Trauma And Stress D/o, Other d/o Flashcards
Essentials of diagnosis for trauma and stress related d/o?
- Exposure to traumatic event
- flashbacks/nightmares
- avoidance symptoms
- increased vigilance
- symptoms impair functioning
What is reactive attachment d/o?
- Inhibited emotionally withdrawn behavior toward adults
- social and emotional disturbance
- pattern of extremes of insufficient care
- not ASD
- age between 9mo and 5years
- persistent x 12 months
Reactive attachment d/o persistent social and emotional disturbance must have at least 2 of?
Minimal social and emotional responsiveness to others
- limited pos affect
- episodes of unexplained irritability, sadness or fearfulness that are evident during non-threatening interactions w adults
The reactive attachment d/o emotional extremes require 2 of?
- Social neglect/deprivation in basic emotional needs for comfort
- repeated changes in caregivers (unstable)
- rearing in settings that limit opportunities for attachments (institutions)
What is disinhibited social engagement d/o?
Child approaches/interacts w unfamiliar adults w 2 of:
- no inhibition of approaching unfamiliar adults
- overly familiar verbal/physical (not age appropriate)
- not checking back w parents
- willingness to go off w unfamiliar adult
Child has experienced pattern of extremes of insufficient care evidenced by 1 of:
- social neglect/deprivation of needs of comfort
- changes in caregiver
- institutions
PTSD is characterized by?
Characterized by re-experiencing a traumatic event and decreased responsiveness and avoidance of current events associated w trauma
Clinical findings of PTSD?
Hx of exposure to real/perceived event
- life threat
- serious inj
- sex
Physiologic hyperarousal
Symptoms x 1 month
Dissociative symptoms
Physiologic hyperarousal w PTSD can include?
- startle
- illusions
- overgeneralized associations
- sleep prob
- nightmares
- dreams
- difficulty concentrating
- hyperalertness
What are the dissociative symptoms w PTSD?
Depersonalizatioin - feeling detached (outside observer of one’s own thoughts)
Derealization - experiences unreliability of surroundings (dream like)
PTSD must include 9 or more symptoms in what categories?
- intrusion
- negative mood
- dissociative
- avoidance
- Arousal
- beginning or worsening after event
DDX for PTSD?
Acute stress d/o (time shorter 3-30 days)
PTSD is often comorbid w?
Often comorbid w:
- Depression
- Panic d/o
Self therapy w
- ETOH
- drugs
FDA pharm tx for PTSD?
SSRI are the only class of meds that are FDA approved
Tx for PSTD?
Psychotherapy (the sooner the better)
- brief 8-12 sessions
- treat the substance abuse
Pharmacotherapy - SSRI - B blockers (propanolol) - A blockers (clonidine - nightmares) - antiseizure meds - carbamazepine (impulsivity/anger) Benzo’s - (anxiety, panic)
What SSRI’s are best for PTSD?
Sertraline
Paroxetine
Are both fda approved
Prognosis for PTSD?
1/2 experience chronic PTSD
Prognosis is better if they we not already crazy
What is Acute stress disorder?
PTSD but shorter timeline
3-30 days
What is adjustment disorder?
Anxiety or depression reaction to an identifiable source that is out of proportion
What constitutes a stressful event for adjustment disorder??
Nothing it is specific to the individual
- stress caused by the overwhelming of the adaptive capabilities of the individual
What is the onset of adjustment disorder?
Emotional or behavioral symptoms w/in 3 months of the onset of the stressor
Clinical findings for adjustment disorder?
- Stressed, anxious or depressed
- Physical symptoms
- Eating/drinking
- Running away
- Anxiety
- Dreams
Ddx for adjustment d/o?
Anxiety Mood Bereavement Acute stress disorder PTSD
The stressor for adjustment d/o is usually less than that of ASD or PTSD
Tx for adjustment disorder?
Behavioral - stress reduction techniques Social - fix your life/job Psychological - not usually required Pharm - sedatives (lorazepam) for anxiety - SSRI’s because we give those for everything
Prognosis for adjustment disorder?
Take away the stressor and they get better quickly
Child maltreatment types:
Injury inflicted by someone who has responsibility for the child
- abuse whether or not they intended injury
Sexual abuse
- any sex act to provide gratification of caregiver
Child neglect?
Egregious act of omission by caregiver that deprives child of basic age-appropriate needs leading to psychological harm to the child
Types of child neglect?
Abandonment
Lack of supervision
Failure to attend emotional needs
Failure to provide:
- education
- medical care
- nourishment
- shelter
- clothing
What is child psychological abuse?
Verbal or symbolic acts
- berating
- disparaging
- humiliating
- threatening
- etc
Adult maltreatment and neglect classifications
Spouse/partner
Non-spouse/partner
Adult maltreatment and neglect types?
- violence
- sexual violence
- neglect
- egregious act or omission (deprives dependent parter of needs)
- psychological (non verbal or symbolic)
What is non-adherence to medical tx?
Focus of clinical attention is non-adherence to an important aspect of treatment for a mental d/o or another medical condition
Reasons for non-adherence to med treatment?
- discomfort
- $$
- personal/religious
- age related debility
- mental d/o
When is non-adherance to medical treatment considered
When problem warrants independent clinical attention
When to suspect malingering?
Any combo of:
- current legal stuff going on
- marked discrepancy between S and O
- lack of cooperation/compliance w exam/treatment
- antisocial personality
Malingering includes?
Motivation for symptoms
- external incentive
- getting out of stuff
Contrast w factitious d/o where there is no incentive
W TBI look for?
Criteria are met for mild/maj neurocognitive d/o
Evidence of injury to brain injury w 1 (+) of:
- LOC
- post traumatic amnesia
- disorientation/confustion
- neurologic signs of injury
When does TBI present?
Immediately after injury or recovery and persists past post injury phase
Tx for TBI?
Find out
