PTSD and trauma

What is the main difference between acute stress reaction and PTSD?

acute stress reaction: within/less than 1 month you have symptoms

PTSD: symptoms last 1+ month

What is the diagnosis?

intrusion, negative mood, dissociation, avoidance, and arousal within 1 month of a traumatic event

acute stress reaction

What is criterion A for PTSD?

stressor

(exposure/witnessing or indirect exposure to a traumatic event)

What is criterion B for PTSD?

intrusive symptoms

(nightmares, flashbacks, etc.)

What is criterion C for PTSD?

avoidance

(avoid reminders, similar situations, etc.)

What is criterion D for PTSD?

negative alterations in cognitions and mood

(inability to recall feature of event, negative beliefs of world or self, etc.)

What is criterion E for PTSD?

alterations in arousal and reactivity

(irritable and aggressive behavior, hypervigilance, exaggerated startle response)

What is criterion F for PTSD?

duration: 1+ month of symptoms

What is criterion G for PTSD?

functional significance

(impaired function in daily activities)

What is criterion H for PTSD?

exclusion: cannot be due to medication, substance, or other illness

What subtype of PTSD is this?

PTSD symptoms AND depersonalization (feeling like this isn’t happening to me) or derealization (this is a dream, this isn’t real)

PTSD with dissociative symptoms

What subtype of PTSD is this?

full diagnosis is not met until 6+ months after event (symptoms may occur immediately but criteria B-H not all met until 6mo)

PTSD with delayed expression

What subtype of PTSD is this?

PTSD in children 6 years or younger

PTSD preschool subtype

What can we use to assess for PTSD?

primary care PTSD screen (PC-PTSD)

this is a series of questions that if 3+ answers are yes you know you need to further evaluate (not diagnostic, just screening)

What is the most well studied form of treatment for PTSD and what are the 3 main subtypes?

CBT

• prolonged exposure

• cognitive processing therapy

• EMDR

What technique/therapy is this?

survivors repeatedly experience traumatic events via imaginal and in vivo exposure in safe situations; aims to reprocess the trauma

prolonged exposure therapy

What technique/therapy is this?

exposure is achieved through written accounts of the traumatic event; aims to investigate feelings and challenge faulty beliefs

cognitive processing therapy

What technique/therapy is this?

CBT where pt imagines traumatic event and clinician moves two fingers in front of their eyes to induce saccadic eye movements until anxiety abates; aims to help pt produce more adaptive thoughts about the event

EMDR

What are the first-line pharmacotherapies and some other options for treating PTSD?

first line: paroxetine and sertraline

others: fluoxetine, venlafaxine, mirtazapine, trazadone, and prazosin (for nightmares)

What are some alternative treatments for PTSD?

complementary and alternative medicine: yoga, acupuncture, tai chi, equine therapy, etc.

mindfulness based stressed reduction: teaches attending to the present moment in a non-judgmental and accepting way

PTSD is often ____ in regards to its prognosis/course and is associated with what two other things?

chronic

has biological effects (increased HTN for example) and increased mortality

What three things are seen in the imaging of patients with PTSD?

1. decreased volume, neuronal activity, and functional integrity of the hippocampus

2. increased amygdala activity (positive correlation with severity of PTSD)

3. inverse relationship with medial prefrontal cortex activity (social cognition, emotional processing, decision-making, and memory)

What are some of the neurobiological changes observed in patients with PTSD?

HPA axis dysregulation (part of endocrine system that regulates body’s rxn to stress), enhanced glutamatergic release, decreased serotonergic release, thyroid function disturbance, and increased sympathetic response (hyperarousal/hypervigilance)

What are some novel treatments for PTSD?

transcranial magnetic stimulation, virtual reality exposure therapy, deep brain stimulation

MDMA, ketamine, psilocybin, or CBD assisted exposure/psychotherapy

What are the 3 types of victims and the 2 types of trauma?

primary victims: happened to them

secondary victims: 1st responders, family members of primary victims, etc.

tertiary victims: people with a connection to the event/place but they are watching/hearing about it from a distance

individual trauma and collective trauma

What are 5 factors that influence recovery after a traumatic event?

• was it natural vs human caused

• degree of personal impact

• severity of event

• probability of recurrence

• community destruction/disruption combined with personal loss

What type of reactions to disasters are these?

trouble concentrating, difficulty making decisions, preoccuptions with the event, recurring dreams/nightmares, questioning spiritual beliefs

cognitive reactions

What type of reactions to disasters are these?

feeling sad/depressed, feeling irritable/angry/resentful, anxiety or fear, being apathetic, overwhelmed, or feeling despair and hopelessness

emotional reactions

What type of reactions to disasters are these?

isolation from others, sleeping problems, increased conflicts with family, hypervigilance, avoiding reminders, crying easily, not eating

behavioral reactions

What type of reactions to disasters are these?

headaches, generalized discomfort, feeling hot or cold, GI issues, fatigue/exhaustion, etc.

physical reactions

What are the special populations in regards to a traumatic event/disaster?

children/youth, older adults, people with disabilities, people with serious mental illness, people with low socioeconomic status, cultural an ethnic groups, and disaster workers

Explain the relationship between PTSD and benzodiazepines

there is no evidence of a PTSD protective benefit with benzodiazepines