Trauma & Stress-Related Disorders Flashcards
Predisposing factors to trauma-related disorders
- Psychosocial Theory
- Learning Theory
- Cognitive Theory
- Biological Aspects
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Examining the cognitive appraisal of an event & focusing on assumptions that an individual makes about the world
Cognitive Theory
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Looks at the role of neurobiological features, which may include brain structure as well as neurotransmitter availability
Biological Aspects
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Seeks to explain why certain people exposed to massive trauma develop trauma-related disorders, while others do not
> Variables include characteristics that r/t the traumatic experience; the individual, which may include ego strength and coping skills in the recovery environment (i.e., social supports)
Psychosocial Theory
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We look @ the concept of negative reinforcements, & those behaviors that decrease the emotional pain of trauma
Behaviors are negatively reinforced when they allow an individual to escape from an adverse of stimuli (think of something as being subtracted from the situation here)
Learning Theory
Stress disorders - PTSD & ASD
- Intrusion sx’s
- Negative mood
- Dissociative sx’s
- Avoidance sx’s
- Arousal sx’s
PTSD & ASD (Acute Stress Disorder) are both stress disorders that result from exposure to traumatic events. They share overall sx’s but vary in length of time that they affect the individual.
In both disorders, the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The disturbance is not attributed to any physiological effect from a substance like a medication or alcohol or any other medical condition.
In ____, the duration of the disturbance criteria B, C, D, and E is more than 1 month following the event and can last for years
PTSD
In ____, the duration of the disturbance, which is symptoms and criteria B, has to last 3 days to 1 month after the trauma. Symptoms typically begin immediately after the trauma, but persistence for at least 3 days in up to 1 month is needed to meet the criteria of this disorder.
ASD
Nursing diagnoses & interventions for ASD & PTSD
- Post-trauma syndrome
- Complicated grieving
Trauma-informed Care
What are the 4 “R’s” ?
Realize
Recognize
Respond
Resist re-traumatization
> Trauma-informed care is a strength-based framework that’s grounded in understanding & responding to the impact of trauma
Realize the widespread impact of trauma in various past recovery
Recognize the s/s of trauma in our clients, families, staff, & everybody who’s involved in the system
Respond by fully integrating knowledge about trauma & policies & procedures & practices
Actively resist re-traumatization
> Re-traumatizing events can occur & not have the intention but unwillingly. This can include seclusion & restraint, which are designed to protect the client’s ability to maintain their safety, but they may be re-traumatizing to a client w/a h/o trauma
Treatment Modalities for PTSD/ASD
- Cognitive Therapy
- Prolonged Exposure Therapy
- Group and Family Therapy
- Eye Movement Desensitization & Reprocessing (EMDR)
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Is a type of behavioral therapy that could be conducted in an imagined or real situation
> In the imagined situation, the individual is exposed to repeated & prolonged mental recounting of the experience
In the real situation, also called in vivo, the exposure involves systematic confrontation within safe limits of the trauma-related situation that is feared & avoided
Prolonged Exposure Therapy
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Strives to help the individual recognize & modify trauma-related thoughts & beliefs
> The individual learns to modify the relationship between these thoughts & feelings
Cognitive Therapy
Psychopharmacology for PTSD
> Antidepressants
Anxiolytics
Anti-hypertensives
Other rx’s
Antidepressants – SSRI’s (first-line treatment d/t their efficacy, tolerability, & safety)
> paroxetine (Paxil), sertraline (Zoloft)
Tricyclic antidepressants (TCAs) – amitriptyline, imipramine
MAO inhibitors – phenelzine (Nardil)
Trazodone (atypical antidepressant)
Alprazolam (Xanax)[benzodiazepine/sedative] – for PTSD b/c of its anti-depressant and anti-panic effects
Other benzodiazepines have been used, despite the absence of controlled studies that demonstrate their efficacy in PTSD. Their addictive properties make them less desirable than some of the other rx’s in the treatment of post-trauma care
Buspirone [anxiolytic] which has some serotonin properties, is similar to SSRI’s & may also be useful
Beta blocker propranolol & the alpha-2 receptor agonist clonidine have been successful in alleviating some sx’s assoc w/PTSD like nightmares, intrusive recollections, hypervigilance, insomnia, startle response, & angry outbursts
Carbamazepine, valproic acid, & lithium carbonate have also been reported to alleviate sx’s
IV ketamine is also being used off-label as it’s believed to disrupt the fear assoc w/the trauma
Prazosin has shown as an effective agent in reducing nightmares as well
Adjustment Disorder
predisposing factors:
* Biological Theory
* Psychosocial Theories
* Transactional Model of Stress & Adaptation
⇢ w/ depressed mood
⇢ w/ anxiety
⇢ w/ anxiety & depressed mood
⇢ w/ disturbance of conduct
⇢ w/ mixed disturbance of emotions & conduct
> unspecified
An ____ ____ is characterized by a maladaptive reaction to an identifiable stressor. It results in the development of clinically significant emotional or behavioral sx’s. It differs from PTSD and ASD because of the time frame.
> The response occurs within 3 mos after onset of the stressor & persists for no longer than 6 mos after the stressor or the consequence has ended
It results in inability to function socially or occupationally
They’re categorized by the distinguishing predominant features of the maladaptive response
adjustment disorder
____ means that it’s a subtype of the maladaptive reaction that’s not consistent w/any other categories
The individual may have physical complaints, withdraw from relationships or exhibit impaired work or academic performance but w/o significant disturbance in emotion or conduct
Unspecified
The biological theory, such as neurocognitive or intellectual developmental disorders, impairs the ability to adapt to stress
> Genetic factors may also influence the risk for maladaptive response to stress
The psychosocial theories include Freud’s psychoanalytic theory, & it views adjustment disorders as a maladaptive response to stress caused by early childhood trauma
> Increased dependency & retarded ego development
In the transactional model of stress & adaptation, this takes into consideration the interaction b/t the individual & the environment, incl sudden shock stressors & continuous stressors
> Of these 2 types of stressors, more individuals respond w/maladaptive behaviors to long-term continuous stressors
Nursing diagnoses & interventions for Adjustment Disorders
- Risk-prone health behavior
- Complicated grieving
Treatment Modalities for Adjustment Disorders
- Individual psychotherapy (allows client to examine the stressors causing the problem)
- Family therapy
- Behavior therapy
- Self-help groups
- Crisis intervention
- Psychopharmacology
> Adjustment disorders are not commonly treated w/rx
They want the client to work through the uncomfortable, distressing symptoms rather than mask them
The physician may prescribe anti-anxiety or antidepressant rx’s, & they should be given in add’n to psychotherapy
