Trauma Intervention and Treatment Quiz

Introduction to Psychopathology

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Traumatic and Stressor-Related Disorders

Kinds of Stress or Trauma Exposure

• Exposure to actual or threatened death, serious injury, or sexual violence, including inappropriate sexual experiences.
• Direct experience of the traumatic event(s).
• Witnessing the event(s) as it occurred to others.
• Learning that the event(s) occurred to a close family member or close friend.
• Experiencing repeated or extreme exposure to aversive details, such as first responders collecting human remains or police officers repeatedly exposed to child abuse. This does not apply to exposure through electronic media unless work-related.

Reactions to Extreme Trauma

• Intrusive recollections (daytime flashbacks, nightmares, illusions) and acute distress.
• Dissociative symptoms ("psychic numbing").
• Emotional detachment.
• Being in a "daze."
• Avoidance of trauma-related topics.
• Forgetfulness.
• Time distortion.
• Feeling detached from one's body or surroundings.
• Chronic hyperarousal (e.g., exaggerated startle, insomnia, hypervigilance, motor restlessness).
• Irritability, angry outbursts, and aggressiveness.
• Survival guilt/shame.
• Reckless, impulsive behaviors.

Major Trauma and Stressor-Related Disorders (DSM-5-TR)

• Acute stress disorder: Disability greater than 2 days and less than 1 month. Occurs in 20% of cases without interpersonal assault and 20-50% of cases following interpersonal assault. Involves extreme anxiety interfering with sleep, energy, concentration, causing withdrawal and absenteeism.
• Post-traumatic stress disorder (PTSD): Disability greater than or equal to 1 month. From a traumatic episode or series of episodes. Prevalence depends on both trauma and pre-existing risk factors.
• Complex PTSD (CPTSD): From prolonged trauma. Approximately 10% of people with PTSD show Delayed Expression (insignificant acute symptoms which increase over succeeding months).

Case Studies

• Acute Stress Disorder: A 10-year-old girl studying in India.
• Post-Traumatic Stress Disorder: A 27-year-old infantryman returning from Iraq.
• Case studies discuss specific symptoms and challenges related to acute and PTSD diagnoses based on real life experiences.

Acute and Post-Traumatic Stress Disorders: U.S. Airways Flight 1549

• Captain "Sully" Sullenberger's successful water landing following a plane failure over the Hudson River.
• Demonstrates the impact of traumatic events on individuals and populations.

Post-Traumatic Stress Disorder: U.S. Airways Flight 1549

• Passenger accounts emphasize the initial and ongoing distress experienced after the near catastrophe.
• Passengers report the psychological and emotional strain of trauma experience.

9/11/2001

• Focuses on the significant event of the 9/11/2001 terrorist attacks.

Post-Traumatic Stress Disorder Prevalence

• Lifetime prevalence of ~7% and ~4% worldwide.
• Females more susceptible.
• High prevalence among adolescents, 5-8%.
• ~90% of ASD sufferers develop PTSD.
• 10% of PTSD sufferers experience delayed expression of symptoms.
• Males more likely to show irritability and alcohol or substance abuse.

Common Precipitants of Trauma and Stressor-Related Disorders

• Sexual violence: More than 300,000 completed rapes or attempted rapes annually in the U.S., with notable differences in prevalence among female groups (college vs. non-college).
• Military combat: 18% of combat veterans and 70% of POWs are impacted by PTSD.
• Physical/emotional abuse: Includes childhood sexual or physical abuse, domestic violence or workplace abuse.
• Human calamities: Deliberate violence (bombings, torture etc), Accidents (motor vehicle accidents etc), Physical trauma including illness), Climatic events (floods, earthquakes, etc).

Risk Factors for Developing Trauma/Stressor-Related Disorders

• Severity and chronicity of trauma.
• Family history and/or current mental health disorders (depression, anxiety, or PTSD).
• Racial or ethnic minority status, past adversity, lack of social support.
• Poor coping mechanisms (smoking, drinking, drugs).
• Intergenerational trauma.
• Poor social support.

Complex PTSD (CPTSD)

• Chronic and repetitive trauma over months or years.
• Symptoms more extreme.
• Examples of CPTSD trauma include victim of neglect, emotional, physical, or sexual abuse; growing up with domestic violence; being a POW or a war zone resident, being a victim of human trafficking, or enduring multiple illnesses or medical procedures or surgeries).
• Associated symptoms include changes in worldview, religion, philosophy, basic trust, and relationships and also preoccupation with past traumas and revenge fantasies.
• Debates exist on whether CPTSD is simply a severe form of PTSD.

Psychotherapy for PTSD

• 1st-line: Exposure therapy combined with relaxation techniques to neutralize fear responses.
• Cognitive techniques: Developing new ways of interpreting trauma and living with its effects.
• Eye Movement Desensitization and Reprocessing (EMDR): A controversial, dubious neurological model, associated with generalized support treatment.
• Polyvagal therapy: Similar questionable neurological model, emphasizing bodily awareness and reducing anxiety.
• Group therapy/self-help: Facilitating catharsis and support for those with PTSD.
• Stress management training: Planning, prioritization, and structuring to manage stress after traumatic events.

Group Management for Acute Stress: Critical Incident Stress Debriefing

• Description of the steps for this process.

Medication Treatment of ASD and PTSD

• Symptomatic care: Anxiolytics for anxiety, panic attacks, antidepressants (SSRIs) for depression, chronic anxiety, and irritability; antipsychotics (e.g., Abilify, Risperdal), and sleep medications as needed.
• Cannabinoids: Can be used as needed, but can make PTSD worse.
• Antihypertensives: Potentially beneficial for people already experiencing hypertension, especially during flashbacks, and nightmares.
• Experimental medications: Possible use of post-stressor propanolol; cautionary notes.

Mental Health Law and Regulations

• California Mental Health Laws (2019).
• Information on where to acces laws.
• Confidentiality - Mental health information cannot be released without patient consent.
• Exeptions to confidentiality rules.
• Duty to report.
• Involuntary commitment - "5150" and "5250" hold procedures.

Involuntary Commitment i.e. "5150"

• Specific procedures within the California Lanterman-Petris-Short (LPS) Act in cases of involuntary hospitalization.

Two Types of Involuntary Commitment

• 5150 Hold: 72-hour treatment and evaluation by specialized personnel (police, nurses, etc) who deem a person poses an imminent danger to the self or others. Discharge occurs if no grounds for continued detention exist.
• 5250 Hold: 14-day hold, added to 5150 holds, for intensive treatment. May be applied to individuals who are a danger to themselves or others who are gravely disabled and for whom additional intervention is needed. Further judicial review is required.

A Crisis of Placement

• Reports on the high numbers of people with mental health issues placed in jail in the US, and lack of treatment provided in these cases.
• Discussion of those with mental health issues ending up in the criminal justice system.
• Implications for mental health care.

Involuntary Long-Term Custodial Care ("Conservatorship")

• Description of involuntary long-term care or conservatorship for gravely disabled individuals with chronic alcoholism.
• Conservators must provide a comprehensive living and treatment plan for the patient based on court order.
• Overview of specific conservatorship cases, such as the conservatorship of Britney Spears.

Assisted Outpatient Treatment (AOT)

• Description of court-ordered outpatient treatment programs (“Laura's Law”) that support people experiencing mental health conditions, including severe chronic conditions.
• Examples of criteria for AOT assignment, including public defenders, and evaluations.
• Benefits discussed regarding reduction in incarceration and victimization.

Mental Health Law Touches UCSB

• Overview of the report by the Sheriff's office regarding the 2014 murderous rampage Elliot Rodger committed.

CA Law AB 1014 – Temporary Gun Seizure

• Overview of a law that allows a court to temporarily remove guns from people considered a danger to themselves or others.
• Details regarding procedures relevant to the law, like no prior notice to the person.

Test your understanding of trauma interventions, including the use of medications like antidepressants and propranolol. This quiz covers symptoms associated with Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) as well as ethical considerations in mental health care. Explore the intricacies of how trauma affects individuals and their daily lives.