Acute stress do and ptsd ch 11

Question 1

Acute stress d/o

Answer 1

S/s:
Dissociation (key characteristic) - organizing info to reduce anxiety, defense mechanism.Allows illusion of psychological control when they sense helplessness, may be primary, secondary, or tertiary.
Primary - many not be integrated in individual’s memory and sense of self identity.derealization,depersonalization, dissociative amnesia, detachment.
Secondary, leaving their bodies at trauma moment and observe from distance.
Teritiary - develop distinct ego states with complex identities.
Also intrusion, avoidance, hyperarousal with impaired social and work functioning.
Occurs within 4 weeks of exposure to traumatic event and must last at least 2 days.

Risk: females, psych hx, bereaved, hgih level of depressive symptoms, avoidant coping style, lower levels of social support,

TX - psychological first aid, psychotherapy, pharmacoptherapy ( benxos, imipramine, fluoxetine, risperidone , beta adrenergic blockers.

Preventing PTSD - psychotherapy, CBT, propanaolol, opiates.

Question 2

PTSD

Answer 2

Primatry feature: disturbance of memory
Severe symptoms for more than 1 month after trauma.
Risk - military, traumatic event, higher risk if inadequate housing, health problems, unemployment, social isolation, lack of security.
Religion and social support help with dealing with ptsd.

Bio - thalamus which transmits fearful stimuli,
Amygdala - evaluates threatening stimuli in fear conditioning.
Hippo - forming conscious memeoris of facts an details.
ACC integrate emotional and cognitive aspects of experices.
PFC - processes info to compare previous experiences
Right hemisphere - activity increases in areas assoc with emotional appraisal.
Left hemi - decreases in areas involved with speech, cognitive analysis, and interpretation of an experience.

Memory - reexperienceing of trauma, intrusive symtomps, memories, dreams, nightmares, flashbacks, avoidance or numbing symptom., arousal symptoms like irritability, angry, hyper vigilance.

Autonomic activation impairment - hard wired response to stress to include SOB, tremulousness, racing hear, sweaty palms, dizziness, faintness, nausea, tingling, chills, dry mouth, diff controlling bladder or bowel.

Self regulatory impairment
regulating anger, anxiety, sexual impulses, focusing attention, impulse control, unctonrollable, rage, anger, sadness, distrust, social isolation, self-destructive behavior, dissociation, self identity.

Subjective feelings of shame, anger, revenge, timelessness.

In children and adolescents - may be expressed by disorganized or agitated behaviors.

Psychotheray - exposure, CBT, EMDR, Trauma mangament therapy, structured writing, technology based interventions. interpersonal psychotherapy, psychodynamic.

psychopharm - Sertraline and paroxetine are FDA approved.

SSRi are first line. Propanolol, Dcycloserine, prazosin, ketamine, morphine.