Trauma, Stress-Related, and Dissociative Disorders Flashcards
T/F Trauma ofter proceeds psychiatric disorders
false, precedes
T/F Children who have been abused and neglected by their caretakers and other adults are at a great risk for developing physical illnesses and psychological problems as a result of their traumatic experiences.
true
What is the most prevalent for of child abuse in the US?
Neglect
What does PTSD look like in preschool children?
- reduction in play
- reduction in repetitive play that includes aspects of the traumatic event
- social withdrawal
- negative emotions (fear, guilt, angle, horror, sadness, shame, or confusion)
- self-blaming
- “I am a bad person”
- self-destructive, sleep disturbances, hypervigilance
Neuroplasticity
describes how experiences reorganize neural pathways ; can increase vulnerability to adverse childhood experiences
T/F Most children however who suffer traumatic and stressful event, do not develop normally
false, they do develop normally
What term refers to positive adaptation or the ability to maintain or regain mental health despite adversity
resilience
What are the 2 priority dx for children trauma-related?
- Risk for impaired attachment
2. Risk for delayed development
What are the implementation stages for a child trauma-related disorder?
Stage 1: Providing safety and stabilization; stop self-destructive behaviors
Stage 2: Reducing arousal and regulating emotions through Sx reduction and memory work
Stage 3: Developmental skills catch up through enhancing problem-solving skills, nurturing self-awareness; social skills training
What is the window of tolerance?
a term that means a balance between sympathetic and parasympathetic arousal
What are 2 adv. practice interventions for children with stress-related disorders?
- CBT
2. Eye movement desensitization and reprocessing
What type of meds are given to children with trauma or stress related disorders?
there are no FDA approved meds for children with PTSD. SSRIs may improve social and school fxning and decrease avoidance, numbing, and dissociation
Describe reactive attachment disorder
a consistent pattern of inhibited and emotionally withdrawn behavior. The child rarely directs attachment behaviors towards any adult caregivers and does not seek comfort from then when distressed
Describe disinhibited social engagement disorder
children come across as being remarkable friendly and confident. they demonstrate no normal fears of strangers and are usually willing to go off w/ people who are strangers
What is the cause of reactive attachment disorder
a lack of bonding may be due to severe neglect, repeated changes of primary caregivers or care in an institutional setting
Describe PTSD in adults
PTSD may be brought about indirect exposure to trauma. When the person recalls a traumatic memory, physiological rxns occur. The person often does not know where these sensations originate and attributes them to present circumstances and the past becomes the present
What is the priority Dx for an adult w/ PTSD?
Posttraumatic syndrome
How do you implement a pt with a Dx of postraumatic syndrome?
- establishing a therapeutic relationship through nonjudgmental acceptance and empathy.
- teach strategies to manage anxiety (deep breathing, imagery, and mindfulness)
Which drugs have been approved for PTSD? State the class of each
- Zoloft and Paxil (SSRIs)
- Effexor and Cymbalta (SNRI)
- Nardil (MAOI)
- Remeron (TCA)
- Clonidine and Minipress
- Propanolol (beta-blockers)
Describe acute stress disorder
develops exposure to a highly traumatic event; Sx develop immediately after exposure after the event, but a Dx is not made until they have persisted for 3 days
What occurs when a pt has acute stress disorder longer than a month?
go on to become PTSD
After establishing a therapeutic relationship with a pt with ASD, what are your implementations?
- promote problem solving, connecting the person to support
- Debriefing
Describe debriefing
occurs w/in 12-48 hrs after the traumatic event
What is adjustment disorder
precipitated by a stressful event but not as severe and may not be considered a traumatic event and diagnosed immediately or w/in 3 mos
Sx of adjustment disorder
- anger
- anxiety
- guilt
- depression
- physical complaints
- social withdrawal
- work/ academic inhibition
How is adjustment disorder treated?
SSRIs
An unconscious defense mechanism that protects the individual against overwhelming anxiety through an emotional separation
dissociation
How are Sx of dissociative disorder classified?
positive and negative
What are the (+) Sx of dissociative disorders?
- unwanted additions to mental activity such as flashbacks
What are the (-) Sx of dissociate disorders?
deficits such as memory problems or the ability to sense or control different parts of the body
Claire says she is beginning to feel outside of her body can see herself walking. What do you recognize this as?
depersonalization
Gina says the couch is larger than it appears but the door is smaller. What do you recognize this as?
derealization
What is the difference between derealization and depersonalization?
derealization is the focus on the outside world and depersonalization is the focus on one’s self
The inability to recall important personal info often of a traumatic or stressful nature
dissociative amnesia
What is the difference between localized and selective amnesia?
localized the pt is unable to remember al events in a certain period and selective the pt is able to recall some but not all events in a certain period
Kristen left NY traveling to LA and is unable to recall her identity in NY. What is this a Sx related to?
dissociative fugue
The presence of 2+ distinct personality states that recurrently take control of behavior
DID
In DID, is the primary personality or host aware of the alters?
no, they are usually perplexed by lost time and unexplained events
How do the alters and primary personality differ?
the primary personality is religious and moralistic and the alters are pleasure-seeking and noncomforming
What part of the brain is involved w/ the development of dissociative disorders?
the limbic system
What are some nursing Dx for a pt with dissociative disorders?
- disturbed personal identity
- ineffective role perfomance
- anxiety self-control
Are there any specific meds for those w/ dissociative disorders?
no, but the following meds can be prescribed for hyperarousal and intrusive Sx that accompany PTSD and dissociation
- antidepressants
- antianxiety
- antipsychotics
