Trauma and Related Disorders Quiz

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Questions and Answers

What is the essential feature that characterizes post-traumatic stress disorder (PTSD)?

Inability to recognize personal identity

Development of symptoms following exposure to a traumatic event (correct)

Presence of chronic pain symptoms

Severe mood swings unrelated to trauma

In which DSM edition was PTSD formally recognized as a diagnostic entity?

DSM-IV

DSM-5

DSM-II

DSM-III (correct)

Which of the following is NOT an intrusion symptom associated with PTSD?

Avoidance of reminders of the trauma (correct)

Repeated distressing dreams

Dissociative reactions like flashbacks

Intense psychological distress to trauma cues

Which example does NOT qualify as a traumatic event linked to PTSD?

Having a chronic illness Signup and view all the answers

Which type of negative alteration in cognition is commonly associated with PTSD?

Inability to remember details related to trauma Signup and view all the answers

What was PTSD previously classified under before it became part of trauma and stressor-related disorders?

Anxiety disorders Signup and view all the answers

Which of the following terms was historically used to describe PTSD during World War I?

Shell shock Signup and view all the answers

What is one common physiological response to reminders of trauma in individuals with PTSD?

Increased physiological arousal Signup and view all the answers

Which of the following is NOT a marked alteration in arousal and reactivity associated with traumatic events?

Ineffective inhibition of the hypothalamus Signup and view all the answers

What is the projected lifetime risk for PTSD at age 75 years in the U.S.?

8.7% Signup and view all the answers

Which brain region is responsible for appraising threats in the fear circuitry associated with PTSD?

Medial prefrontal cortex (mPFC) Signup and view all the answers

What is a common characteristic of PTSD in relation to gender?

Females are more affected and have longer duration symptoms Signup and view all the answers

Which of the following symptoms is NOT associated with hyperarousal in PTSD?

Cognitive distortions Signup and view all the answers

What is a significant anatomical finding in individuals with PTSD?

Reduced volume of the hippocampus Signup and view all the answers

What psychological impact does PTSD have over at least one month?

Significant impact on psychological well-being Signup and view all the answers

What role does the amygdala play in PTSD?

It activates the brainstem response to fear. Signup and view all the answers

What issue arises with the hippocampus in relation to trauma?

It cannot signal safety using contextual cues. Signup and view all the answers

How does the vmPFC function in relation to traumatic learning?

It fails to maintain extinction of conditioned responses. Signup and view all the answers

What physiological changes are often seen in PTSD patients?

Dysregulated levels of adrenaline and cortisol. Signup and view all the answers

What does the exaggerated amygdala activation when exposed to trauma-related stimuli suggest?

Inability to distinguish between safe and threatening cues. Signup and view all the answers

What was found to be the effect of administering propranolol shortly after trauma exposure in relation to PTSD?

It reduces physical reactivity to trauma cues. Signup and view all the answers

Which of the following best describes the role of noradrenaline in PTSD?

It is linked to hyperarousal and traumatic memory formation. Signup and view all the answers

What does the presence of higher numbers of cannabinoid receptors in PTSD patients indicate?

Dysregulated endocannabinoid system post-trauma. Signup and view all the answers

What was the initial theory about noradrenaline and traumatic memory formation?

Strong adrenergic responses may help form durable traumatic memories. Signup and view all the answers

Study Notes

Trauma- and stressor-related disorders, as defined in DSM 5, are characterized by an explicit exposure to a traumatic or stressful event as the diagnostic criterion.

Introduction

Post-traumatic stress disorder (PTSD) is a type of trauma-related disorder.

History of Post-Traumatic Stress Disorder (PTSD)

Early recognition of PTSD-like symptoms included "soldier's heart" (American Civil War), "shell shock" (WWI), combat fatigue (WWII), and delayed stress (Vietnam War).
PTSD was formally recognized as a distinct diagnostic entity in 1980 (DSM-III).
Initially, the recognition of PTSD was met with hesitancy, but current understanding emphasizes the importance of biomarkers in diagnosis, and PTSD is now classified as an anxiety disorder.

Clinical Features of PTSD

The core feature of PTSD is the development of characteristic symptoms following exposure to one or more traumatic events.
Traumatic events can include war experiences (civilian or combatant), threatened or actual physical assault, and threatened or actual sexual violence.
Clinical presentations of PTSD can vary from fear/anxiety to anhedonic/dysphoria, arousal/reactivity, or dissociative symptoms or a combination of these.

PTSD Diagnostic Features

A. Confirmed experience of trauma: Exposure to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing, or learning about it from a close friend or family member. In first responders, this can manifest as repeated or extreme exposure.
B. Presence of intrusion symptoms: These persistent and reemerging symptoms include recurrent, involuntary, intrusive distressing memories or dreams; dissociative reactions (e.g., flashbacks); intense, prolonged psychological distress and physiologic response to trauma-related cues.

PTSD Diagnostic Features (2)

C. Persistent avoidance of stimuli: Avoidance of trauma-related stimuli (people, places, conversations, activities, objects, situations, thoughts, or feelings).
D. Negative alterations in cognitions and mood: Negative beliefs about self, expectations, and feelings of detachment from others, inability to remember key components of the traumatic event, etc.
F. Marked alterations in arousal and reactivity: Increased irritability, angry outbursts, reckless/self-destructive behaviors, hypervigilance, exaggerated startle response, and sleep disturbances. These symptoms must have significantly impacted psychological well-being for at least 1 month.

PTSD Epidemiology

The projected lifetime risk of PTSD in the US at age 75 is 8.7%.
12-month prevalence is approximately 3.5%.
Canada's projected lifetime risk is 9.2%, while the current 1-month rate is 2.4% (2008).
Females show higher rates of PTSD across the lifespan compared to males, often experiencing longer durations of the disease. This difference could be associated with greater trauma exposure, such as rape.
PTSD is associated with a higher risk of suicidality.

What is the Neural Basis of PTSD?

The fear circuitry involves the amygdala, medial prefrontal cortex (mPFC), and hippocampus/hypothalamus.

Fear Circuitry: Traumatic Events

The amygdala becomes hyper-sensitive, and prefrontal cortex activity is reduced, leading to an ineffective inhibition of amygdala response.
The impact of this is hypervigilance, intrusive symptoms, avoidance of trauma-related stimuli, and cognitive distortion.

Structural Anatomical Findings

Reduced volume of hippocampus and ventral medial prefrontal cortex (vmPFC).
This could be a result of pre-existing conditions.
Hippocampal dysfunction impedes context-based safety cues.
vmPFC fails to extinguish conditioned fearful responses.
Reduced cortical capacity to control fear and negative emotions is observed.

Gene x Environment Interactions

Risk for PTSD varies based on the interplay between genetic predisposition and environmental factors. Individuals with a genetic predisposition and significant trauma exposure are more susceptible to developing PTSD, whereas less vulnerable individuals may experience little to no impact.

Functional Anatomical Differences

Exaggerated amygdala activation occurs in response to trauma-related and generic stimuli.
Traumatic events can become unconditioned stimuli, leading to fear responses from exposure to associated stimuli (such as noises or scents).
This heightened response is frequently paired with decreased mPFC activity.

Different Symptoms of PTSD Correlate with Distinct Circuits

Symptoms and correlates, such as avoidance, cognition, mood disorders, arousal and stress, are associated with particular anatomical brain circuits.

Neurobiological Differences

PTSD patients typically experience heightened stress responses in both the sympathetic (SAM) and hypothalamic-pituitary-adrenal (HPA) axes.
Dysregulated adrenaline, noradrenaline, and cortisol levels are common.
Elevated noradrenaline signaling is a potential marker for PTSD.

PTSD Pharmacological Treatment

Propranolol, a beta-receptor antagonist, can be used to prevent noradrenaline binding. It appears to be effective in preventing the consolidation of traumatic memories within the first 20 hours following trauma. Timing is vital, as its efficacy is reduced when administered after memory formation.
Though early data suggests efficacy, findings have been inconsistent and are actively being studied.

Treatment (2): PTSD and Cannabis Use

Cannabis use is associated with a higher risk in PTSD patients.
Reduced endocannabinoids and increased Cannabinoid Receptors in these individuals can suggest possible self-medication or dysregulation of the endocannabinoid system.
However, smoking cannabis exacerbates rather than alleviates the affliction.
Cannabidiol (CBD) may reduce some symptoms.
Enhancing eCB activity offers promising treatment, possibly replacing cannabis use.

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Description

This quiz explores trauma- and stressor-related disorders, with a focus on Post-Traumatic Stress Disorder (PTSD). Participants will learn about the history, clinical features, and diagnostic criteria for PTSD as outlined in the DSM-5. Test your knowledge on this important topic in mental health.