Psychosocial Stressors Flashcards
What is a psychosocial stressor?
-A psychosocial stressor is any life event, condition or circumstance that places strain on a person’s current coping skills.
-Psychosocial stressors are subjective – what is a stressor for one person may not be a stressor for another!
-The subjective nature of a psychosocial stressor can vary depending on the person’s circumstances and stage of life.
-Examples of psychosocial stressors could include: examinations, divorce, loss (or threatened loss) of employment, moving home, domestic discord or financial difficulties
What is traumatic stressors?
-A traumatic stressor is an event where a person feels their own (or a loved one’s) physical or psychological integrity is seriously threatened.
-Traumatic stressors describe events that occur outside the range of normal human experience.-The magnitude of a traumatic stressor is such that it would be perceived as traumatic by most people
-Examples of traumatic stressors include: natural disasters, physical or sexual assault, serious RTAs, terrorist attacks, torture and military combat
Describe the response to stress
-Psychosocial stresses are common. Although it can be challenging, most people are able to manage these and the majority do not cause psychiatric morbidity.
-The risk of developing pathological response to a stressor is dependent on:
1. The nature and severity of the stressor.
2. Any underlying vulnerabilities the patient may have
Differential diagnosis of stress-related disorders
-Adjustment disorders
-Acute stress reaction
-Post-traumatic stress disorder
-Normal bereavement reaction
-Dissociative disorder
-Exacerbation or precipitation of other psychiatric illness:
=Mood disorders
=Anxiety disorders
=Psychotic disorders (especially acute and transient psychotic disorders)
-Malingering
Overview of adjustment disorder
-Occurs within 1 month of the onset of the stressor and symptoms fully resolve within 6months.
-Patients experience mood and/or anxiety symptoms out of proportion to original stressor, and/or which can disturb social or occupational function. Suicidal ideation is common.
-Symptoms of adjustment disorder are below the threshold for diagnosis of other mental illnesses – if the patient’s symptoms meet the criteria for another disorder, then that should be diagnosed instead.
-Adjustment disorder is self-limiting – no specific treatment is required. However, addressing the psychosocial stressor is likely to be helpful
Describe dissociative disorders
-Dissociation describes a phenomenon where an aspect of a patient’s consciousness or cognition becomes separated from the rest of their personality and functions independently and outside voluntary control (mental state of disconnection from what is going on)
-Dissociative disorders can include disruption/impaired awareness of memory, identity, thoughts, emotions, movements, sensation or control of behaviour.
-Derealisation (feeling that external reality is unreal) and depersonalisation(feeling yourself to be unreal) are dissociative experiences which can occur as symptoms of psychiatric illness and substance misuse
-Dissociative disorders often occur in response to stressful events, however these can arise in the absence of a stressor. Associated with early childhood trauma like abuse or neglect (adaption?)
-Dissociative disorders should not be diagnosed if there is a physical or psychiatric disorder which could explain the patient’s symptoms.
-Dissociative disorders vary in prognosis – some patients may experience an acute episode and then make a full recovery, while other patients may end up becoming very disabled by their condition
Types of dissociative disorder
-Depersonalisation/ derealization (low severity)
=Detachment from oneself/ world around not fully real
=Numb, weak sense of self, deadpan speech, trouble forming relationships
=Severe: trouble recognising familiar places, people, objects/ altered sense of time/ brain fog and light-headed/ rumination or anxiety
-Dissociative amnesia
=Block out/ forget important personal information
=Localised (most, trouble recalling traumatic event up to months and years)/ generalised (no past)/ systematized (One category of information associated with trauma)/ continuous (forget each new event, nothing but present moment)
-Dissociative identity (high severity)
=Multiple personality disorder
=Covert: sudden and dramatic shifts in the way they perceive, think, feel/ characteristics of different person, aware its unusual but powerless to understand moods and behaviours
=Overt: outright assume >2 distinct identities alters, not always aware, high suicide rate
Differentials of dissociative disorders
-Substance intoxication
=Hallucinogens (LSD)
=Dissociative drugs (PCP, ketamine)
-Seizures
-Brain trauma
-Dementia
-Anxiety disorder (impaired sense of time, identity, sensation)
-BPD
-Schizophrenia (dramatic mood swings)
Treatment of dissociative disorders
-Psychotherapy
=Process trauma safely
=Dissociative identity disorder: facilitate fusion of identities
Exacerbation of psychiatric illness
-Almost all mental illnesses can be exacerbated by psychosocial stressors.
-Psychiatric illnesses should be managed according to the general principles for that particular condition.
-It is helpful to consider if anything can be done to reduce a patient’s current psychosocial stressors as part of their overall management plan
Describe the acute stress reaction
-Develops immediately after exposure to a traumatic stressor.
-Initially patients are disorientated and show narrowing of attention. Afterwards, there may be a period of diminished responsiveness or psychomotor agitation and overactivity. Amnesia of the episode can occur.
-Symptoms normally begin to diminish after 24-48 hours and resolve within 3days. No specific treatment is required.
-Represents symptoms which are part of the spectrum of normal response to traumatic stress
ICD-10 criteria of PTSD
-Persistent re-experiencing, remembering or “reliving” the stressor by:
1. Flashbacks
2. Vivid memories
3. Recurring dreams
4. Distress caused by triggers that resemble stressor
-Actual or preferred avoidance of circumstances resembling or associated with the stressor (i.e. “triggers”)
-Increased psychological sensitivity and arousal (e.g. difficulty falling or staying asleep, irritability or outbursts of anger, hypervigilance, poor concentration and exaggerated startle response.)
-Symptoms develops 1-6 months after exposure to traumatic stressor and cause significant distress or functional impairment
Epidemiology of PTSD
~4% one-year prevalence in the general population.
-Two times more common in women than men.
-Onset at any age – occurs after trauma.
-Only around 10-30% of people who experience a traumatic stressor go on to develop PTSD
Pathophysiology of PTSD
-Genetic and biological factors:
=Most anxiety disorders have a hereditability of around 30-50%
=There is also a likely considerable genetic overlap with depression
=Implicated neurotransmitter systems include GABA, serotonin and noradrenaline
=Amygdala hyperactivation has been found in patients with PTSD
-Social and psychological factors
=PTSD is defined as occurring after exposure to a traumatic stressor.
=The biggest risk factor for PTSD is previous experience of trauma, particularly during childhood
Assessment of PTSD
-Fully explore the nature, meaning and severity of both the specific stressor and the patient’s reaction to it.
-Seek evidence of re-experiencing, avoidance, increased psychological sensitivity / arousal, and degree of functional impairment.
-Investigate possible history of head injury or epilepsy (which can present similarly).
-Screen for comorbid substance misuse, mood disorders, psychosis, other anxiety disorders, and personality traits (as these should be addressed first).
