Day # 105: Review Quiz -> Trauma/Stressor Disorders

Today will be our first review quiz for the trauma and stressor disorders theme. Take a few minutes and check your learning.

1) Which of the following is accurate regarding diagnostic timelines?

a) Adjustment disorder: Symptoms develop within 1 month of the stressor and resolve within 3 months after the stressor has terminated.

b) Acute stress disorder: Symptoms develop within 1 month of the trauma and resolve within 1 months after the traumatic event.

c) Post-traumatic stress disorder: Symptoms develop within 6 months of the trauma and symptoms must last greater than 3 months.

d) Persistent complex bereavement disorder: Symptoms occur more days than not for more than 6 months.

2) What is the most common diagnosis in inpatient psychiatric consultation settings?

a) Major depressive disorder

b) Delirium

c) Depressive disorder due to another medical condition

d) Adjustment disorder

3) Which of the following is NOT one of the major criterion in the diagnosis of PTSD?

a) Exposure to actual or threatened death, serious injury, or sexual violence.

b) Intrusive symptoms (ex: flashbacks; nightmares)

c) Persistent avoidance of stimuli

d) Negative alterations in cognitions (ex: amnesia; anhedonia; detachment)

e) Dissociative symptoms (ex: depersonalization; derealization)

f) Arousal/Reactivity alterations (ex: hypervigilance; irritability; insomnia)

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ANSWERS

Question 1:

From day #100

Answer: b

The diagnostic timeline presented for acute stress disorder is correct.

Explanation: 1

Correct timelines:

• Adjustment disorder: Symptoms develop within 3 months of the stressor and resolve < 6 months after the stressor has terminated.

• Acute stress disorder: Symptoms develop within 1 month of the trauma and resolve < 1 month after the traumatic event.

• Post-traumatic stress disorder: Symptoms develop any time after trauma and symptoms must last > 1 month.

• Persistent complex bereavement disorder: Symptoms occur more days than not for >12 months.

Question 2:

From day #101

Answer: d

Adjustment disorder

Explanation: 2, 3, 4

• Prevalence of adjustment disorders vary depending on the setting. Estimates of 2% in the general population; 1-18% in primary care settings; 5-20% in outpatient mental health clinics; 15-20% in psychiatric ED; and ~10% in inpatient psychiatry.

• It is the most common diagnosis in inpatient psychiatric consultation settings (frequently reaching 50% of consults) and is 3x as common as MDD in medically ill inpatients (~14% vs 5%). Two studies showed a prevalence between 12% and 35% of adjustment disorder in patients with head/neck cancer and breast cancer respectively.

Question 3:

From day #103

Answer: e

Dissociative symptoms is not one of the major criterion for PTSD although it can be seen and is a "specifier" of PTSD.

Explanation:

Diagnostic Criteria for PTSD (adults and children > 6 years old)

• Exposure to actual or threatened death, serious injury, or sexual violence. Exposure may occur through direct experience or witnessing the trauma (see "what is trauma" above for details).

• Timing: Trauma occurred at any time in the past. Symptoms last > 1 month. Contrast this with acute stress disorder (trauma occurs < 1 month ago and symptoms last > 3 days and < 1 month).

• Intrusive symptoms (≥1): recurrent and intrusive re-experiencing of the event. Can occur via memories, nightmares, or "flashbacks" (dissociative reactions). May include intense psychological distress or physiological reactions to cues relating to the trauma.

• Avoidance behaviors (≥1): active and persistent avoidance of reminders of the trauma which can include internal (memories/thoughts/feelings) and external (people/places/conversations/activities/situations) reminders.

• Mood/Cognitive alterations (≥2): negative alterations of mood or cognitions can include amnesia, negative beliefs about self/others/world, distorted sense of self-blame, persistent negative emotions (guilt, fear, anger, etc.), anhedonia, feelings of detachment or isolation, and inability to experience positive emotions.

• Arousal/Reactivity alterations (≥2): increased arousal/reactivity manifested in a number of possible ways such as irritability/anger, reckless behavior, hypervigilance, exaggerated startle response, difficulty concentrating, or insomnia.

• Specifiers

  • With dissociative symptoms. Depersonalization = feeling of being detached from your mental process or body. Derealization = feeling of unreality of surroundings. Make sure this is not due to substance use or another medical condition.

  • With delayed expression. If the full diagnostic criteria are not met until >6 months after the event.

Helpful MNEMONIC = TRAUMA

• Traumatic event

• Re-experience

• Avoidance

• Unable to function

• Month or more of symptoms

• Arousal increased

CONCLUSION

Nice work. If you want to see all of the weekly quizzes you can see them here. Next up we will cover clinical pearls for PTSD.

If you are looking for more reading material then check out our recommended resources.