PTSD et al

Question 1

ABC

DEF

Answer 1

airway breathing circulation
distress (reduce)
emotional (support)
family (remember)

Question 2

distorted appraisal

Answer 2

perception of event distorted by prior experiences; interferes with meaning attached to situation

• biologic changes in brain may have been produced

Question 3

shattered assumption

Answer 3

disruption of assumption that we live in a meaningful, safe world

• result: fear, helplessness

Question 4

fear conditioning

Answer 4

all sensory stimulation coming into brain related to fear, anxiety.

Question 5

sensitization

Answer 5

patient becomes increasingly sensitive over time; less arousal results in symptoms

Question 6

amygdala

Answer 6

part of limbic system; associated with aggression, danger reactions

Question 7

frontal cortex

Answer 7

turns fight-or-flight off when no longer needed

Question 8

hypothalamus

Answer 8

command/control center when receiving stressful signals; receives input from amygdala especially
- engages autonomic nervous system (fight or flight

Question 9

ptsd onset

Answer 9

• actual or threatened death, serious injury
• outside usual range of experience

initial response intense fear, horror

Question 10

ptsd duration + persistent symptoms

Answer 10

1+ month of PERSISTENT

• re-experiencing
• avoidance of triggers
• numbing of responsiveness
• symptoms of increased arousal

constant switch between rest/arousal = feeling needy, helpless

Question 11

crisis intervention

Answer 11

ptsd prevention!

immediately after event, exploring experience several times; “debriefing”

Question 12

acute ptsd

Answer 12

< 3 months of symptoms

• symptoms typically occur within first 4 weeks
• usually only last 2-4 weeks

Question 13

ptsd (timing classification)

Answer 13

symptoms past 2-4 weeks

Question 14

chronic ptsd

Answer 14

3+ months of symptoms

Question 15

ptsd with delayed onset

Answer 15

onset delayed 6+ months after event

Question 16

preferred antidepressants for ptsd

Answer 16

TCA, MAOI

Question 17

back up choice antidepressant for ptsd

Answer 17

SSRI - can cause CNS excitablity, stimulation

Question 18

dissociative disorder: definition

Answer 18

severe interruption in consciousness after significant event, including:

• consciousness
• perception
• memory
• identity

they are considered extreme ptsd

Question 19

dissociation

Answer 19

unconscious defense mechanism that protects individual from overwhelming anxiety
- can separate from emotion

Question 20

depersonalization, derealization

Answer 20

feeling detached from body, body parts, mental processes, environment

flat affect and unemotional presenting demeanor demonstrates incongruence between inner thoughts and outward appearance

mean age of onset is 16 years of age
< 20% after age 20

Question 21

dissociative amnesia

Answer 21

Inability to recall important personal information

• NOT related to medical etiology
• localized, selective, or global (generalized)
• forgotten events can span minutes to decades
• single episodes predispose pt to future episodes

sx may resolve rapidly if removed from the stressful situation, others may persist for long periods. may gradually recover the dissociated memories years later.

Question 22

dissociative amnesia: localized

Answer 22

loss of memory during a period of time

Question 23

dissociative amnesia: selective

Answer 23

loss of pieces of memory during a period of time (remembers some parts and not others)

Question 24

dissociative amnesia: global/generalized

Answer 24

complete loss of memory

onset: sudden

Question 25

dissociative fugue

Answer 25

sudden, unexpected travel without remembering identity and some or all past events

• common in persons with dissociative identity disorder; often described as “lost time” or a gap in memory
• most pt initially unaware it occurred, i.e. until discovering/given evidence by others
• exacerbated by stressful events (natural disaster, war)

Question 26

dissociative identity disorder

Answer 26

presence of at least 2 recurrent personality states; at least 2 control behavior.

• each has separate cognitive, memory, behavioral patterns; dissimilar physiological responses (allergies, labs, vision)
• fragmentation of ONE personality
• dissociative fugue common
• flashbacks happen
• many present with comorbid: depression, anxiety, substance abuse, self-injury, seizures,

Question 27

dissociative identity disorder: primary manifestations (3)

Answer 27

• gaps in remote memory of personal life events (important events occurring in childhood, adolescence)
• lapses in dependable memory (what happened today, loss of a well-learned skill)
• discovery of evidence of everyday actions they don’t recall (unexplained new possessions, drawings, etc.)

Question 28

dissociative disorder coping strategy

Answer 28

distraction; goal: prevent dissociation by removing focus from anxiety

• not typical for psych nursing, but appropriate here