Discussion on case-2-learning-issues

[Zeshen Wu]

Phantom limbs were originally thought to be caused by inflamed nerve
endings from amputated arms sending pain signals to the brain, but
treatments based on this theory did not work.

Sensory input from the entire skin surface is mapped on a strip of
cortical tissue on the
parietal lobe of the cerebrum called the postcentral gyrus. It is the
location of the primary somatosensory cortex and its area can be
patterned as a homunculus. Eg. legs and trunk sensation at the midline
of the strip, arms and hands along the middle lateral, and face at the
bottom.

According to Ramachandran, When the arm is amputated, the part of the
cortex corresponding to the arm stops receiving signals from the arm.
Sensory input from an adjacent area on the cortex can begin to
crosswire with the region no longer receiving input. This causes
signals from sensory neurons from other skin surfaces reaching the
sensory cortex region corresponding to the arm in the cerebrum through
the newly strengthened synapses. Postulated mechanisms for
reorganization: Reduced activity from deprived sensory stimulation
also means reduced GABA mediated inhibitory stimulation, disinhibiting
previously suppressed synapses which may be intercortical synapses.

[Sara Fohn]

2. Tx for post traumatic stress disorder (PTSD)-
a. Trauma therapy is done only when the patient is not currently in
crisis. If a patient is severely depressed or suicidal, experiencing
extreme panic or disorganized thinking, in need of drug or alcohol
detoxification, or currently exposed to trauma (such as by ongoing
domestic or community violence, abuse, or homelessness), these crisis
problems must be handled first.
b. When a shared plan of therapy has been developed within an
atmosphere of trust and open discussion by the patient and therapist,
a detailed exploration of trauma memories is done to enable the
survivor to cope with post-traumatic memories, reminders, and feelings
without feeling overwhelmed or emotionally numb.
c. The goal of "trauma focused" exploration is to enable the survivor
to gain a realistic sense of self-esteem and self-confidence in
dealing with bad memories and upsetting feelings caused by trauma;
trauma memories usually do not go away entirely as a result of
therapy, but become manageable with new coping skills.
d. Treatment includes immediate support, removal from the scene of the
trauma, use of medication for immediate relief of grief, anxiety, and
insomnia, and brief supportive psychotherapy provided in the context
of crisis intervention.
e. A group of peers provides an ideal therapeutic setting because
trauma survivors are able to risk sharing traumatic material with the
safety, cohesion, and empathy provided by other survivors.
f. Brief psychodynamic psychotherapy focuses on the emotional
conflicts caused by the traumatic event. Through the retelling of the
traumatic event to a calm, empathic, compassionate and non-judgmental
therapist, the patient achieves a greater sense of self-esteem,
develops effective ways of thinking and coping, and more successfully
deals with the intense emotions that emerge during therapy. The
therapist helps the patient identify current life situations that set
off traumatic memories and worsen PTSD symptoms.
g. There are two cognitive-behavioral approaches, exposure therapy and
cognitive-behavioral therapy.
i. Exposure therapy involves therapeutically confronting a past
trauma by either (a) repeatedly imagining it in great detail, an
example of this treatment is called Eye Movement Desensitization and
Reprocessing (This type of therapy combines exposure therapy with a
series of guided eye movements that help you process traumatic
memorie), or (b) going to places that are strong reminders of the
trauma experience(s). Exposure therapy is intended to help the patient
face and gain control of the fear and distress that was overwhelming
in the trauma, and must be done very carefully in order not to re-
traumatize the patient.
ii. Cognitive-behavioral therapy involves learning skills for coping
with anxiety (such as breathing retraining or biofeedback) and
negative thoughts ("cognitive restructuring"), managing anger,
preparing for stress reactions ("stress inoculation"), handling future
trauma symptoms and urges to use alcohol or drugs when they occur
("relapse prevention"), and communicating and relating effectively
with people ("social skills" or marital therapy).
3. Finally, drug therapy can reduce the anxiety, depression, and
insomnia often experienced with PTSD, and in some cases may help
relieve the distress and emotional numbness caused by trauma memories.
Several kinds of antidepressant drugs have achieved improvement in
most (but not all) clinical trials, and some other clases of drugs
have shown promise. At this time no particular drug has emerged as a
definitive treatment for PTSD, although medication is clearly useful
for symptom relief thereby making it possible for patients to
participate in group, psychodynamic, cognitive-behavioral, or other
forms of psychotherapy.
a. MEDICATIONS
i. Antidepressants- They can also help improve sleep problems and
improve your concentration
1. Selective Serotonin Reuptake Inhibitors (SSRIs) (Zoloft, Prozac,
etc)- Affects the concentration and activity of the neurotransmitter
serotonin, a chemical in the brain thought to be linked to anxiety
disorders.
2. Tricyclic Antidepressants (TCAs)- Affects the concentration and
activity of the eurotransmitters serotonin and norepinephrine,
chemicals in the brain thought to be linked to anxiety disorders.
3. Monoamine Oxidase Inhibitors (MAOIs)- inhibits the activity of
monoamine oxidase, preventing the breakdown of the brain’s monoamine
neurotransmitters. This effect is thought to increase/prevent the
breakdown of the available stores of serotonin, norepinephrine and
dopamine.
4. Other Antidepressants (Cymbalta, etc)- Affects the concentration of
the neurotransmitters serotonin and/or norepinephrine, chemicals in
the brain thought to be linked to anxiety disorders.
ii. Noradrenergic Agents
1. Alpha Blocker- PTSD nightmares
iii. Prazosin, which has been used for years in the treatment of
hypertension, also blocks the brain's response to an adrenaline-like
brain chemical called norepinephrine. Prazosin can reduce or suppress
nightmares in many people with PTSD.