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Enduring personality changes after a catastrophic experience may be diagnosed if the personality change was present for less than 2 years.
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.
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.
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.
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.
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%.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
