Other Behavioral/Emotional Disorders Flashcards
Acute stress disorder
brief period of intrusive recollections w/in 4 wk of witnessing/experiencing an overwhelming traumatic event.
Symptoms begin w/in 4 wk of event & last at least 3 days but, not > 1 month (PTSD)
Pt must have been exposed in/directly to a traumatic event, and ≥ 9 sx w/in specific time frame
sx of acute stress disorder
- Recurrent, involuntary, and intrusive distressing memories of event
- Recurrent distressing dreams of event
- Dissociative reactions (eg, flashbacks) in which pt feels like event is recurring
- Intense psychologic/physiologic distress when reminded of event (its anniversary, sounds)
- Persistent inability to experience positive emotions
- Altered sense of reality (in a daze, time slowing, altered perceptions)
- Inability to remember an important part of the event
- Efforts to avoid distressing memories, thoughts, or feelings associated with the event
- Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) associated with the event
- Sleep disturbance
- Irritability/angry outbursts
- Hypervigilance
- Difficulty concentrating
- Exaggerated startle response
Suspect child abuse if
- Injury not adequately explained/inconsistent w/ given hx
- Bruises/lacerations/soft-tissue swelling, dislocations/fractures, spiral fractures
- Burns (doughnut-shaped, stocking-glove, symmetrically round)
- Bruises/injuries with regular patterns on face, back, buttocks, thighs
- Internal hemorrhages, abdominal injuries, bite marks, injury with shape of instrument used
Anxiety Aggressive/violent behavior PTSD Depression or suicide Substance abuse Poor self-esteem Dissociative disorders Paranoid ideation Failure to thrive can all indicate
child abuse
consider neglect if:
in-Mor allowed to engage in potentially harmful behavior (ie, ETOH consumption)
-Child is unattended (some states cannot leave child < age 13 home alone)
child sexual abuse
Common ages 9-12 and often by male known to child
Any raises suspicion:
- evidence of sexually transmitted infection
- knowledge about sexual acts inappropriate for age
- initiates sexual acts with others, peers
- exhibits sexual knowledge through play
Elderly physical/sexual abuse
- bruises/puncture wounds/fractures/cuts/burns
- poor hygiene/soiled clothing, hair loss in clumps
- weight loss, poor nutrition, dehydration
- lack of eyeglasses/hearing aids
- injuries from restraints
- genital/rectal injuries or bleeding
- evidence of excessive drugging
- lack of/delay seeking medical attention
elderly psychological/financial abuse, neglect
- threats/insults/verbal abuse
- refuse to allow travel, church attendance, family visits
misuse of funds
withholding food/meds/clothing, routine health care, basic necessities
watch our for caregiver with
- previous hx of abuse
- conflicting accounts of accidents
- unwilling to agree to implementation of tx plans
- inappropriate defensiveness
- failure to allow/limits pt’s responses to questions
Conduct disorder
children/adolescents who have ≥ 3 of the following behaviors in the last 12 mos PLUS at least 1 in the last 6 mos:
- Aggression toward people and animals
- Destruction of property
- Deceitfulness, lying, or stealing
- Serious violations of parental rules
- Sx/behaviors must be significant enough to impair functioning in relationships, at school, or at work.
Oppositional defiant disorder
children w/ ≥ 4 of the following symptoms for at least 6 mos. Sx must be severe & disruptive
- Lose their temper easily and repeatedly
- Argue with adults
- Defy adults
- Refuse to obey rules
- Deliberately annoy people
- Blame others for their own mistakes or misbehavior
- Be easily annoyed and angered
- Be spiteful or vindictive
- Many affected children also lack social skills.
domestic violence
Physical, sexual, and psychological abuse between intimate partners - victim usually female
Physical injuries, psychological problems, social isolation, loss of a job, financial difficulties, and even death can result
Keeping safe (ie. escape plan) = most important consideration
Women more likely to be assaulted/murdered when attempting to report abuse/leave (up to 75% of domestic assaults occur after separation)
management of domestic violence
Medical attention to address physical needs
Recognition of abuse (non-threatening questioning to determine if it occurred); emphasize someone cares
Contact numbers for referral agencies (legal, shelters, support groups)
Present options, allow pt. to decide
victim & children of domestic violence work-up
Establish diagnosis by open-ended questions followed by more direct, closed-ended questions.
Explain importance of removal of victim and children to a safe environment (preferably a place that makes peer counseling and other therapy available)
Use supportive psychotherapy in safe environment to reestablish victim’s self-esteem and reverse ingrained feeling of learned helplessness.
abuser of domestic violence work-up
Referral for therapy (group psychotherapy facilitates sharing experiences w/ other abusers)
Treatment for substance abuse
Treatment of any concurrent psychiatric problems
Gradual, cautious reuniting with family
