Introduction to Psychopathology The Psychiatric Evaluation: Trauma and Stressor-Related Disorders Flashcards
What is a mental disorder?
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g. political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”
In the DSM-5, Mental Illnesses are broken down into the following categories:
- Neurodevelopmental Disorders
- Schizophrenia Spectrum and Other Psychotic Disorders
- Bipolar and Related Disorders
- Depressive Disorders
- Anxiety Disorders
- Obsessive-Compulsive and Related Disorders
- Trauma-and Stressor-Related Disorders
- Dissociative Disorders
- Somatic Symptom and Related Disorders
- Feeding and Eating Disorders
- Elimination Disorders
- Sleep-Wake Disorders
Early experience sets the stage for resiliency later in life. Please make sure you can compare and contrast these theories and apply what you have learned to clinical case scenarios. Refer to Sahler and Carr, Chapter 10. This will be a review of material previously covered in PCM. Please be familiar with the terms and be able to identify the ages and stages. This will remain relevant when we talk about disordered behavior later in this module. Pay special attention to the role of stress and abuse.
As arousal (anxiety and stress) increases past a certain point, quality of performance and coping skills deteriorate.
These are the “top 10” stressful events that have been shown to put people at risk for illness. The effect is cumulative and may vary from person to person. For example, death of a beloved family pet may be felt as painfully by some as the death of a close family member.
Remember, the subjective interpretation of the event is what counts.
What is a reactive attachment disorder?
Childhood problem that results from grossly inadequate parenting.
PTSD is a fairly common problem in medical settings. Not everyone who has witnessed traumatic events develops PTSD. Resilient people are at lower risk. (Remember discussion of resilience earlier in this pre-study).
}Medically relevant when participating in relief operations, emergency or urgent care; follow up with trauma patients, burn patients, rape victims, sexual disorders, behavior disorders
}Affects sick role behavior, causes disability
}Requires sensitivity (“trauma informed care”)
}Invasive medical procedures can exacerbate PTSD
Here are the most common symptoms of PTSD:
Arousal: Sleep problems, startle, irritability, self destructive behavior, poor concentration, hypervigilance
Intrusion: nightmares, flashbacks, forced recollection,physiologic reactivity
Avoidance: internal (memories) or external (cues, reminders)
Negative emotional and cognitive change: Amnesia, negative beliefs (I’m bad, everyone bad, world unsafe); guilt; fear, anger, shame; loss of interest; detachment/estrangement; lack of positive emotion
Primary Care Checklist for PTSD Screening (from a lecture by Julia Frank, MD, George Washington Univ. used with her permission)
Instructions to the patient:
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:
- Have had nightmares about it or thought about it when you did not want to?
- Tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
- Were constantly on guard, watchful, or easily startled?
- Felt numb or detached from others, activities, or your surroundings?
Current research suggests that the results of the PC-PTSD should be considered “positive” if a patient answers “yes” to any three items.
Acute Stress Disorder:
Symptoms are precipitated by an acute stress or trauma, such as a tornado, car wreck, terror attack. They last for 3 days to one month and cause significant distress and impairment. Common in first responders and victims of disaster. Intrusive thoughts; intense anxiety, or other emotional response, including angry outbursts. Often involves nightmares, flashbacks, and re-living the event. Guilt is not uncommon; neither are panic attacks and impaired memory. The trauma experience may be a vicarious one. Symptoms must be present for at least 3 days after the traumatic event, and must not last more than one month. Not related solely to seeing the event on TV or electronic media, unless that exposure was connected to the job at hand (first responers).
A physician who provides trauma-informed care:
Recognizes the trauma survivor’s need to be respected, informed, connected, and hopeful
Stays calm, does not get upset along with the patient
Recognizes the interrelation between trauma, and the behavioral symptoms of trauma (e.g., substance abuse, eating disorders, self-injurious behavior, depression, and anxiety)
Works in a collaborative way with survivors, family and friends of the survivor, and other human services agencies, empowering survivors
Sees the world though the patient’s eyes, rather than try to fix things that can’t be fixed, or dwell on what is wrong with the patient
Adjustment Disorders are emotional or behavioral symptoms in response to an identifiable stressor, occurring within 3 months of the onset of the stressor(s)
Marked distress and/or significant impairment
When stress is gone, symptoms don’t linger for more than 6 months. Remember, this is only a guideline.
Not due to another mental disorder
Not due to normal bereavement
