Trauma- and stress-related disorders: Pathology review

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Trauma- and stress-related disorders: Pathology review

Psychological disorders

Mood disorders

Major depressive disorder

Suicide

Bipolar disorder

Seasonal affective disorder

Premenstrual dysphoric disorder

Anxiety disorders

Generalized anxiety disorder

Social anxiety disorder

Panic disorder

Agoraphobia

Phobias

Obsessive-compulsive disorders

Obsessive-compulsive disorder

Body focused repetitive disorders

Body dysmorphic disorder

Stress-related disorders and abuse

Post-traumatic stress disorder

Physical and sexual abuse

Psychotic disorders

Schizoaffective disorder

Schizophreniform disorder

Delusional disorder

Schizophrenia

Cognitive and dissociative disorders

Delirium

Amnesia

Dissociative disorders

Eating disorders

Anorexia nervosa

Bulimia nervosa

Personality disorders

Cluster A personality disorders

Cluster B personality disorders

Cluster C personality disorders

Somatoform and factitious disorders

Somatic symptom disorder

Factitious disorder

Substance use disorders and drugs of abuse

Tobacco dependence

Opioid dependence

Cannabis dependence

Cocaine dependence

Alcohol use disorder

Sleep disorders

Bruxism

Nocturnal enuresis

Insomnia

Night terrors

Narcolepsy (NORD)

Sexual dysfunction disorders

Erectile dysfunction

Male hypoactive sexual desire disorder

Orgasmic dysfunction

Female sexual interest and arousal disorder

Genito-pelvic pain and penetration disorder

Pediatric disorders

Attention deficit hyperactivity disorder

Disruptive, impulse control, and conduct disorders

Learning disability

Fetal alcohol syndrome

Tourette syndrome

Autism spectrum disorder

Rett syndrome

Shaken baby syndrome

Enuresis

Encopresis

Psychiatric emergencies

Suicide

Serotonin syndrome

Neuroleptic malignant syndrome

Psychological disorders review

Mood disorders: Pathology review

Amnesia, dissociative disorders and delirium: Pathology review

Personality disorders: Pathology review

Eating disorders: Pathology review

Psychological sleep disorders: Pathology review

Psychiatric emergencies: Pathology review

Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review

Malingering, factitious disorders and somatoform disorders: Pathology review

Anxiety disorders, phobias and stress-related disorders: Pathology Review

Trauma- and stress-related disorders: Pathology review

Schizophrenia spectrum disorders: Pathology review

Drug misuse, intoxication and withdrawal: Stimulants: Pathology review

Drug misuse, intoxication and withdrawal: Alcohol: Pathology review

Developmental and learning disorders: Pathology review

Childhood and early-onset psychological disorders: Pathology review

Assessments

Trauma- and stress-related disorders: Pathology review

USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 23-year-old woman comes to her primary care physician to evaluate recurrent nightmares. The patient was sexually assaulted two weeks ago, and since that time, reports recurrent nightmares surrounding the event. She states, “Ever since the incident, I can’t return to campus. The thought of being back at school after what happened is unbearable.” The patient avoids thinking about the incident and feels depressed, irritable, and distracted throughout the day. The patient has not had any suicidal ideation or thoughts. The patient has no past medical history. Which of the following is the most likely diagnosis?  

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Transcript

Content Reviewers

Antonella Melani, MD

Contributors

Antonia Syrnioti, MD

Kaylee Neff

Alaina Mueller

Abbey Richard, BFA

A 31 year old female named Amelia comes to the mental health clinic complaining of trouble sleeping due to vivid nightmares recounting an armed bank robbery she witnessed 4 months ago.

Ever since that event, she has avoided going to crowded places that remind her of the bank, to the point where she had to give up her job at the mall.

Suddenly, your phone starts ringing and Amelia jumps from her seat. You apologize, and she then mentions that this happens whenever she hears sudden or loud noises.

Okay, based on the initial presentation, Amelia seems to have some form of trauma or stress-related disorder.

Many individuals at some point in their lives experience trauma, which can be thought of as a distressing event that causes an overwhelming amount of stress, exceeding one’s ability to cope or process the emotions caused by that experience.

Trauma can be caused by one single event, such as a serious car crash or sexual assault or abuse; or can last for a more prolonged period of time, such as experiencing poverty, neglect during early childhood, or military combat.

Most of the time, with support from loved ones, individuals are able to recover from a traumatic experience.

Unfortunately, some individuals may develop trauma and stress-related disorders, where traumatic experiences lead to symptoms like flashbacks, nightmares, and anxiety, all of which can interfere with day-to-day activities like working, studying, eating, and sleeping.

Now, the underlying cause of trauma and stress-related disorders is poorly understood; but what you need to remember is that individuals affected usually have altered levels and response to stress hormones like adrenaline and cortisol.

For your exams, the most high-yield trauma and stress-related disorders are post-traumatic stress disorder, acute stress disorder, and adjustment disorder. Okay, let’s start with post-traumatic stress disorder, or PTSD for short.

This usually occurs in individuals who have either directly experienced a traumatic event or witnessed as it happened to others, but it can also affect someone who just heard that a close family member or friend was involved.

Summary

Trauma- and stress-related disorders are a group of mental health conditions that can occur as a result of exposure to traumatic or stressful events. This group of disorders includes post-traumatic stress disorder (PTSD), acute stress disorder, adjustment disorders, and reactive attachment disorder.

Both PTSD and acute stress disorder can affect individuals who have experienced prolonged traumatic events, especially involving a close family member or friend. Symptoms include recurrent, involuntary, and intrusive memories associated with nightmares or flashbacks; as well as intense psychological distress or physical reactions. People with these two disorders can also present with hypervigilance or hyperarousal; avoidance behavior; and negative alterations in thinking or mood. What differentiates PTSD from acute stress disorder is that in PTSD, the symptoms must last for more than one month, while in acute stress disorder, they should last at least three days but less than one month following the traumatic event.

Next, we have adjustment disorder, which is characterized by emotional or behavioral symptoms in response to a stressor or life change. Symptoms typically develop within three months of a stressful or life-changing event and resolve within six months. There is also reactive attachment disorder, which typically affects infants or young children who don't get attached to their caregivers. The symptoms appear following the lack of adequate care or negligence and are often evident in young children between the age of nine months and five years. Treatment of trauma and stress-related disorders typically includes cognitive behavioral therapy and lifestyle changes. It can also involve medications like selective serotonin reuptake inhibitors (SSRIs), and selective norepinephrine reuptake inhibitors (SNRIs).

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Diagnostic and Statistical Manual of Mental Disorders" NA (1980)
  4. "Post-traumatic stress disorder" BMJ (2015)
  5. "Suicidality and posttraumatic stress disorder (PTSD) in adolescents: a systematic review and meta-analysis" Social Psychiatry and Psychiatric Epidemiology (2014)
  6. "Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature" Neuroscience & Biobehavioral Reviews (2013)
  7. "Wilderness and Rescue Medicine" Jones & Bartlett Publishers (2012)
  8. "Adjustment disorder as proposed for ICD-11: Dimensionality and symptom differentiation" Psychiatry Research (2015)
  9. "Adjustment Disorder: Current Developments and Future Directions" International Journal of Environmental Research and Public Health (2019)
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