psych - violence and sexual assault Flashcards
Violence accepted within a family often leads to a perception in the children that this is
appropriate behavior (transgenerational)
CPS/APS can force legal investigations only with
children and dependent adults.***we can’t report independent adults
With non-dependent adults we can only:
inform clients of their rights
refer them to DV shelters/help them create safety plans
try to alleviate their fears of leaving the abuser/getting help.
GHB - onset
GHB (gamma-hydroxybutyrate) – legal by prescription. Onset within 20 minutes. used for narcalpsy. will be out of system fast, so hard to prosecute.
Rohypnol
(a potent BZD) – illegal. Onset within 30 minutes. short half-life.
Ketamine
Ketamine – legal anesthetic. Onset within 20 minutes. Duration an hour or less.
Rape-trauma syndrome
Similar symptoms to PTSD (covered with anxiety disorders). startle reflex, nightmares.
Physical assessment
Bilateral, often symmetric bruises
Multiple bruises/scars/fractures of different ages
Bruises/scars/lacerations in genital areas
Anxiety/fear around parents/caretakers/partners
Age-inappropriate hypersexuality/sexual acting-out in children
Explanations of wounds that change or are inconsistent with objective evidence
Unexplained malnutrition, poor wound healing, failure to thrive, poverty
Tension-building stage –
minor incidents of abuse that both perpetrator and victim rationalize as acceptable. Substance misuse is a common method for dealing with this.
Acute battering stage –
Brutal beatings.
Honeymoon stage –
Perpetrator remorseful and ‘loving.’ Victim feels needed and believes perpetrator’s promise
cardiomyopathy - which drugs
(stimulants and alcohol)
Substance Use Disorder:
Maladaptive use of drugs leading to impairment of social, physical or occupational functioning
Addiction
primary, chronic disease of brain reward, motivation, memory and related circuitry (i.e. brain dysregulation, esp in the reward pathway)
Cross-tolerance
the development of tolerance to one substance as a result of using another substance of the same class. higher dose of morphine for surgery for addict, ALSO, benzos for alcoholics - both acting on gaba so high doses of benzos.
theories of addiction - biology
genetic predisposition, physiological response (liver enzymes) - how ppl metabolize substances. asians lack enzyme that breaks down alcohol - then it builds up and makes them sick, so they don’t want to drink. or native americans who get addicted.t
theories of addiction - Psychological
low self-esteem, low frustration tolerance
theories of addiction - learning
environmental, peer pressure, positive experience w/ drugs and alcohol, family
Ritalin for what? and 2 surprising ones
Rx for ADHD, narcolepsy, refractory depression
stimulant withdrawals - how long
w/d sxs peak 24-72 hours, last 5-7 days
coke withdrawals
(Effects and withdrawal sxs similar to amphetamines, but begin earlier
MDMA - MOA
(“ecstasy,” “E”) rave drug, seratonergic.
MDMA - risk
risk for hyperthermia
MDMA - longterm use
long-term and/or heavy use may cause depression (destruction of serotonin neurons) may cause treatment resistant depression
less frequent use can be therapeutic
alcohol - harder on men or women?
more serious health effects in women, ex. GI, liver
alcohol - thiamine
thiamine deficiency (resulting in Wernicke and Korsakoff syndromes - language deficiets)
alcohol withdrawal - early symptoms
(early signs) anxiety, tremor, N/V, HA, elevated BP, pulse
alcohol withdrawal - late or severe symptoms
VH (visual hallucinations), TH (tactile hallucinations) (formication - crawling), (less common) AH, illusions, disorientation, seizures (can turn into status epiliticus), delirium tremens (DTs)
how long do alcohol withdrawals last?
peak sxs occur 24-72 hours after last drink, last 5-7 days
when do alcohol withdrawals start?
8-12 hours later
alcohol withdrawals and water
push fluids - 2-4 liters of water
alcohol withdrawal - how often to check VS?
frequent VS - every 4 hours
Sedatives, Hypnotics and Anxiolytics
Barbituates (e.g. Phenobarbital), Barbituate-Like Hypnotics (e.g. Quaaludes), Carbamates (e.g. Meprobomate), Benzodiazepines (e.g. Xanax, Valium, Klonopin, Ativan)e
effects of sedatives
decreased coordination, ataxia, double vision, respiratory depression, seizures, coma
sedatives - withdrawal - high potential for what?
high suicide potential
high addiction potential
Withdrawal Sxs: similar to ETOH w/d sxs, intense craving
hallucinogens - VS
elevated
PCP - in the hospital -give what?
↓stimuli, may give Haldol or Ativan
weed - Withdrawal sxs:
more psychological (irritability, anger, depression), but also can cause insomnia, abdominal pain, diaphoresis, HA, fever, chills
labs
CBC, LFT, BAL (blood alcohol level), U-Tox
pts w/ PSA often have
problems in every area of their life. Assess which drugs they have been using, quantity and frequency.
Tx for codependence:
accept powerlessness, meet own needs, must grieve codependence role loss, Codependence Anonymous groups
Risk for injury
(this would be withdrawal***): fall, sz, DTs, trauma, assault
Acknowledge
feelings of guilt, hopelessness, anger, shame
ask the pt if
they have ever been clean and sober? and how for long?
