Exam 2: week 6 Flashcards
What is stress
A negative emotional experience that results in predictable changes in the body
What is the ACE study
Adverse childhood experiences cause people to be more sensitive to stress later in life
- any form of abuse (sexual, emotional, physical)
- violence against a parent (usually mother)
- living with people who are mentally ill, use substances, or are incarcerated
What is the flight-or-flight response theory
Walter Cannon
- body prepares for threat to survival
- adrenal glands release epinephrine and norepinephrine increasing heart and respiration rates as well as causing mobilization of sugar and fat in the body to dull pain
- only studied animals and men
- men and women respond to stress in different ways
What is general adaptation syndrome
Hans Selye
- expands Cannons fight-or-flight theory
- talks about the HPA axis and its role in stress
- Three stages
- focuses on men
What is the HPA axis
Hypothalamus, Pituitary, and adrenal glands
- keeps the system on high alert in response to stress
What are the three stages of general adaptation syndrome
- alarm stage
- resistance stage
- exhaustion stage
What is happening during the alarm/acute stress stage
- activation sympathetic nervous system
- activation of HPA axis to stay on alert
What is happening during the resistance/adaptation stage
- resistance to the stressor
- recovery
- repair
- renewal
What is happening during the exhaustion stage
- resources are depleted
- stress may become chronic
What is distress
Bad stress that leads to:
- anxiety
- depression
- confusion
- helplessness/hopelessness
- fatigue
What is eustress
Good stress that leads to
- hope
- joy
- purposeful movement
What are some criticisms of the general adaptation syndrome theory
- focused on men (women respond to stress in different ways)
- different stressors bring different patterns of response
- the degree of stress is what is important
What is “tending and befriending”
A survival strategy used by women in response to stress
- Tend to the young
- befriend a close social group for support
What demographic is most susceptible to stress related disorders
Women
women are more sensitive to even low levels of corticotropin-releasing hormone released by the hypothalamus in response to stress
How does stress affect the immune system
- interacts with immune system during the alarm phase of general adaptation syndrome
- affects body’s ability to produce protective factors
- acute stress can boost the immune system
- chronic stress hurts the immune system
What is biofeedback
through a sensitive recording device, this tell you immediate and exact information regarding:
- muscle activity
- brain waves
- skin temperature
- heart rate
- blood pressure
- other bodily functions
What is cognitive reframing
A type of relaxation technique that aims to take negative thoughts and make them positive
- reassess and replace irrational beliefs
What are some trauma-related disorders
- reactive attachment disorder
- disinhibited social engagement disorder
- posttraumatic stress disorder (PTSD)
- acute stress disorder
- adjustment disorder
What are attachment disorders
Trauma from an inadequate caring environment can lead to this. There are two extremes to this disorder:
- reactive attachment disorder
- disinhibited social engagement disorder
Both these conditions are very rare and seen in children
What is reactive attachment disorder
Occurs when emotional and physical need are unmet in childhood
- severe emotional inhibition
- withdrawn behavior
- not attached to adult caregivers
- not trusting of others
What is disinhibited social engagement disorder
occurs when emotional and physical needs are unmet in childhood
- very social
- no normal fear of strangers
- unfazed by separation from caregiver
- willing to wander off with people they don’t know
What does PTSD look like in children
- reduction in play
- repetitive play of traumatic event
- social withdrawal
- negative emotions
- blaming themselves for traumatic event
- irritability
- aggressive or self destructive behaviors
- sleep disturbances
- concentration issues
- hypervigilance
What are some risk factors for childhood PTSD
- genetics
- neurobiological
- environmental
What are the neurobiological risk factors for childhood PTSD
Trauma disrupts neural pathways which triggers a hypoaroused state which leads to dissociation
- polyvagal theory
What is the polyvagal theory
Suggests that the autonomic nervous system consists of more than just fight-or-flight. It in fact has three different responses
1. myelinated ventral vagal responses
2. unmyelinated ventral vagal responses
3. dorsal vagal response
What is the myelinated ventral vagal response
Activated during a social or intellectual situation when the person is in a state of pleasant, not overwhelming arousal
What is the unmyelinated ventral vagal response
- Activated when we sense a threat
- Activates fight-or-flight
- increases heart rate and respiratory rate
- this cannot be sustained
What is dorsal vagal response
Parasympathetic response to a persistent threat
- lowers heart rate and respiratory rate
- animals play dead
- mind numbing activities keep them in hypoaroused state
What is the Denver II developmental screening test
Test for infants to age six to assess for PTSD
What is the “window of tolerance”
A balance between sympathetic and parasympathetic nervous systems
Children with PTSD tend to alternate from hyperarousal (anxiety, fear, aggression) and hypoarousal (withdrawal, isolation, numbness)
What is EMDR therapy
A therapeutic technique used for children and adults with PTSD where the advanced practice nurse will have the patient recount the traumatic event while listening to other stimuli such as tapping, eye movements, or audio tones.
What are some symptoms see in PTSD in adults
- flashbacks of the traumatic event
- avoidance of stimuli regarding the event
- persistent increased arousal (hypervigilance)
- mood alterations
What are some drugs used to treat PTSD
- SSRIs (for anxiety and depressive symptoms)
- SNRIs (for anxiety and depressive symptoms
- Imipramine (if SSRI/SNRI doesn’t work)
- mirtazapine (if SSRI/SNRI doesn’t work)
- clonidine (for hyperarousal and intrusive symptoms)
- propranolol (for hyperarousal and panic)
What is acute stress disorder
Diagnosed 3 days to a month after the traumatic event happened
Like PTSD but immediately after the stressful event occurs
What is acute stress disorder
Diagnosed 3 days to a month after the traumatic event happened
Like PTSD but immediately after the stressful event occurs
What are some symptoms of acute stress disorder
- numbness
- derealization
- unable to remember part of the event
- intrusive memories of event
- recurrent distressing dreams
- feeling that the event is still happening
- prolonged distress
- avoidance of thoughts about event
- sleep disturbance
- hypervigilance
- aggression
- anger
- irritability
- exaggerated startle response
- agitation/ restlessness
What is adjustment disorder
Milder form of ASD or PTSD
- traumatic event that’s not “as bad” as PTSD inducing event
- breakup, chronic illness, retirement
- also called situational depression
What is a dissociative disorder
In response to trauma, the body responds with an interruption in consciousness. This is an unconscious response in order to protect themselves from the trauma
What are the three dissociative disorders
- Dissociative amnesia
- depersonalization/derealization disorder
- dissociative identity disorder
What are some symptoms of dissociation
- flashbacks
- memory problems
- inability to sense or control certain body parts
What is dissociative amnesia
The inability to recall important personal information
- often of traumatic or stressful nature
- dissociative fugue
What is dissociative fugue
A subtype of dissociative amnesia where the person will travel away from their usual place and adopt a new identity forgetting their old identity.
- often live simple lives
- when they remember their old lives, they usually go back to them with no recollection of the fugue life
What is depersonalization/derealization disorder
Persistent and recurrent episodes of depersonalization and derealization
- no loss of contact with reality
- short lived
- usually go away without treatment
What is depersonalization
- focus is on self
- feeling disconnected from one’s body and thoughts
- observing oneself from the outside or like being in a dream
What is derealization
- focus is on the environment
- external world is strange or unreal
- feels as though they are walking in a fog or a dream
What is dissociative identity disorder
The presence of two or more distinct personality states. Each alter has their own way of seeing, relating to, and thinking about the self and the environment
What are grounding techniques
techniques used to combat a dissociative episode. This can include:
- holding an ice cube
- counting beads
- deep breathing
- touching soft fabric
What are some treatments for dissociative disorders
No specific medications available, but meds to help hyperarousal and anxiety can help
- CBT
- psychotherapy
- exposure therapy
- EMDR therapy
- hypnotherapy
What is the goal of treatment for dissociative disorders
Integration of multiple emotional states or personalities into one
