Trauma and stress disorders Flashcards Preview

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Flashcards in Trauma and stress disorders Deck (77):
1

What are the four major reactions to trauma?

-Anxiety and fear
-Dysphoria and anhedonia
-Anger and aggression
-Dissociation

2

What is reactive attachment disorder?

-Pattern of inhibited and emotionally withdrawn behavior toward adult caregivers, after a child has experience extreme of insufficient care

-Persistent social and emotional disturbance

3

What causes reactive attachment disorder? (3)

-Lack of emotional needs for comfort, stimulation, and affection
-Repeated changes in primary caregivers
-Living in settings with limited opportunities to form attachments with caregivers

4

True or false: developmental delays commonly occur with reactive attachment disorders

True

5

What indicates a better prognosis with reactive attachment disorder? (2)

With excellent caregiving environment following the neglect, and help received at an earlier age

6

What is disinhibited social engagement disorder? What are the 4 characteristics of their behavior?

-Child actively approaches and interacts with unfamiliar adults, and exhibits 2+ of:
-Lack of reticence in approaching
-Overly familiar verbal or physical behavior
-Diminished checking with adult caregiver
-Willingness to go off with unfamiliar adult w/o hesitation

7

What percent of severely neglected kids develop disinhibited social engagement?

20%

8

Which is more common: disinhibited social engagement disorder or reactive attachment disorder? Which has a worse prognosis?

Disinhibited social engagement disorder x2

9

At what age will disinhibited social engagement disorder not develop (assuming adequate care prior to that point)?

If older than 2 years

10

Which is an externalizing and which an internalizing response to a lack of appropriate care: disinhibited social engagement disorder and reactive attachment disorder?

Internalizing = RAD
Externalizing = DSED

11

What is the treatment for RAD or DSED? (2)

-Family therapy if appropriate
-Psychosocial interventions to address unmet basic needs

12

What are the diagnostic criteria for PTSD, in terms of exposures (4)?

Exposure to:
-Direct experience
-Direct witness it
-Learning event occurred to a close person
-Repeated personal exposure to aversive details of traumatic events

13

What are the symptoms of PTSD? (5)

-Recurrent intrusive memories, dreams or dissociated flashbacks
-Psychological distress with internal or external cues
-Physiological rxns to internal or external cues
-Avoidance of memories

14

What are the five major categories of symptoms for PTSD?

1. exposure to actual or threatened death etc
2. Intrusive symptoms
3. Persistent avoidance
4. Negative alterations in cognitions
5. Alterations in arousal and reactivity

15

What are the negative alterations in cognition and mood associated with PTSD? (6)

-Unable to recall important aspects of trauma
-Exaggerated negative beliefs/expectations
-Distorted cognitions about cause or consequences
-Persistent negative emotional state
-Feelings of estrangement/detachment
-Inability to experience positive emotions

16

What is the duration for PTSD to meet the diagnostic criteria?

More than 1 month

17

What are the two major dissociative symptoms with PTSD?

-Depersonalization (you're not human)
-Derealization (nothing is real)

18

PTSD can occur at any age after what?

1 year

19

Symptoms of PTSD usually occur within what timeframe after the event?

3 months, but can be years

20

What are the risk factors for PTSD?

-Severity/duration of trauma
-Prior exposure to trauma

21

Is female or male sex a risk factor for the development of PTSD?

Female

22

Is lower or higher intelligence a risk factor for PTSD? Higher or lower income?

Lower intelligence
Lower income

23

What fraction of adults with PTSD will have remission within 12 months?

1/2

24

What is the treatment for PTSD in terms of trauma focused CBT? (3)

Trauma focused CBT:
-anxiety management
-Confrontation of traumatic memories
-Reworking distorted cognitions

25

What is the pharmacotherapy for PTSD?

-SSRIs/SNRIs
-Prazosin (reduces dreams)

26

What is the role of benzos in the treatment for PTSD?

Do not use

27

What is the foundation for psychotherapy for PTSD?

Exposing people to the trauma in a therapeutic manner

28

What is the MOA of prazosin? What is the use of treatment in PTSD?

-Alpha-1 antagonist
-Reduces nightmares

29

Within what timeframe is starting of treatment and early social support particularly effective in treating PTSD?

Within 3 months

30

Is a high level of functioning pre-trauma a good or bad prognostic indicator for PTSD?

Good

31

What is the central characteristic for complex PTSD?

Chronic trauma involving totalitarian control for an extended period of time (months to years)

32

What are the cognitive effects of complex PTSD?

Intense preoccupation with the perpetrator (attachment to the perpetrator)

33

What are the affected regulation problems with complex PTSD?

Persistent dysphoria--chronic suicidality

34

What are the consciousness problems with complex PTSD?

Amnesia for trauma experience; transient dissociative episodes
-Feel crazy

35

What are the self perception problems with complex PTSD?

Helplessness, shame and guilt

Defiled, stigmatized, an unlike other people

36

What should never be done with complex PTSD?

Try to control them

37

What is the appropriate approach to complex PTSD?

Gentle, and supportive

38

What type of medical history is characteristic for complex PTSD?

A lot of various somatic complaints, with confusing presentations

39

What is acute stress disorder?

Timeframe of anxiety within 1 month following event--more than 1 month = PTSD

40

What are the general categories of acute stress disorder diagnostic criteria?

1. Intrusive symptoms
2. Negative mood
3. Dissociative symptoms
4. Avoidance
5. Arousal symptoms

41

What is the timeframe in which acute stress disorder occurs in?

3 days after event to less than 1 month (more than 1 month is PTSD)

42

What percent of people get acute stress disorder following exposure to trauma? When does it increase markedly?

Less than 20%

If done on purpose, much more prevalent

43

What is the treatment for acute stress disorder?

Similar to PTSD--secondary prevention of PTSD

44

What are the current goals with acute stress disorder?

Normalize symptoms and reactions, and facilitate positive coping strategies

45

What are adjustment disorders?

Emotional or behavioral symptoms in response to an identifiable stressors (but not significant trauma) occurring within 3 months of stressors onset

46

What are the s/sx of adjustment disorder? (2)

-Distress is out of proportion to the severity or intensity
-impairment in social work

47

When is the timeframe for diagnosing adjustment disorder?

Must RESOLVE within 6 months

48

What is the general prognosis with adjustment disorders?

Generally good

49

What is the prevalence of adjustment disorders?

2-8%

50

What is the role of support groups with adjustment disorders?

Helpful

51

What is the treatment for adjustment disorder? (3)

Psychotherapy
-reduce the stressor
-improving healthy coping
-Optimize support

52

How can you encourage resilience with adjustment disorders?

-Faith or spirituality
-humor
-Role models
-Social support
-Life's mission

53

What are dissociative disorders? (BASK model)

Separation of:
-Behavior
-Affect
-Sensation
-Knowledge

54

True or false: some amount of dissociation can be normal

True

55

What is the stepwise examples of dissociation?

-Finding yourself dressed in clothes you don't remember putting on
-Feeling as though you are standing next to yourself, watching
-Looking in a mirror and not recognizing yourself

56

What is dissociative identity disorder? (3)

-Disruption of identity--2 or more personality states involving discontinuity in sense of self and agency (split personality disorder)
-Gaps in recall of events
-Distress and/or impairment across one's life

57

What must you always be certain of prior to diagnosing dissociative identity disorder?

Not a normal part of accepted cultural or religious practices

58

What is dissociative personality disorder strongly associated with?

Child abuse

59

True or false: auditory hallucinations is an exclusion criteria for dissociative personality disorder

False--common and may be confused with psychosis

Antipsychotics will not affect this however

60

What is the usual female presentation of dissociative identity disorders? Males?

Females = dissociative states

Males = violent or criminal

61

What is the usual cause of dissociative disorder?

Strongly associated with severe child abuse

62

What are the 3 major s/sx of reactive attachment disorder?

-Minimal social/environmental responsiveness to others
-Limited positive affect
-Unexplained irritability/sadness/fearfulness

63

How old must a child be to be diagnosed with reactive attachment disorder?

9 months, and began before 5

64

What causes disinhibited social engagement disorder?

Lack of a consistent caregiver or not having emotional needs met

65

What are the two major ways to distinguish between auditory hallucinations 2/2 dissociative personality disorder, and those from psychosis?

Psychosis = voices from outside, and will respond to antipsychotics

Dissociative personality disorder = voices from within, and will not response to antipsychotics

66

What is the treatment for dissociative personality disorder?

-Standard PTSD treatment
-Psychotherapy

67

What is dissociative amnesia? What must be true for this to be diagnosed?

-Inability to recall important autobiographical info, usually of a traumatic or stressful nature
-is distressing

68

What is the treatment for generalized amnesia?

Similar to DID

69

What is depersonalization disorder?

Being an outside observer with respect to one's own thoughts or feelings

70

What is derealization disorder?

Being outside observer with respect to surroundings

71

True or false: In both derealization and depersonalization disorders, reality testing is not intact

False--is intact

72

True or false: occasional feelings of derealization or depersonalization is common

True

73

What is the mean age of onset of derealization or depersonalization disorder?

16

74

What is the prevalence of of derealization or depersonalization disorder

1-2%

75

Which gender is more affected with of derealization or depersonalization disorder?

Equal

76

What is the common history prior to of derealization or depersonalization disorder?

Emotional abuse and neglect

77

What is the treatment for of derealization or depersonalization disorder?

No controlled trials for psychotherapy are available

(Lamotrigine?)