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MSc Psychosocial > Trauma > Flashcards

Trauma Flashcards

1
Q

Does trauma increase the risk for psychosis?

A

Yes, victimisation, descrimination, bullying, migration, seperation and loss, war trauma, ubran dwelling, childhood truma/ avercity, any trauma exposure have all been found to increase the risk for psychosis

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2
Q

What is the implicated biological mechanisms for trauma ‘causing’ psychosis?

A

HPA axis disregulation

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3
Q

Clinical and functional outcomes of PTSD on psychosis

A

Greater PTSD symptomatology results in:
* Higher levels of depression/affective symptoms
* Higher risk for psychosis
* Increased severity of psychotic & negative symptoms
* Earlier onset of full threshold psychosis
* More hospitalisations
* Increased rates of suicide
* Increased risk of substance use
* Worse functional outcome

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4
Q

Which types of trauma are associated with with psychosis symptoms?

A
  • Childhood sexual abuse- Auditory hallucinations
  • Bullying- Persecutory delusions
  • Neglect- Persecutory delusions
  • Emotional Abuse- Persecutory & referential delusions
  • Disorganised parental communication- Thought Disorder
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5
Q

What biological mechanisms are related to trauma having an impact on psychosis?

A
  • Neurobiological disruption:
  • HPA axis over-activation –> increases dopamine release
  • Reduced hippocampal volume in clients with psychosis
  • Reduced BDNF – which is necessary for hippocampal neurogenesis – following exposure to stress and in those with psychosis
  • Impaired Neurocognition
    *Increased stress sensitivity
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6
Q

Four Subgroups of Trauma in Psychosis
(Stevens, 2017

A

Traumatic Psychosis
Neurodevelopmental Psychosis
Psychotic PTSD
Psychosis-Induced PTSD

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7
Q

Traumatic Psychosis

A

Childhood trauma leading to schematic vulnerability, exacerbated by later triggers e.g. hear voice of perpetrator

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8
Q

Neurodevelopmental Psychosis

A

Genetic/organic vulnerability manifesting in affective blunting, poorer premorbid functioning, poor concentration, slowness, making them vulnerable to victimisation

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9
Q

Psychotic PTSD

A

Psychosis secondary to PTSD symptoms. Flashbacks/nightmares/hyper-vigilance, resulting in insomnia and increased arousal leading to emergence of psychosis

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10
Q

Psychosis-Induced PTSD

A

The triggering of PTSD as a result of acute psychosis

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11
Q

Comonnalities between PTSD and psychosis

A
  1. Re-experiencing memories, perceptions, sensations, feelings, nightmares — Hallucinations and delusions, sensory and perceptual intrusions and cogntions.
  2. Hypervigilance/arousal to threat — agitation/ arousal
  3. Avoidance — Expressive & experiential negative symptoms
  4. Negative cognition and mood — Expressive & experiential negative symptoms
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12
Q

NICE (2014) guidelines on PTSD and psychosis

A

Assess people with psychosis for PTSD; if nessesary follow guidelines for PTSD

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13
Q

NICE (2018) PTSD guidelines

A

Consider Eye Movement Desensitisation & Reprocessing (EMDR)
Offer individual trauma-focused CBT

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14
Q

Cognitive model of PTSD (Ehlers & Clark, 2000)

A

PTSD persistence due to porcessin trauma can leade to serious current threat

It is dirven by:
1. Negative appraisals
2. Memory disturbance
3. Unhelpful cognitve and behavioural strategies

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15
Q

Trauma appraisals

A
  • Believes about self (I am weak, cannot cope, I attract disasters, bad things will always happen to me)
  • Believes about others (Untrustworthy, dangerous, abusers)
  • Believes about the world (Unpredictable, unforgiving, punishing, dangerous)
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16
Q

Unhelpful behavioural mechanisms (coping strategies)

A

The negative trauma appraislas maintain PTSD symptoms by producing negative emotions thus encouraging negative ‘coping’ behaviour

  1. Avoidance
  2. Hypervigilance
  3. Rumination
17
Q

Memories

A

Fragmented, details missing, temporal order
unclear
*BUT- also experience a high frequency of involuntarily triggered intrusive memories involving re- experiencing aspects of the event in a very vivid and emotional way.

Discrepancy between difficulties in intentional recall and easily triggered re-experiencing of the event.–> If they try they can’t remember but if they are triggered they remember all details

18
Q

Re-experiencing

A
  • Sensory impressions in any sensory modality (physical sensations/visual imagery/smells/sounds)
  • Experienced as happening right here right now
  • ‘Affect without recollection’- re-experiencing physiological sensations/emotions associated with the trauma without recollecting
    the event
  • Re-experiencing triggered by wide range of stimuli- temporal rather
    than semantic associations with the event
19
Q

Engagement in PTSD

A

Client pase
Speak with heal-lines/ themes
Promote psychoeducation about trauma-normalising, destigmatising (Explain their experience as PTSD- (intrusions, numbing,
hyper-arousal) are common reactions to a traumatic event.)
Manage intensity of arousal in session (don’t talk about all trauma all at once)
Collaborative, empathic, facilitate trust
Metaphorical panic button (way to escape and not get a panic attack/ feel trapped in the session)
Providing reassurance and support
Reinforcing resilience and strengths
Time-line

20
Q

Types of trauma

A
  • Physical Abuse
  • Sexual Abuse
  • Verbal Abuse
  • Emotional Abuse
  • Neglect
  • Abuse in Childhood vs Adulthood
  • Trauma of psychosis
21
Q

Assessment

A

Risk
Listen out for trauma events
Ask about the worse moment of the traumatic even - traumatic hotspot
Explore what aspect of the memory cause most distress
Triggers to intrusions
Predominant emotion?
Current coping mechanisms
Imagery re-script

22
Q

Challanges of CBT for PTSD

A

*Substantial co-morbidity-what to target first?
[Substance misuse/psychosis/affect?]
* Client disengagement
* Reluctance to discuss the trauma
* Reliving deemed too aversive by client
* Fear of psychosis relapse
* Fear of increasing self-harm & suicidal ideation RISK
* Therapist anxiety about hearing traumatic events
* Traumatising effects on the therapist/Therapist burnout
* Need for supervision & managing self-care

MSc Psychosocial (3 decks)

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