trauma and stress disorders Flashcards
r/t…
early interpersonal trauma
depersonalization and derealization d/o
traumatic events
combat, pow, crime, natural disasters, mass violence, interpersonal, sudden and traumatic loss in any stage of life, serious accident
acute stress d/o: clinical picture
3days - 1 mo post trauma
continuous re-experience, avoid situations that remind, increase anx and excitation that negatively affects lifestyle
PTSD = s/s >1mo
exposure directly or indirectly to traumatic event
need 9+ s/s from intrusion, negative mood, dissociative, avoidance, arousal categories
cause sig distress and dec F
not attributable to substance or med d/o
acute stress d/o: s/s - intrusion
recurrent, involuntary, intrusive distressing mem, or dreams
dissociative reaction -> flashback
intense psych or phys distress when reminded of event -> similar location/sounds
acute stress d/o: s/s - arousal
sleep disturb, irritable/angry outburst, hypervigilence, difficult [], exaggerated startle response
acute stress d/o: s/s - dissociative
altered sense of reality -> daze, time slow, altered perception
dont remember important part of traumatic event
acute stress d/o: s/s - negative mood
persistent inability to experience positive emotions
acute stress d/o: s/s - avoidance
efforts to avoid mems, thoughts, feelings
avoid external reminders
acute stress d/o: tm
psychotherapy = main
trauma focused CBT -> 4 components
EMDR
when they avoid they never learn they can survive
pharm not really helpful
PTSD: clinical picture
persistent re experience, intense fear, helpless, horror
trauma: direct experience, witness in person trauma to someone else, learn about event happening to close friend/fam/stranger -> death must be violent or unexpected
not just exposure to media
can begin 1 mo post exposure, but s/s delay common
epidemiology: F>M
comorbid: most have another MI
PTSD: s/s
similar to ASD, last >1mo
4 core: re experiencing (flashback, dream, thoughts), avoidance, arousal and reactivity, cog and mood (dont remember key factors, neg thoughts, distorted feelings, anhedonia)
can l/t phys rxns
decreased F
trust is common issue
PTSD: rf
before, during, and/or after
previous trauma -> esp childhood
injuries to self or others
feel horror, helpless, fear
low support
extra stress -> death, job, $
fam/personal hx MI/SUD
PTSD: children and adolescents
less coping skills
preschool: decreased play, scary play that includes aspects of event, social w/d, negative emotions
children: may blame self
other s/s: relive, nightmare, very upset with mem of event, lack of positive emotions, easily startled, hypervigilant, helpless, hopeless, withdrawn, deny, numb, irritable, aggressive, self destructive, problems [], detached or estranged, avoid reminders, less interest or participation, somatic s
PTSD: tm
primary tm is trauma focused psychotherapy and some meds
antidep for dep and anx, sleep and []: SSRI, SNRI, MAOI
psychotherapy: exposure (PE), CBT, EMDR -> usually combo with anx management and stress reduction, focus on alleviating s/s
children and adolescents: early dx important (dev and QOL), tm depend on s/s, age, health severity
psychotherapy: CBT, play, emdr
pharm: not FDA approved, SSRI may improve social and school F
emdr
1st line in kids
helps process mems: think about event while focusing on other stimuli, neuro and phys change that helps process and integrate traumatic mems, unfreeze traumatic mem
trauma focused care
complete pic of pts life to provide effective care
recognize and respond to effects of all trauma types, recognize s/s, avoid retraumatization
whats wrong -> what happened
improve pt engagement, adherence, outcomes, hcp and staff wellness
PTSD: in pt
trauma informed care, provider recognition, collab, individualize
issues that affect: sleep, pain, anx and anger
depersonalization/derealization d/o: clinical picture
persistent or recurrent episodes of 1 or both
episodes can last hrs, days, wks, mos
decreased F
cause unknown, likelihood: genetic and env factors, increased stress and fear
comorbid: MDD, anx, personality (avoidant, borderline, obsessive-compulsive)
depersonalization
being an observer of ones own body or mental processes
feeling of unreality, detach, unfamiliar with parts of self: feelings, thoughts, body parts, sensations
derealization
focus on outside world, feel it is unreal or distant
walking in fog, bubble, dream, invisible veil
visual distortions: blurry, change in visual field, altered size of object
auditory distortions: must or increased sound
depersonalization/derealization d/o: rf
personality traits
serious trauma -> violence or abuse
severe stress
dep and anx
substance misuse
depersonalization/derealization d/o: tm
short lived and go away without
self hypnosis, cbt (learn why, new strategies, coping), rTMS
pharm: none but meds used for cm and comorbid
trauma related d/o in kids
abuse and neglect, M > F, many die, neglect is most common, experience or witness, cyclic patterns if no tm, usually parents
brain
temporal lobes decrease in activity
intervention stages
- safety and stabilize: safe and predictable env, no self harm, educate on trauma and effects
- decrease arousal, regulate emotion via s/s reduction and mem work -. integrate suppressed emotions, overcome avoidance, decrease dissociation, transform mem
- catch up dev and social skills, dev value system: enhance problem solve, increase self awareness, coping skills, support system, window of tol -> hypo and hyper arousal
attachment d/o: attachment
profound reciprocal phys and emotional relationship btw child and caregiver, sets stage of all future relationships
attachment d/o: rf
parent doesnt meet child’s needs: MI, huge stress, SUD, dep
social, emotional, phys needs
temperament, no communication needs, hard to soothe, irregular sleep, shy
attachment d/o: reactive attachment d/o - dsm5
consistent pattern of inhibited, emotionally withdrawn behavior to adult caregivers manifested by: rarely or minimally seeks or responds to comfort when distressed
persistent social or emotional disturbance characterized by at least 2: minimal social and emotional responsiveness to others, limited positive affects, episodes of unexplained irritability, sadness, or fearfulness evident even during nonthreatening interactions with caregivers
experienced pattern of extremes of insufficient care about at least 1: neglect or deprivation, repeated changes of primary caregivers, rearing in unusual settings
attachment d/o: reactive attachment d/o - behaviors
withdrawal, fear, sad, irritability not readily explained
sad or listless
dont seek comfort or respond when comfort given
dont smile
watch others closely. but dont engage in social interaction
dont ask for support or assistance
dont reach out when picked up
no interest in peek a boo or other interactive games
disinhibited social engagement d/o
w/n first 2 years
approach and interact with unfamiliar adults: decreased reservation about approaching, over familiar, violate social/cultural boundaries, dont check back with caregiver, go to unfamiliar person without reservation
evidence of persistent pathogenic care (severe social neglect) show by 1+: neglect, repeated change in caregiver -> no stable attachment
behavior not explain by dev delay
disinhibited social engagement d/o: tm
RAD and DSED
include primary caregiver
ensure child has + interactions and attachment via 5 senses, safe and stable living after d/c
disinhibited social engagement d/o: tm - safe and stable env
consistent care giver, nurtur, responsive and caring
positive, stim, interactive env
address med, safety, housing needs
increase touch, talk, socialization: hold, hug, touch, feed, talk, story telling, meals with other kids and caregivers, educate caregivers
adjustment d/o
milder PTSD
emotional/behavioral reaction within 3 mo exposure to stressor
decrease F, rxn out of proportion
s/s end by 6 mo: anx, dep, mixed, regression, fearful or acting out
need support, understanding, encouragement, therapeutic comm, active listening, increase coping to avoid further instances
