Questions and Answers
Enduring personality changes after a catastrophic experience may be diagnosed if the personality change was present for less than 2 years.
False
A permanent hostile attitude towards the world is one of the criteria for enduring personality changes after a catastrophic experience.
True
PTSD can be diagnosed in individuals regardless of their prior history of psychiatric disorder.
True
Re-experiencing symptoms of PTSD do not include recurrent distressing dreams.
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Individuals experiencing enduring personality changes after a catastrophic experience may have a personality disorder prior to the event.
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Estimates of PTSD prevalence in the general population range between 6% and 9%.
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Social withdrawal is not a criterion for diagnosing enduring personality changes after a catastrophic experience.
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The only differential diagnosis for PTSD is acute stress disorder.
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Cognitive behaviour therapy is considered the least effective treatment for PTSD.
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The majority of people will experience at least two traumatic events in their lifetime.
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Narrative exposure therapy (NET) was initially designed for patients suffering from PTSD due to multiple traumatic events.
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Exposure therapy in cognitive behaviour therapy involves facing trauma-related situations both in imagination and in reality.
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Women are less likely to develop PTSD in response to traumatic events compared to men.
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Medication is generally recommended as the first-line treatment for PTSD.
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Genetic variation accounts for about one-half of the variance in susceptibility to PTSD.
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Fear conditioning suggests that PTSD patients experience intrusive memories of traumatic events.
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Anxiolytic drugs like benzodiazepines are recommended for long-term use in patients with PTSD.
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Lower intelligence is considered a protective factor against the development of PTSD.
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The effect size for cognitive behavioural treatments compared to waitlist control is around 1.6.
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Changes in the amygdala during PTSD are associated with decreased arousal.
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Eye movement desensitization and reprocessing has a larger evidence base than cognitive behaviour therapy for PTSD.
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Cognitive restructuring involves assessing evidence for and against personal appraisals and assumptions.
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The presence of social support does not influence the likelihood of developing PTSD.
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Around 50% of patients no longer meet the criteria for PTSD after psychological treatment.
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PTSD can develop from witnessing a traumatic event, even if the observer is not directly harmed.
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Mirtazapine has no supportive data regarding its efficacy for PTSD.
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Epidemiological research shows that women tend to experience more traumatic events than men.
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Twin studies have shown that environmental factors contribute significantly to susceptibility to PTSD.
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Individuals exposed to extreme stressors are guaranteed to develop PTSD.
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The term PTSD originated from studies of American soldiers after World War I.
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Re-experiencing, avoidance, and hyperarousal are the three main clinical features of PTSD.
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Symptoms of PTSD can only begin to manifest three months after the initial traumatic event.
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Maladaptive coping responses associated with PTSD can include excessive alcohol use and aggressive behavior.
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Dissociative symptoms, such as depersonalization, are rarely seen in PTSD patients.
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Depressive symptoms, guilt, and shame are common among survivors of disasters related to PTSD.
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ICD-10 includes a category for 'Enduring personality changes after catastrophic experience' which is separate from PTSD.
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The original concept of PTSD suggested that only psychological distress could result from extreme stressors.
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Survivors of traumatic events often experience negative views of themselves and the world.
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Low plasma cortisol levels are consistently observed in all PTSD patients.
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In PTSD, there is an increased startle response linked to noradrenaline.
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The hippocampus is typically larger in patients with PTSD than in those without the disorder.
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Suppression of intrusive memories can help decrease their recurrence in PTSD patients.
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Psychological treatments are generally less effective than pharmacotherapy for treating PTSD.
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Negative appraisals of early symptoms can contribute to the maintenance of PTSD symptoms.
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All PTSD patients experience a significant decrease in activity in the amygdala.
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Cognitive models indicate that individual differences in response to trauma are purely biological.
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Treatment for PTSD may require addressing comorbidities such as depression and substance misuse first.
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Dexamethasone suppression testing shows increased sensitivity in PTSD patients.
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Study Notes
Cognitive Behavioural Treatment
- Cognitive behaviour therapy (CBT) is the preferred treatment for PTSD, encompassing several key components.
- Information is provided on normal stress responses and the necessity of facing traumatic memories or situations.
- Self-monitoring of symptoms is encouraged to track progress.
- Exposure therapy includes imagining feared situations followed by real-life confrontations.
- Patients recall traumatic memories to integrate these into their broader life context.
- Cognitive restructuring involves evaluating and discussing patients’ beliefs and assumptions about their trauma.
- Anger management techniques are employed for those struggling with anger related to their experiences.
- A meta-analysis shows CBT has a therapeutic effect size of around 1.6 compared to waitlist controls, indicating significant effectiveness.
- Roughly 50% of patients cease to meet PTSD criteria following treatment, although some may still experience symptoms.
Eye Movement Desensitization and Reprocessing (EMDR)
- EMDR was developed specifically for PTSD treatment.
- Trials have shown EMDR effects are similar to CBT, yet the supporting evidence is less comprehensive.
- The therapeutic value of eye movements in EMDR is questioned regarding its exposure component.
Narrative Exposure Therapy (NET)
- NET enhances memory processing by framing traumatic experiences within a chronological life narrative.
- Initially developed for victims of multiple traumas, particularly in refugee contexts, NET is delivered successfully by lay therapists and adapted for children.
- The therapy is gaining traction in both low- and middle-income regions, bolstered by an expanding evidence base.
Medication
- Anxiolytics like benzodiazepines should be avoided due to dependency risks in PTSD patients.
- Antidepressants such as SSRIs, SNRIs, tricyclics, and MAO inhibitors have shown effectiveness.
- Mirtazapine and atypical antipsychotics like olanzapine may assist treatment-resistant patients with severe sleep issues.
- The anticonvulsant topiramate shows promise based on limited studies.
- Structured psychotherapies typically yield higher effect sizes than medications and are regarded as the first-line approach for PTSD treatment.
Aetiology
- PTSD necessitates exposure to an exceptionally traumatic event, which need not involve direct harm to the individual.
- Factors such as personal vulnerability, potentially genetic or acquired, influence whether PTSD develops post-trauma.
- Epidemiological studies reveal that while most will encounter a traumatic event, specific types (e.g., interpersonal violence) are more likely to lead to PTSD.
- Women experience PTSD at higher rates than men, even though men encounter more general trauma.
Genetic Factors
- Twin studies indicate a genetic component to susceptibility for PTSD, with genetic variation contributing to approximately one-third of PTSD liability.
- Genetic influences also affect personality traits that might increase risky behaviors, further influencing PTSD risk.
Other Predisposing Factors
- Individual risk factors for PTSD include:
- Previous trauma.
- Personal history of mood or anxiety disorders.
- Female gender.
- Neuroticism.
- Lower intelligence.
- Insufficient social support.
Neurobiological Correlates
- Research highlights the role of monoamine neurotransmitters and HPA axis dysregulation in PTSD.
- Brain imaging reveals:
- Reduced hippocampal volume, impacting memory processing.
- Overactive amygdala associated with traumatic stimuli.
- Decreased activity in the anterior cingulate cortex and prefrontal cortex leading to dysregulated emotional response.
Psychological Factors
- Fear conditioning enhances the symptoms of PTSD through maladaptive responses to trauma.
ICD-10 Criteria for Enduring Personality Changes
- Individuals may exhibit persistent negative attitudes and social withdrawal two years post-trauma, with a distinct change in personality following the event.
Principal Symptoms of PTSD
- Symptoms include:
- Hyperarousal: Irregular anxiety, irritability, insomnia, poor concentration.
- Re-experiencing: Flashbacks, recurrent nightmares, intrusive distressing memories.
- Avoidance: Memory suppression of events, detachment, emotional numbness.
Prevalence of PTSD
- Lifetime prevalence rates in the general population range from 6% to 9%.
- Higher rates may be observed in high-risk groups, such as combat veterans, reaching up to 40%.
Onset and Course
- PTSD symptoms may commence immediately following trauma or up to three months later, with some cases experiencing delayed onset.
Assessment and Treatment
- PTSD assessments encompass a comprehensive review of personal and psychiatric histories and symptom duration.
- Treatment of co-occurring conditions is critical in PTSD management.
- Psychological interventions are preferred, with pharmacological treatments reserved for severe comorbid cases or inadequate psychotherapy responses.
Maintaining Factors
- Negative appraisals of PTSD symptoms and avoidance behaviors can sustain the disorder, complicating recovery and symptom persistence.
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Description
Explore the key components of cognitive behaviour therapy in treating severe stress responses. This quiz covers the importance of confronting traumatic memories, self-monitoring symptoms, and exposure techniques. Test your understanding of how these elements come together in therapy.
