t43 - trauma and stressor disorders

PTSD

-persistent psychological distress following exposure to actual or threatened death, serious injury, or sexual violence

-most do not seek treatment until 4.5 years after sx onset

PTSD patho

-failure of normal fear extinction

-hyperactive amygdala leads to exaggerated fear response

-sympathetic nervous system hyperactivity

-elevated norepinephrine contributes to hypervigilance and exaggerated startle, serotonin dysregulation affects mood and impulse control

PTSD risk factor

-exposure to actual or threatened death, serious injury or sexual violence

-intentional trauma have higher risk of developing PTSD

-combat exposure, sexual violence, childhood trauma

-MVA, natural disaster, medical trauma

Protective factors: resilience, positive coping, strong social support, prior positive life experience, higher socioeconomic resource, early intervention

PTSD sx

-marked cognitive, affective, or behavioral sx in response to reminder of traumatic event

-persist >1 month

-flashbacks, severe anxiety, dissociative episodes, fleeing or combative behavior

-unwanted intrusive memories, nightmares, flashbacks, psychologic distress

-can occur spontaneously or be triggers by event that resemble trauma

-avoidance of stimuli associated with event

-depression and negative mood

-irritability, aggressive physical or verbal behaviors

-headache, GI issue, chronic pain, muscle tension, fatigue

-anxious, hypervigilant, guarded, cant sit still

-asses for suicidal ideation/plan/intent -> up to 20% may attempt suicide

PTSD dx

DSM-5 Criteria

-must be exposed to traumatic event + sx from the following catagories for >1 month

- 1 Intrusion symptoms

- 1 Avoidance symptoms

- 2 Negative effects of cognition and mood

- 2 Altered arousal and reactivity

-Not better explained by something else

Screening

-PCL-5 -> 31-33 suggest PTSD

-Primary care PTSD screen

PTSD tx

Nonpharm

-first line = trauma focused psychotherapy

-sleep hygiene, exercise, stress management

Pharm

-first line = sertraline and paroxetine

-second line = fluoxetine

-prazosin -> help with nightmares

Acute Stress Disorder

-trauma and stressor related disorder characterized by intrusion, negative mood, dissociation, avoidance and arousal sx occuring 3 days - 1 month

-50-80% develop PTSD

Acute Stress Disorder patho

-failure of normal psychological and physiological recovery process in the immediate aftermath of trauma

Acute Stress Disorder etiology

-MVA

-physical assault

-serious accident, natural disaster

-life threatening medical events

Acute Stress Disorder sx

-temporal relation of sx to traumatic event must be present 3 days - 1 month

-intrusive sx, negative mood, dissociative sx, arousal sx

-hypervigilance, withdrawn affect, anxious or depressed mood

Acute Stress Disorder dx

DSM-5 Criteria

-must be exposed to traumatic event + 9 sx across the categories from 3 days - 1 month after exposure

- Intrusion symptoms

- Avoidance symptoms

- Negative effects of cognition and mood

- Altered arousal and reactivity

-Not better explained by something else

Screening

-ASDI, ASDS

Acute stress disorder tx

Nonpharm

-first line = trauma focused psychotherapy

-sleep hygiene, education

-safety planning, social support

adjustment disorder

-maladaptive emotional or behavioral responses to identifiable psychosocial stressor -> response is out of proportion to severity of stressor

-women

-15-25 year old

adjustment disorder patho

-failure of normal stress adaptation and coping mechanism rather than fundamental neurological dysfunction

adjustment disorder etiology

-occur within 3 months of stressor onset

-any type or severity

-can be a single or multiple event

-relationship issues

-occupational/academic concern

-financial issue

-loss

-developmental milestones

adjustment disorder sx

-sx develop within 3 months of onset of identifiable stressors and typically resolve within 6 months after stressor

-depressed mood, sadness, hopelessness

-crying spell, loss of enjoyment, irritability, anger

-decreased performance

-sx do not meet full criteria for another mental disorder

adjustment disorder dx

-only dx when criteria for other specific disorders are not met

-sx develop within 3 months of onset of identifiable stressors and typically resolve within 6 months consequence has ended

adjustment disorder tx

Nonpharm

-first line = psychotherapy or CBT

-stress management

grief and prolonged grief disorder

-higher risk: sudden death, child loss, violent death, poor social support, personal hx of depression

-symptoms persist >12 months

-significant function impairment

grief and prolonged grief disorder sx

-intense yearning/longing

-preoccupation with deceased

-identity disruption

-sense of meaningless

-intense emotional pain

-difficulty re-engaging with life

grief and prolonged grief disorder dx

DSM-5 Criteria

-loss of someone over one year ago

-persistent and pervasive grief response characterized by longing, yearning, and preoccupation with deceased

->3 of the following sx: identity disruption, disbelief, avoidance, intense emotional pain, difficulty reintegrating, emotional numbness, feeling like is meaningless, intense loneliness

grief and prolonged grief disorder tx

Nonpharm

-psychotherapy, psychoeducation, CBT