BH 3 Trauma and Stressors

An emotional response to a stressful event.

Adjustment disorder definition?

Financial issues, medical illness, or relationship problems.

Typical adjustment-disorder stressors?

One or more unpredictable stressors.

What precipitates adjustment disorder?

Not always.

Does stressor severity predict adjustment-disorder severity?

Yes; children and adults may respond differently.

Can the same stressor affect age groups differently?

School problems, parental rejection, divorce, substance abuse.

Adolescent adjustment-disorder risk factors?

Marital problems, divorce, moving, financial problems.

Adult adjustment-disorder risk factors?

People with disadvantaged life circumstances and frequent stressors.

Who may have increased adjustment-disorder risk?

Women are diagnosed 2× more often.

Adjustment disorder: women vs men?

Adolescents.

Most frequently diagnosed age group for adjustment disorder?

Depression, anxiety, or mixed features.

Adjustment-disorder symptoms in adults?

Physical symptoms.

Adjustment-disorder symptoms in children/elderly?

Assault, reckless driving, excess drinking, legal defaulting, withdrawal.

Adolescent/young-adult behavioral signs of adjustment disorder?

Vegetative signs, insomnia, suicidal behavior.

Other adolescent/young-adult adjustment-disorder signs?

Bereavement, MDD, GAD, substance-related disorder, PTSD.

Adjustment-disorder differential diagnosis?

Within 3 months.

Adjustment disorder: symptom onset after stressor?

Marked distress out of proportion to stressor severity/intensity.

Adjustment disorder: distress criterion?

External context and cultural factors.

What modifies assessment of adjustment-disorder distress?

Significant social, occupational, or other important impairment.

Adjustment disorder: impairment criterion?

No.

Can another mental disorder better explain adjustment disorder?

No.

Can adjustment disorder be an exacerbation of a prior disorder?

No.

Can normal bereavement be adjustment disorder?

No more than 6 additional months.

After a stressor ends, maximum symptom persistence?

Psychotherapy alone.

Adjustment-disorder treatment of choice?

Benzodiazepines.

Adjustment disorder: medication for intense anxiety?

Antipsychotics.

Adjustment disorder: medication for decompensation/psychosis?

Antidepressants.

Adjustment disorder: medication for traumatic grief symptoms?

Generally favorable.

Adjustment-disorder prognosis with treatment?

Within months.

When do most adjustment-disorder patients regain prior function?

Symptoms developing after exposure to traumatic life events.

Acute stress disorder (ASD) definition?

Fear and helplessness.

Typical reaction to trauma in ASD?

Persistent reliving and avoidance of reminders.

Characteristic ASD patterns after trauma?

Severity, duration, and proximity of trauma exposure.

Most important ASD risk factors?

Sufficiently overwhelming to almost anyone.

How severe is an ASD-associated stressor?

War, torture, natural catastrophes, assault, rape, serious accidents.

Traumatic experiences associated with ASD?

Young adults.

ASD is more prevalent in which age group?

Less than 20%.

ASD occurs in what proportion after trauma?

After interpersonal trauma: assault, rape, witnessing a mass shooting.

When are ASD rates highest?

Panic, illusions, hallucinations, aggression, violence, poor impulse control.

ASD possible perceptual/behavioral symptoms?

Depression and substance abuse.

ASD other psychiatric symptoms?

Memory and attention.

ASD can impair what cognitive functions?

Catastrophic or extremely negative thoughts.

Typical ASD thoughts about one's role in trauma?

Chaotic or impulsive behavior.

ASD behavioral pattern that may occur?

Acute grief reactions.

ASD may involve what grief response?

PTSD, adjustment disorder, substance abuse, panic disorder, GAD, MDD.

ASD differential diagnosis?

Actual/threatened death, serious injury, or sexual violation.

ASD Criterion A qualifying trauma?

Directly experiencing the traumatic event.

ASD Criterion A: direct route?

Witnessing the event in person as it occurs to others.

ASD Criterion A: witness route?

Learning it occurred to a close family member or close friend.

ASD Criterion A: learning route?

Repeated/extreme exposure to aversive trauma details (torture)

ASD Criterion A: repeated-exposure route?

No, unless the exposure is work related.

Does media exposure usually meet ASD Criterion A?

9 or more.

How many ASD Criterion B symptoms are required?

Intrusion, negative mood, dissociation, avoidance, arousal.

Five ASD Criterion B symptom categories?

Recurrent, involuntary, intrusive distressing memories.

ASD intrusion sx: memories?

Recurrent distressing dreams related to the event.

ASD intrusion sx: dreams?

Feeling or acting as if the traumatic event is recurring.

ASD intrusion sx: dissociative reactions?

Intense/prolonged distress or marked physiological reactions.

ASD intrusion sx: response to trauma-related cues?

Persistent inability to experience positive emotions.

ASD negative-mood symptom?

Altered sense of reality of surroundings or oneself.

ASD dissociation sx: altered reality symptom?

Inability to remember an important aspect of the trauma.

ASD dissociation sx: memory symptom?

Avoiding distressing trauma-related memories, thoughts, or feelings.

ASD avoidance sx: internal symptom?

Avoiding external reminders that trigger trauma-related distress.

ASD avoidance sx: external symptom?

Sleep disturbance.

ASD arousal sx: sleep symptom?

Irritability/angry outbursts; verbal or physical aggression.

ASD arousal sx: anger symptom?

Hypervigilance.

ASD arousal sx: threat-monitoring symptom?

Problems with concentration.

ASD arousal sx: attention symptom?

Exaggerated startle response.

ASD arousal sx: reactivity symptom?

3 days to 1 month after trauma exposure.

Required ASD duration?

Clinically significant distress or impairment.

ASD functional criterion?

Social, occupational, or other important areas.

Areas of function ASD may impair?

A substance or another medical condition.

ASD must not be attributable to what?

Brief psychotic disorder.

What disorder must not better explain ASD?

Psychotherapy.

ASD treatment of choice?

Support, discussion of event, education about coping mechanisms.

Focus of ASD psychotherapy?

Yes, if necessary.

Can pharmacotherapy be added for ASD?

Self-limiting, but it can progress to PTSD.

Typical ASD course?

Symptoms developing after exposure to traumatic life events.

PTSD definition?

Fear and helplessness.

Typical reaction to trauma in PTSD?

Persistent reliving and avoidance of reminders.

Characteristic PTSD patterns after trauma?

The stressor.

Prime causative factor in PTSD?

Severity, duration, and proximity of trauma exposure.

Most important PTSD risk factors?

About two-thirds.

How many PTSD patients have other mental health disorders?

Depressive, substance abuse, anxiety, bipolar disorders.

Common PTSD comorbidities?

3.5%.

PTSD lifetime incidence in the lecture?

Rape, military combat/captivity, internment, genocide survivors.

Groups with highest PTSD rates in the lecture?

Panic attacks, illusions, hallucinations.

PTSD perceptual/fear symptoms?

Aggression, violence, poor impulse control.

PTSD aggression/control symptoms?

Depression and substance abuse.

PTSD mood/substance symptoms?

Memory and attention.

PTSD can impair what cognitive functions?

Loss of speech.

Developmental regression possible in young children with PTSD?

Paranoid ideation.

Suspicious thinking possible in PTSD?

Frightening dreams.

Dream symptom possible in PTSD?

ASD, adjustment disorder, substance abuse, panic disorder, GAD, MDD.

PTSD differential diagnosis?

Adults, adolescents, and children older than 6.

Who do these PTSD DSM-V criteria apply to?

Lecture directs the learner to DSM-V.

PTSD criteria for children age 6 or younger?

Actual/threatened death, serious injury, or sexual violence.

PTSD Criterion A qualifying trauma?

Directly experiencing the traumatic event.

PTSD Criterion A: direct route?

Witnessing the event in person as it occurs to others.

PTSD Criterion A: witness route?

Learning trauma occurred to close family or a close friend.

PTSD Criterion A: learning route?

Family/friend event must have been violent or accidental.

Learning of death: required qualifier for PTSD Criterion A?