks +/- agoraphobia Alcohol/Drug Dependence Brief Hypomania Specific Phobias (e.g., travel) ```
33
what is commonly comorbid with PTSD
depression, drug and alcohol abuse, and other anxiety disorders Approximately 80% of patients with PTSD will have >1 co-morbid psychiatric condition
34
what is the diagnostic criteria for PTSD
traumatic event(s) 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) duration 1 month distress and impairment in social or occupational functioning
35
what are intrusive symptoms
``` recurrent distressing recollections nightmares flashbacks, in any modality distress accompanies reminders physiological reactions (fight or flight) ```
36
what are Avoidant & 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
37
what are hyperarousal symptoms
``` sleep disturbance irritability / anger concentration difficulties hypervigilance exaggerated startle response ```
38
what are the associated symptoms of ptsd
``` dissociative symptoms depersonalisation, derealisation, awareness of surroundings near death or out of body experiences survivor guilt performance guilt ```
39
what are the features of complex PSTD
``` PTSD symptoms & Cognitive disturbances- low self-esteem, self-blame, hopelessness, helplessness, pre-occupation with threat Identity disturbance Emotional dysregulation Chronic interpersonal difficulties Dissociation Somatisation Tension reduction activities - binge-purging, self mutilation, substance misuse etc) ```
40
what does the limbic system do
emotional and somatosensory memory, attachment
41
what does the frontal cortex do
Regulatory abilities, cognitive and executive functioning
42
when in brain for memory
hippocampus
43
what is bottom up/top down regulation
Processing led by either Mammalian brain “top-down” processing ``` Reptilian brain “bottom-up” processing acting on fear response, physiological mechanisms, can’t orientate to other things, all about escape ```
44
what parts of the brain are important in PTSD
Hippocampus knowledge of its role in declarative or explicit memory & the stress response Amygdala role of fear during both trauma & its recollection
45
what can happen to the size of the hippocampus after trauma
atrophys
46
what happens to brocas area when individuals access personal traumatic memories
deactivated
47
what might explain the timeless quality of traumatic memories
right hemispheric lateralisation
48
what are the general principles for the treatment of PTSD
Ensure safety before starting treatment management of ongoing trauma (e.g., domestic violence, civil disturbances) create theraputic relationship psychological therapy rather than drugs (CBT/ eye movement desensitisation and reprocessing)- should be long, regular and with same therapist
49
what are the aims of PSTD Tx
``` normalise reactions enable catharsis inspire hope, restore sense of safety &/or trust treat core symptoms and comorbidity limit kindling of symptoms educate ```
50
when should medication for PTSD be considered
Consider symptomatic treatment for acute phase Consider medication second for augmentation of Trauma-focused psychological treatment for chronic PTSD Consider issues of patient choice & ongoing threat
51
is PTSD a stress response
no is an overwhelming of the stress response

Psychiatry (27 decks)

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