Trauma and stressor related disorders Flashcards
(20 cards)
What is the clinical definition of an ADJUSTMENT DISORDER?
Adjustment disorder = An emotional or behavioural reaction to a NON-LIFE THREATENING adverse event or psychosocial stressor.
- The reaction is considered to be unhealthy or excessive.
ADJUSTMENT DISORDER:
1. What is the timeframe for the initial presentation of symptoms post stressor?
2. How long do symptoms persist for post stressor?
3. Does this disorder cause minimal, moderate, or significant impairment in occupations and areas of functioning?
- Initial presentation = within 3 MONTHS post stressor.
- Symptoms do NOT persist for longer than 6 MONTHS post stressor has terminated.
- Adjustment disorders causes SIGNIFICANT impairment in social, occupational, or other important areas of functioning.
ADJUSTMENT DISORDER:
List possible precipitants.
- Loss of employment or job change
- Ending of a relationship
- Residential move
- An injury or illness
- Natural disaster
- Living in difficult conditions
- Difficulty at school or work
- Family problems
- Financial difficulties
- Injury, disease, or death of a loved one
ADJUSTMENT DISORDER:
What are the 6 subtypes of Adjustment disorders and the clinical features of each?
1.Unspecified: includes physical symptoms (e.g. headache, heart palpitations etc.).
2. With mixed disturbance of emotions and conduct: includes anxiety, depression, and behavioural problems.
3. With disturbance of conduct: includes behavioural problems.
4. With depressed mood: includes feelings of sadness, hopelessness, crying, lack of joy from previous pleasurable things.
5. With anxiety: includes worry, nervousness, poor concentration.
6. With mixed anxiety and depressed mood: includes symptoms of both anxiety and depression.
ADJUSTMENT DISORDER:
What are the risk factors for developing Adjustment Disorder?
- Previously experiencing, witnessing, or having knowledge of a traumatic event.
- Previous or current mental health disorders.
- History of dissociative reactions to past traumatic events.
- Being younger than 40 years old.
- Lower educational level
ADJUSTMENT DISORDER:
Name 5 possible differential diagnoses.
- Grief - normal stress reaction or bereavement
- Major depressive disorder
- Generalised anxiety disorder (GAD) - if symptoms of anxiety last >6 months
- PTSD and acute stress disorder - if stressor is a traumatic event (Adjustment disorder’s stressor is a life event NOT a traumatic event)
- Personality disorders
ACUTE STRESS DISORDER:
Provide a clinical description of Acute Stress Disorder.
Acute stress disorder = the development of a strong psychological / physiological reaction to a traumatic event characterised by ACUTE SYMPTOM ONSET and the persistence of symptoms for a least 3 DAYS and up to 1 MONTH.
ACUTE STRESS DISORDERS.
List some associated features.
- Catastrophic or extremely negative thoughts about their role in the traumatic event.
- Interpretation of symptoms in a catastrophic manner (e.g. losing one’s mind).
- Panic attacks - triggered by trauma reminders or spontaneous.
- Post concussive symptoms - headache, dizziness, sensitivity to light, and irritability.
- Chaotic or impulsive behaviour.
ACUTE STRESS DISORDER:
What are the five categories of the clinical features of Acute Stress Disorder?
INDIA
I: Intrusion: distressing memories, distressing dreams, flashbacks, distressing reactions to internal and external cues.
N: Negative mood: inability to experience happiness or pleasure.
D: Dissociation: depersonalisation / derealisation, feeling dazed, time slowing.
I: Increased arousal: decreased sleep, decreased concentration, increased vigilance, increased startle response, irritability and anger outbursts.
A: Avoidance: avoiding memories or reminders of the trauma.
** Diagnosis requires 9 symptoms out of the 5 categories.
** Causes significant distress / impairment in social, occupational, or other important areas of functioning.
ACUTE STRESS DISORDER:
Explain the stressor, according to DSM 5 criteria A, that causes Acute Stress Disorder.
Stressor = Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways:
* Directly experiencing the traumatic event.
* Witnessing (in person) the event that occurred to others.
* Learning that a traumatic event (accidental or violent) has occurred to someone close to you (family / friend).
* Experiencing repeated or extreme exposure to averse details of the traumatic event(s).
ACUTE STRESS DISORDER:
Name the three categories that detail the risk factors for the development of Acute Stress Disorder.
(List the associated risk factors that belong to each category)
- TEMPERAMENTAL:
* Previous mental illness
* Increased negative affectivity (neuroticism)
* Exaggerated appraisals of future harm
* Guilt and hopelessness - ENVIRONMENTAL:
* Exposure to a traumatic event
* History of prior trauma - GENETIC AND PHYSIOLOGICAL:
* Females at greater risk
* Elevated reactivity prior to trauma exposure
ACUTE STRESS DISORDER:
What does the diagnosis progress to if symptoms persist for >1 month?
Acute stress disorder —> PTSD
PTSD:
Provide a clinical description of for the following condition: Post-traumatic Stress Disorder.
PTSD = A psychiatric disorder that may occur in people who have experienced or witnessed a TRAUMATIC EVENT, series of events or set of circumstances (e.g. natural disasters, serious accidents, terrorist acts, war / combat, rape / sexual assault, historical trauma, intimate partner violence, or bullying).
PTSD:
List the clinical presenting features of PTSD.
- Intense, disturbing thoughts and feelings related to the experience.
- Reliving the event through flashbacks or nightmares.
- Sadness, fear or anger.
- Detachment or estrangement from other people.
- Avoidance of situations or people that remind them of the traumatic event.
- Strong negative reactions to something as ordinary as a loud noise or an accidental touch.
PTSD:
What are the risk factors for PTSD?
Pre-trauma risk factors:
* Female gender
* Younger age
* Neuroticism (Borderline PD)
* Lower intellectual capacity
* Lower SES
* Pre-existing mood and anxiety disorders, previous PTSD
* Family history
* CNS function abnormalities
*** There are also peri-trauma and post-trauma risk factors (obvious connections)
PTSD:
What are the clinical features of PTSD?
- Exposure to traumatic event… (same as acute stress disorder - yourself/some-one close to you/repeated exposure/witnessing)
- Significant distress and impairment in functioning.
- Disturbances last >4 WEEKS.
PTSD:
What does each letter stand for in the acronym “TRAUMMA” - which details the features of PTSD?
T: Traumatic event
R: Re-experience
A: Avoidance
U: Unable to function
M: More than a month
M: Mood and cognition altered
A: Arousal in increased
PTSD:
What are the two subtypes / specifications of PTSD?
- With dissociative symptoms… (depersonalisation or derealisation)
- With delayed expression… (full diagnostic criteria only met >6 months after the event)
PTSD:
What is ‘Complex PTSD’?
Complex PTSD = PTSD that results from exposure to long term trauma
PTSD:
List some good prognostic factors and bad prognostic factors for PTSD.
GOOD prognostic factors:
* Rapid onset of symptoms
* Short duration of symptoms (<6 months)
* Good premorbid functioning
* Strong social support
* Absence of other psychiatric, medical, or substance-related disorders
BAD prognostic factors:
* Physical disability
* Pre-existing psychiatric disorder / personality disorder
* Comorbidity - other psych disorders present
* Poor social support
