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Psychiatry pro +1700 > Trauma and stress disorders > Flashcards

Trauma and stress disorders Flashcards

1
Q

What are the four major reactions to trauma?

A
  • Anxiety and fear
  • Dysphoria and anhedonia
  • Anger and aggression
  • Dissociation
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2
Q

What is reactive attachment disorder?

A
  • Pattern of inhibited and emotionally withdrawn behavior toward adult caregivers, after a child has experience extreme of insufficient care
  • Persistent social and emotional disturbance
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3
Q

What causes reactive attachment disorder? (3)

A
  • 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
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4
Q

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

A

True

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5
Q

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

A

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

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6
Q

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

A
  • 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
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7
Q

What percent of severely neglected kids develop disinhibited social engagement?

A

20%

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8
Q

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

A

Disinhibited social engagement disorder x2

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9
Q

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

A

If older than 2 years

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10
Q

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

A 
Internalizing = RAD
Externalizing = DSED
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11
Q

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

A
  • Family therapy if appropriate

- Psychosocial interventions to address unmet basic needs

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12
Q

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

A

Exposure to:

  • Direct experience
  • Direct witness it
  • Learning event occurred to a close person
  • Repeated personal exposure to aversive details of traumatic events
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13
Q

What are the symptoms of PTSD? (5)

A
  • Recurrent intrusive memories, dreams or dissociated flashbacks
  • Psychological distress with internal or external cues
  • Physiological rxns to internal or external cues
  • Avoidance of memories
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14
Q

What are the five major categories of symptoms for PTSD?

A
  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
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15
Q

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

A
  • 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
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16
Q

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

A

More than 1 month

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17
Q

What are the two major dissociative symptoms with PTSD?

A
  • Depersonalization (you’re not human)

- Derealization (nothing is real)

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18
Q

PTSD can occur at any age after what?

A

1 year

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19
Q

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

A

3 months, but can be years

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20
Q

What are the risk factors for PTSD?

A
  • Severity/duration of trauma

- Prior exposure to trauma

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21
Q

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

A

Female

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22
Q

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

A

Lower intelligence

Lower income

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23
Q

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

A

1/2

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24
Q

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

A

Trauma focused CBT:

  • anxiety management
  • Confrontation of traumatic memories
  • Reworking distorted cognitions
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25
Q

What is the pharmacotherapy for PTSD?

A
  • SSRIs/SNRIs

- Prazosin (reduces dreams)

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26
Q

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

A

Do not use

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27
Q

What is the foundation for psychotherapy for PTSD?

A

Exposing people to the trauma in a therapeutic manner

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28
Q

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

A
  • Alpha-1 antagonist

- Reduces nightmares

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29
Q

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

A

Within 3 months

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30
Q

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

A

Good

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31
Q

What is the central characteristic for complex PTSD?

A

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

32
Q

What are the cognitive effects of complex PTSD?

A

Intense preoccupation with the perpetrator (attachment to the perpetrator)

33
Q

What are the affected regulation problems with complex PTSD?

A

Persistent dysphoria–chronic suicidality

34
Q

What are the consciousness problems with complex PTSD?

A

Amnesia for trauma experience; transient dissociative episodes
-Feel crazy

35
Q

What are the self perception problems with complex PTSD?

A

Helplessness, shame and guilt

Defiled, stigmatized, an unlike other people

36
Q

What should never be done with complex PTSD?

A

Try to control them

37
Q

What is the appropriate approach to complex PTSD?

A

Gentle, and supportive

38
Q

What type of medical history is characteristic for complex PTSD?

A

A lot of various somatic complaints, with confusing presentations

39
Q

What is acute stress disorder?

A

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

40
Q

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

A
  1. Intrusive symptoms
  2. Negative mood
  3. Dissociative symptoms
  4. Avoidance
  5. Arousal symptoms
41
Q

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

A

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

42
Q

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

A

Less than 20%

If done on purpose, much more prevalent

43
Q

What is the treatment for acute stress disorder?

A

Similar to PTSD–secondary prevention of PTSD

44
Q

What are the current goals with acute stress disorder?

A

Normalize symptoms and reactions, and facilitate positive coping strategies

45
Q

What are adjustment disorders?

A

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

46
Q

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

A
  • Distress is out of proportion to the severity or intensity

- impairment in social work

47
Q

When is the timeframe for diagnosing adjustment disorder?

A

Must RESOLVE within 6 months

48
Q

What is the general prognosis with adjustment disorders?

A

Generally good

49
Q

What is the prevalence of adjustment disorders?

A

2-8%

50
Q

What is the role of support groups with adjustment disorders?

A

Helpful

51
Q

What is the treatment for adjustment disorder? (3)

A

Psychotherapy

  • reduce the stressor
  • improving healthy coping
  • Optimize support
52
Q

How can you encourage resilience with adjustment disorders?

A
  • Faith or spirituality
  • humor
  • Role models
  • Social support
  • Life’s mission
53
Q

What are dissociative disorders? (BASK model)

A

Separation of:

  • Behavior
  • Affect
  • Sensation
  • Knowledge
54
Q

True or false: some amount of dissociation can be normal

A

True

55
Q

What is the stepwise examples of dissociation?

A
  • 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
Q

What is dissociative identity disorder? (3)

A
  • 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
Q

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

A

Not a normal part of accepted cultural or religious practices

58
Q

What is dissociative personality disorder strongly associated with?

A

Child abuse

59
Q

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

A

False–common and may be confused with psychosis

Antipsychotics will not affect this however

60
Q

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

A

Females = dissociative states

Males = violent or criminal

61
Q

What is the usual cause of dissociative disorder?

A

Strongly associated with severe child abuse

62
Q

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

A
  • Minimal social/environmental responsiveness to others
  • Limited positive affect
  • Unexplained irritability/sadness/fearfulness
63
Q

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

A

9 months, and began before 5

64
Q

What causes disinhibited social engagement disorder?

A

Lack of a consistent caregiver or not having emotional needs met

65
Q

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

A

Psychosis = voices from outside, and will respond to antipsychotics

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

66
Q

What is the treatment for dissociative personality disorder?

A
  • Standard PTSD treatment

- Psychotherapy

67
Q

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

A
  • Inability to recall important autobiographical info, usually of a traumatic or stressful nature
  • is distressing
68
Q

What is the treatment for generalized amnesia?

A

Similar to DID

69
Q

What is depersonalization disorder?

A

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

70
Q

What is derealization disorder?

A

Being outside observer with respect to surroundings

71
Q

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

A

False–is intact

72
Q

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

A

True

73
Q

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

A

16

74
Q

What is the prevalence of of derealization or depersonalization disorder

A

1-2%

75
Q

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

A

Equal

76
Q

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

A

Emotional abuse and neglect

77
Q

What is the treatment for of derealization or depersonalization disorder?

A

No controlled trials for psychotherapy are available

Lamotrigine?

Psychiatry pro +1700 (28 decks)

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