Trauma & Stress-Related Disorders

Question 1

Predisposing factors to trauma-related disorders

• Psychosocial Theory
• Learning Theory

Answer 1

• Cognitive Theory
• Biological Aspects

Question 2

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Examining the cognitive appraisal of an event & focusing on assumptions that an individual makes about the world

Answer 2

Cognitive Theory

Question 3

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Looks at the role of neurobiological features, which may include brain structure as well as neurotransmitter availability

Answer 3

Biological Aspects

Question 4

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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)

Answer 4

Psychosocial Theory

Question 5

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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)

Answer 5

Learning Theory

Question 6

Stress disorders - PTSD & ASD

• Intrusion sx’s
• Negative mood
• Dissociative sx’s
• Avoidance sx’s
• Arousal sx’s

Answer 6

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.

Question 7

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

Answer 7

PTSD

Question 8

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.

Answer 8

ASD

Question 9

Nursing diagnoses & interventions for ASD & PTSD

• Post-trauma syndrome
• Complicated grieving

Answer 9

Question 10

Trauma-informed Care

What are the 4 “R’s” ?

Answer 10

Realize
Recognize
Respond
Resist re-traumatization

Question 11

> 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

Answer 11

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

Question 12

Treatment Modalities for PTSD/ASD

• Cognitive Therapy
• Prolonged Exposure Therapy
• Group and Family Therapy
• Eye Movement Desensitization & Reprocessing (EMDR)

Question 13

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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

Answer 13

Prolonged Exposure Therapy

Question 14

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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

Answer 14

Cognitive Therapy

Question 15

Psychopharmacology for PTSD

> Antidepressants
Anxiolytics
Anti-hypertensives
Other rx’s

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

Prazosin has shown as an effective agent in reducing nightmares as well

Question 18

Adjustment Disorder

predisposing factors:
* Biological Theory
* Psychosocial Theories
* Transactional Model of Stress & Adaptation

Answer 18

⇢ w/ depressed mood
⇢ w/ anxiety
⇢ w/ anxiety & depressed mood

⇢ w/ disturbance of conduct
⇢ w/ mixed disturbance of emotions & conduct

> unspecified

Question 19

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

Answer 19

adjustment disorder

Question 20

____ 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

Answer 20

Unspecified

Question 21

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

Answer 21

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

Question 22

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

Question 23

Nursing diagnoses & interventions for Adjustment Disorders

• Risk-prone health behavior
• Complicated grieving

Answer 23

Question 24

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

Answer 24

• 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