Trauma/Stress Disorders Flashcards
What is trauma ?
response to an incident or series of events that are emotionally disturbing or life-threatening with lasting adverse effects on the individual
What does PTSD look like in preschoolers ?
- reduction in play
- repetitive play that includes aspects of traumatic event
- social withdrawal
- negative emotions: fear, guilt, anger, horror, sadness, shame or confusion
What is reactive attachment disorder ?
inhibited, emotionally withdrawn
- inability to form attachments
- has difficulty forming relationships
- Ex.) a kid in foster care who doesn’t want to connect with others
What is disinhibited social engagement disorder ?
displays overly familiar behaviors towards strangers without regard to appropriate social boundaries
- attaches to anyone with no fear of strangers
- willing to go off with people they don’t know
- hugging/cuddling unknown adults
What are some assessments for children ?
- play activities for younger children
- observance of caregiver interactions
- post traumatic symptoms: nightmares, night terrors, flashbacks, traumatic play, bedwetting, regression
- somatic symptoms: HA, stomachache, pain
What are some assessment tools ?
- child dissociative checklist
- trauma symptoms checklist for children
- child sexual behavior inventory
- denver II developmental screening test (infant to 6 yrs)
What are the intervention stages for PTSD ?
- stage 1: provide safety and stabilization
- stage 2: reduce arousal and regulate emotion through symptom reduction
- stage 3: catch up on developmental and social skills
How would CBT help kids with trauma ?
uses psychoeducation, behavior modification, cognitive therapy and stress management
- helps child manage behavior and change maladaptive thoughts and beliefs
How does eye movement desensitization and reprocessing (EMDR) help ?
processes traumatic events through an 8-phase protocol
- pt thinks of traumatic event while doing specific eye movements, audio tones, or tapping
- resulting in neurological and physiological changes that help process traumatic memories
What are characteristics of PTSD in adults ?
- re-experiencing the traumatic event (flashbacks)
- sustained high level of anxiety or arousal
- general numbing of responsiveness
- intrusive recollection or nightmares
- amnesia to certain aspects of the trauma
- depression, survivor’s guilt
- substance use
- anger and aggression
- relationship problems
What outcomes do you want for those with PTSD ?
- manage anxiety: adequate sleep, ADL functioning
- increase self-esteem: eye contact, and positive statements
- improved coping: decrease in physical symptoms, and seek help/treatment
What are treatments for PTSD in adults ?
- CBT
- prolonged exposure therapy (PET): you gradually expose yourself to what makes you nervous
- group/family therapy
- eye movement desensitization and reprocessing (EMDR)
- psychopharmacology
What are some medications used for PTSD ?
- SSRIs: paxil, zoloft
- SNRI: effexor
- TCAs: remeron (helps people that feel really anxious and really on edge)
- hyperarousal, panic, intrusive symptoms: clonidine, minipress, propranolol (short-term to produce calming effect)
What is acute stress disorder ?
happens immediately after a highly traumatic event
- symptoms persist for 3 days +
- diagnosis made with month
After 1 month either:
- resolution
- becomes PTSD once it persists for more than 1 month
What are some S&S of acute stress disorder ?
- alterations in concentration
- anger
- dissociative amnesia (mind unconsciously forgets you experienced the trauma)
- HA
- irritability
- nightmares
What are some consequences of insomnia/poor sleep ?
- memory impairment
- automobile accidents
- poor job/school performance
- relationship between insomnia and depression, pain disorders, heart disease
- higher rate of hospitalizations
- increased risk for GAD and MD
- four fold increase in new onset psychiatric episodes
What are some good sleep hygiene habits ?
- exercise daily, but not right before bed
- take a hot bath 2 hours before bedtime
- a hot non-caffeinated beverage may help with relaxation
- avoid heavy meals before bedtime
- keep room dark, quiet, well-ventilated, and at a comfortable temperature throughout the night
- smoking can affect sleep, nicotine is a stimulant
- avoid caffeine
- limit alcohol: alcohol fragments sleep
What is some stimulus control for sleep ?
- go to bed only when sleepy
- use the bed/bedroom for sleep only (no TV, reading, or other activities in bed)
- get out of bed when unable to sleep
- maintain regular sleep-wake schedule
- avoid daytime napping (limit to 20-30 mins at most)
What is imagery distraction ?
thinking of something interesting that is also pleasant and relaxing
- when intrusive thoughts start to occur say “stop” to the thought
- then think of that pleasant image
What is biofeedback ?
helps the pt learn how to increase awareness and gain control of reactions to a trigger
What is Zolpidem (ambien and ambien-CR) used for ?
decrease time to sleep onset and increase amount of sleep
- can cause sleepwalking but in extreme forms (driving, cooking, teaching)
What is Zaleplon (Sonata) used for ?
decrease time to sleep onset
What is Eszopiclone (Lunesta) used for ?
decrease time to sleep onset and increase amount of sleep
What is Ramelteon (Rozerem) used for ?
decrease time to sleep onset
- non habit forming
- affects melatonin
