post traumatic stress disorder (PTSD)

Identify the psychotherapeutic options for preventing and treating PTSD

trauma focused CBT )cognitive behavioural therapy. CBT: cognition, emotions and behaviour these are 3 components of CBT. it aims to challenge the negative thoughts/beliefs associated with the traumatic event to influence emotion and behaviour.

re-experiencing symtoms

trauma is re-experienced through flashbacks / nightmares. they feel "real" for the patient . often described as being in a film: at first the patient might feel like they are in the film but perspective might change to an observer as they recover.

PTSD presentation

- 4 symptoms described above can develop immediately but in some <15% they are delayed. - PTSD patients may not be able to seek help for months/years despite considerable distress. - diagnosis of PTSD can be difficult as they avoid talking about their problems.

Discuss the psychological factors associated with PTSD

- personal impact of the event i.e the meaning attached to the event. - the extent of the perceived control over future threats - how one is prepared to deal with the experience - coping abilities - one's beliefs and assumptions about the trauma - social support after the event

mechanism of the stress response

1. hypothalamus to secretes CRF. 2. CFR stimulates pituitary gland (anterior lobe) to secrete ACTH into systemic circulation, which acts on the adrenal glands (adrenal cortex) to secrete cortisol which ensures blood sugar levels are maintained (promotes glycogenolysis). 3. the hypothalamus also stimulates the adrenal medulla to secrete catecholamines (NE, epinephrine), functions to increases HR, CO, BP (peripheral vasoconstriction) etc.

railway spine

this was a 19th century diagnosis, patients clinically presented with spinal pain following a railroad accident. initially attributed to solely being physical but later accounted for psychological trauma.

what are the characteristics of resilient people

1. can adapt to challenges 2. sense of continuity in their beliefs about themselves and the world 3. able to regenerate positive experiences, even when faced with a potentially traumatic experience.

Discuss the predictors of PTSD

1. characteristics of the event 2. characteristics of the person

prevention of PTSD

1. psychological debriefing: talking to a counsellor soon after the trauma to prevent the development of PTSD. This is usually single session. (this is not recommended). *psychological debriefing refers to this single session. there is evidence that psychological debriefing can actually increase the risk of developing PTSD by causing secondary traumatisation, medicalise normal distress, may prevent protective responses such as denial and distancing (which can be helpful in preventing development of PTSD) this is not endorsed by NICE guidelines.

resilience study 9/11 (September 11 attacks)

2752 participants from the new york area 65% had only 1 or no PTSD symptom during the first 6 months these people exhibited resilience, the adult capacity to maintain healthy psychological and physical function when faced with a potentially traumatic experience.

PTSD and medical conditions

also associated with medical conditions with a sudden onset or conditions that are life threatening as these are traumatic experiences. examples include MI, stroke, HIV, cancer etc. also the prolonged treatment are unpleasant. can have flashbacks to operating theatre for example. be alert to PSTD symptoms in patients with such medical conditions described above.

avoidance

avoidance of thoughts, feelings, people, places etc. remind the sufferer of the event.

Discuss the characteristics of resilient people

capacity to maintain healthy psychological and physical functioning when faced with a potentially traumatic event, therefore do not develop PTSD.

characteristics of the events

characteristics of event: natural disasters (e.g tsunami) vs man-made disasters (e.g chernobyl). man-made disasters appear to cause PTSD than natural disasters. also how deliberate the man-made disaster is also important in development of PTSD.

shell shock

concussion of artillery shells caused CNS damage. this does not explain the cases of shock or distress caused among those who were not exposed to exploding artillery shells.

what does it mean by hyperarousal

insomnia irritable, bursts of anger difficulty concentrating hypervigiliant - always on guard

post traumatic stress disorder

intense, persistent feelings of anxiety caused by a traumatic experience. 3 components to the traumatic experience: 1) threatens life or well-being 2) overwhelms coping abilities 3) challenges assumptions that we make about the world around us. it is clearly an experience of serious nature.

incidence of PTSD?

it depends on the event: - following rape: 80% incidence rate - following witnessing/experiencing someone's tragic death: 30% incidence rate - following motor vehicle accidents with injury: 23% incidence rate it is clear that the incidence rate varies depending on the event.

emotional numbing

lack of ability to experience feelings, they become detached.

physiology of PTSD?

patients with PTSD display substantially higher level of catecholamines compared to those without PSTD. they also show lower levels of cortisol (adrenal glands become chronically fatigued) low levels of circulating cortisol associated with blood sugar imbalanced (hypoglycaemia), fatigue, sleep disruption, lowered immune function etc. https://adrenalfatigue.org/cortisol-adrenal-function/

Identify the 4 clusters of symptoms associated with PTSD

re-experiecing symptoms avoidance of reminders of trauma hyperarousal emotional numbing

how long do symptoms need to last for in order to be diagnosed with PTSD?

symptoms must present for more than 3 months following the trauma

what is the stress response?

the flight or fight response in response to stressors. we either fight or runway from the stressor (potentially harmful situation)

characteristics of the person

vulnerability factors: not all people exposed to traumatic experience develop PTSD. those who are most vulnerable and more susceptible to developing PTSD are those who have experienced childhood trauma, early separation from parents, depression or anxiety, family history of depression/anxiety, lower socioeconomic background, gender (women at a higher risk), younger and older age groups, those belong to a minority status (e.g. refugees)