How can you further classify individually exposed trauma?

Intentional vs unintentional

What are examples of intentional individual trauma?

Assault robbery rape

What are examples of unintentional individual trauma?

Motor vehicle accident industrial accident

What are your distinct categories for community trauma?

Human-made vs natural

What are examples of human-made community trauma?

Technological issues train/plane crash terrorist attack

What are examples of natural community traumatic events?

Hurricane tornado earthquake flood

What is type 1 trauma?

When there is a single incident that is sudden and unexpected

Tell me about type 2 trauma

That's repetitive trauma ongoing abuse hostage-taking betrayal of trust from primary caregiver expectance of trauma large effect is in children's

What is the difference between centrifugal and centripetal trauma?

Fugal- together only for the time of trauma like a plane crash petal- community that gets destroyed by something

What is the definition of a major incident?

any situation associated with multiple casualties and fatalities, and damage to property, because of natural or unnatural causes, which is beyond what can be coped with ordinarily by the deployment of the emergency services

What determines how traumatic a situation was

The perception of the patient- different people will see different things as more or less traumatic

Is trauma an exceptional event

No, they are usually things that can happen as part of daily life

Is a socioeconomic link to trauma?

Yes - more likely to suffer it if from a poor area or marginalized

Panic is a common response to trauma

False people usually stay rationale and try to help others in trauma

People are dazed in trauma

False they are more active

If you suffer a trauma esp. if recurrent at an early age what is that a massive risk factor for

Chronic depression that will need psych and pharma therapy

Apart from depression, what other mental disorder is highly linked to trauma and neglect at an early age

Bipolar

Are we good at recording the significant trauma that occurs in people’s lives?

No - needs to be in their notes

Will significant trauma affect your physical health?

Yes, especially if it gives PTSD  

What sort of issues with physical health can you get if you have been exposed to significant trauma?

Infection brain disorders hypertension diabetes asthma allergies

What does PTSD do to physical health

It makes you more likely to get chronic conditions affecting cardio, GI, MSK, endocrine, and respiratory systems

What is the point in anxiety and fear?

It promotes survival

How is fear and anxiety linked to PTSD?

There are massive links as their responses that are supposed to be for survival are massively up played

What does one person having PTSD mean for their family

It will have direct effects on their family members at the time but there will also be fall out and more likely to get TSD for the next 7 generations after them

If one is raped and then raped again, what means for their second response?

They are more likely to have a worse response the second time

What are the 2 primitive behaviors that anxiety and fear acutely cause us to do

Freeze or flee- like fight or flight

Where does the fight-or-flight response come from in the brain?

ventral tegmental area

Explain the difference between the freeze and flee responses to fear and anxiety

Freeze- when there is a distant but inescapable threat flee- threat nearby that is escapable

What are the 2 different freeze responses that you can get as a response to fear and anxiety?

Can get a voluntary one where you stop the watch and listen to avoid threat can get an involuntary one where there is an imminent inescapable threat

What is the physical response like in the freeze response to an imminent threat?

Tonic immobility profound, but reversible, motor inhibition made worse if there is direct contact with the threat you lose the ability to vocalize dampen down muscle tremors and chills any pain you may feel

Who is tonic immobility a common response in trauma?

Sexual assault- allows you to be harmed but also survive the attack

What hospital setting is tonic immobility because of fear common in

Intensive care due to delirium

Why does tonic immobility increase survival?

Predator less likely to attack may increase the chance of escape decrease the risk of extreme violence

What are the distinct types of freeze responses you get in fear?

Frozen fight froze flight frozen attack frozen hide attentive freeze (pay attention to everything) attention freeze (focus on the attacker) tonic immobility low arousal freeze

Take me through identifying a threat

Arousal- if unfamiliar stimulus registered arrest alert, muscular change orient scan - search for location locate identify evaluate act reorganize

What will vary how you respond to fear stimuli

Nature of the stimulus (was it gradual or abrupt, familiar, or unfamiliar) internal state of you (are you fully conscious, already alert) previous experience with that stimuli

What are the changes in the brain like as it goes from relaxed to under threat?

Shifts from the ventromedial prefrontal cortex to periaqueductal grey, sup colliculus, and midbrain

What is the neurobiology of PTSD said to be like?

There is a deficiency in the top-down modulation of amygdala activation by the prefrontal cortex

What is the stress response?

A dose-dependent rise in catecholamines and cortisol will then negatively feedback

What are cortisol levels like in PTSD?

Low

What is the ICD class of traumatic events?

The exceptionally threatening or catastrophic event likely to cause pervasive distress in anyone

What is the diagnostic and statistical manual of mental disorders classification of a traumatic event?

Something experienced or witness that had a threat of death or severe injury to self or others with intense fear, helplessness or horror

How long do you have to have had symptoms to be classed as having PTSD?

1 month

If you have symptoms of a post-traumatic event but you have not had them for a month yet, what is it called?

Acute stress disorder

Can you get the delayed onset of PTSD?

Yes, can take up to 6-12months to present

Does PTSD have to significantly impair you?

Yes, will have massive effects on social and occupational functioning

What are your intrusive symptoms of PTSD?

Flashbacks (can be visual, auditory, gustatory, etc.) nightmares- may avoid going to sleep distress accompanying any form of a reminder of the event physiological reactions like heart racing and sweating avoidance symptoms of people and places that may remind you

What are the generalized diverse ways that people can respond to trauma?

Resistant resilient recover chronically suffers post-event get better post-event but never fully and plateau there

What do we have to remember about resilience in trauma victims?

Just because they are resilient in one setting like school doesn't mean they are in another like home

Before experiencing trauma, what is the key thing that will affect your resilience to trauma?

Personal factors; - severe acute stress reactions having low cortisol that was then raised acutely Fx or personal history of mental disorder- loss of job beforehand - extremes of age- genetic predisposition- generation you are from - experiences of trauma - coping mechanisms -hopeless and powerless feelings -personality traits- behavior issues before 15- lower educational status- if lifestyle led to trauma female

During the trauma, what is the chief thing that will affect your resilience to the trauma?

What happens in the trauma; - was it sudden and unexpected - man-made is worse-prolonged exposure makes it a harder-perceived threat to life is worse- grotesque sites and multiple deaths- family member injured

Post-trauma, what is the key thing that will affect your resilience to that trauma

Environmental factors: lack of support network-ongoing life stressors- economic resources- disadvantages- displaced from home and life

What sign as a child is a risk factor for PTSD and why?

Bedwetting past 6 as shows less developed brain

What are your pre-traumatic risk factors for PTSD?

Personal qualities (attachment to others, are you in charge of yourself, males cope better, extremes of age cope worse) childhood trauma, substance misuse and disadvantage, and psych Hx all make it owrselots of life stressors additionally make it worse

Form a minor trauma can a person get a PTSD response

Yes, if they were vulnerable at the time, they can- other way round if not very vulnerable you can deal with large trauma without PTSD response

What are your normal reactions to trauma?

Numbness, shock, and denial fear depression or elation anger and irritability guilt impaired sleep hopelessness perceptual changes avoidance flashbacks hyperarousal and vigilance

What are your psychological reactions post-trauma?

Depression grief reaction panic attacks and agoraphobia alcohol and drug dependence brief hypomania specific related phobias ie travel

Why can you get brief hypomania post-trauma

If you were a responder that helped people you feel great and then you must accept that so many people may have died

What are the most likely traumas to cause PTSD?

Rape and sexual assault veterans burn civil violence RTA.

Is comorbidity common in PTSD

Yes, they tend to also have; - depression drug and alcohol abuse anxiety disorders

What are your intrusive symptoms of PTSD?

Recurrent distressing recollections nightmares flashbacks of any form distress accompanying reminders, physiological reactions

What are your avoidance symptoms for PTSD?

Avoidance of thinking or talking about its avoiders of places or people or activities that remind them amnesia for aspects of trauma loss of interest in activities detachment emotional numbing sense of foreshortened future

What are the hyperarousal symptoms in PTSD?

Sleep disturbance irritability and anger concentration issues hypervigilance exaggerated startle response

What are your associated symptoms of PTSD?

Depersonalization derealization near death and out-of-body experiences survivors guilt performance guilt

What is the diagnostic and statistical manual of mental disorders criteria for diagnosing PTSD?

Traumatic event 1 or more intrusive symptom1 avoidance symptom negative changes to cognition and mood increased arousal and reactivity- need 2 features needs to have lasted for 1 month needs to be impairing social and occupational function

Tell me about the just world hypothesis in trauma

Usually people are raised with core beliefs that the world in benevolent and meaningful and that they are self-worthy but in kids with childhood neglect or trauma they don't have these assumptions so they can’t deal with trauma as well and get depression

Is responses to trauma always negative

No some people can grow after trauma but not that common

What is complex PTSD

This is something that veterans get where the PTSD burns out and they get;- cognitive issues like low self-esteem self-worth and preoccupation with threat- identity disturbance- emotional dysregulation- chronic interpersonal issues- dissociation- somatism - self mutilation, binge purging

In the midbrain you have your periaqueductal grey region, what behaviors is it responsible for?

Seeking rage fear lust care panic and grief play shame

Why is it important to know what functions the PAG in the midbrain is involved in

Because this is the area that is involved in PTSD and trauma

What is the true brain?

It’s the idea that central you have a reptilian brain responsible for autonomic arousal and instinctive responses and then a mammalian brain that does memory attachment and emotional and somatosensory things and then a frontal cortex for cognitive higher functioning

What brain areas are we interested in in PTSD and why

Hippocampus: it has a role in explicit memory and stress response amygdala- role of fear in trauma and its recollection, pre-clinical evidence for role of amygdala in fear

What happens physically to the hippocampus in PTSD

Shrink due to excess cortisol (right if adult trauma left if childhood trauma)

How long does it take post trauma to get hippocampal changes?

>6months

What is a brain risk factor for PTSD?

Small hippocampus

Can the size of the hippocampus recover post PTSD?

Yes

What diseases can reduce hippocampal volume be associated with

Bipolar aging preceding dementia Cushing alcohol missus borderline personality disorder

What is the filtering of information of a stimulus like through the brain?

Thalamus to decide if we are paying attention amygdala to assign an emotional response hippocampus to send it to memory smell goes straight to amygdala

What hormone does the amygdala trigger the release of in threat

Adrenaline

What is the main issue with flashbacks in PTSD?

The side of the brain that does the processing of the stimuli through the thalamus and amygdala is on the right side which has no perception of time so you don't know it its now you are under attack

What is important about the fact that the processing of dangerous stimuli occurs on the right side of the brain

Broca’s area is on the left side of the brain which is why they can’t vocalize their trauma

Why do people struggle to speak about their trauma in PTSD?

Broca’s area is decreased the emotional part of the brain is working not the higher cortical part of the memories are fragmented

Why are visual flashbacks so stressful for PTSD patients?

Because the area of the visual cortex that's activated is the exact same as when they first saw it and the brain can’t work out that this is a different time, so they think they are going through it again

What is a summary of the main brain findings in PTSD?

Under threat activity moves to para hippocampus trophies, you get the increased activity of the amygdala deactivation of Broca’s area when accessing memories right hemisphere lateralization which explains why they can’t differentiate it then from now

Why is the treatment of PTSD difficult?

Delayed treatment poor compliance comorb still in trauma denial loss of trust

Is it mostly therapy or meds we use to treat PTSD?

Therapy

When may you give a drug early in someone’s PTSD treatment?

If they have not slept in weeks

What are the aims of PTSD treatment?

Normalize reactions to memories and triggers enable catharsis to inspire hope and restore safety treat core symptoms limit worsening of symptoms educate on the condition and what is to come

What are the main therapies we give for PTSD and the other general principles?

Cbt EMDR treatment should be long enough, frequent enough, and with the same therapist usually twelve sessions but more if complex meds used if failure to respond

Who can’t we use EMDR for therapy in?

Veterans

What is the main thing you must do in PTSD therapy for it to work?

Exposure therapy so you can change their emotions towards the memories to one that is not threatening

What is the 3-step approach to PTSD therapy?

Stabilize patient and establish safety reprocess the trauma memories/material reintegrate the patient

When may you use meds for PTSD?

Symptomatically in the acute phase if therapy is not working if patient choice or ongoing threat

What are the main meds you will give in PTSD?

SSRI risperidone if hyper-aroused paroxetine or mirtazapine amitriptyline and phenelzine carbamazepine (mood stabilizer)

What medication is good for nightmares in PTSD?

Prazosin