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22 Cards in this Set
- Front
- Back
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Explain the 'stress diathesis model'
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Excess of life events is associated with onset of mental health problems
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Explain salience/significance of event
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The way that environmental factors resonate with individuals
- Important to consider personal background and triggering events |
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Explain neural network theory linking life events and depression
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Dormant networks established in early life can be switched on by salient event
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Define stress
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Environmental challenge that threatens to overwhelm the ability to cope
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Explain the appraisal of stress
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- Primary appraisal - scoping challenge
- Secondary appraisal - scoping available coping resources |
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Explain different cognitive styles with regard to coping with stress
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- Breaking up tasks, lateral thinking - better coping
- Lumping problems into one insurmountable task - worse coping |
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Define stress diathesis
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threshold of stress where illness is triggered if exceeded
Takes into account underlying ambient stress and specific events on top |
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Define trauma (DSM-IV)
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Exposure to a traumatic event with:
- Experience or confrontation of event involving actual or threatened death or serious injury, or a threat to physical integrity - Response involved fear, helplessness, or horror |
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Define Type I trauma (Terr's typology of trauma)
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acute, 'one-off', full detailed memories, omens and misperceptions
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Define Type II trauma (Terr's typology of trauma)
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Recurrent and chronic traumatic stress, denial and numbing, dissociation and rage
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Burden of post-traumatic morbidity
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Depression - 44%
Anxiety - 39% PTSD - 16% (often overdiagnosed) Other (e.g. psychosis) 1% |
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DSM-IV criteria for PTSD
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Criteria B - Re-experiencing of the trauma event
Criteria C - Avoidance Criteria D - Arousal C and D criteria most distressing/disruptive |
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Diagnosis of PTSD
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2 or more ‘persistent symptoms of increased psychological sensitivity and arousal’ (not present before exposure to the stressor):
- Difficulty falling or staying asleep - Irritability or outbursts of anger - Difficulty in concentrating - Hypervigilance - Exaggerated startle response |
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Comorbidities seen in PTSD
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- Depression
- Overlapping C and D symptoms - Trauma-specific phobia - Mood disorders and substance abuse in chronic PTSD |
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Neurotransmitters involved in stress
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- Catecholamines
- Opioids - Neuropeptides |
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Explain the 'kindling hypothesis'
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Repeated traumatisation of limbic nuclei eventually leads to behavioural change (e.g. startle reflex)
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Explain the 'glucocorticoid cascade hypothesis'
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Spikes in glucocorticoid secretion due to stress leads to excess secretion at baseline stress levels, causing:
1. Altered glucose metabolism 2. Impaired neurotrophin synthesis 3. Inhibited long-term potentiation of memories |
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Consequences of glucocorticoid cascade hypothesis
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Low-dose glucocorticoids can be protective - reduced activation of SNS following a spike due to stress
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Principles of treatment for PTSD
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- Address basic needs - security (living arrangements), ecology (food), homeostasis (sleep), distress, meaning, justice, resolution
- Pharmacotherapy - Psychological treatments No evidence for debriefing |
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Pharmacotherapy used in PTSD
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- SSRIs mainstay - fluvoxamine, escitalopram
- SNRIs for PTSD + depression - Benzos for short-term symptom relief - Valproate - off-licence, augments antidepressants and dampens other symptoms - Antipsychotics - quetiapine or olanzapine for agitation or metabolic complications |
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Psychological treatments for PTSD
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- Arousal reduction
- Exposure-based therapies Little empirical support Low drop-out rates (c.f. pharmacotherapy) |
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Sequential approach to treating PTSD
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1. Education, treatment of comorbidities
2. Arousal reduction 3. In-vivo exposure 4. Imaginal exposure 5. Interpersonal approaches 6. Long-term supportive approaches 7. Dealing with medicolegal aspects |
