Trauma, Stressor, And Dissociative Flashcards
Trauma is…
How you respond to the incident
Trauma impacts the CNS and imbalances the….
Adaptations occur in (Sympathetic or Parasympathetic) system?
HPA
Hypothalamus, Anterior Pituitary, Adrenal Axis
Both systems
Describe how PTSD may affect a preschooler
Reduction in play- play that includes reenactment of traumatic events
Negative emotions
Blaming themselves
Detachment
Attachment Disorders happen when there is a grossly inadequate nurturing environment deficits with primary care giver by ….
8 months
Children with Reactive attachment disorder …..
Consistent pattern of emotional withdrawal. Rarely seeks comfort from adult caregivers
What is disinhibited social engagement disorder….
When a child gets neglected, severely and will go with strangers
Isn’t afraid of strangers
Trauma-Related Disorders
Comorbidities
Phobias
Somatic
Impulse control
Identity
Learning/attention
Sleep
Depression/ Suicide
Dissociation
Substance abuse
Polyvagal theory is a model that explains ….
how the autonomic nervous system (ANS) regulates our emotions, social connections, and fear responses.
ANS is influenced by the central nervous system, and that different physiological states support different behaviors
Dissociation happens from…
Following traumatic event
Parasympathetic response triggers hypo-aroused state with dysregulation of the Hypothalamus Pituitary Adrenal axis. Resulting in dissociation
Is dissociation ever normal
Yes, exp. When driving and space out.
Episodic failure of dissociation causes intrusive symptoms such as flashbacks, thus dysregulating _____
Cortisol
Severe neglect cause
Decreased serotonin
Increased CRF
Decreased Oxytocin
Describe what each do…
Decreased serotonin:
Irritatability / reduced emotional control
Increased CRF
Decreased Deep Sleep, Depression, Anxiety
Decreased Oxytocin
Attachment problems
Type of abuse that is most damaging
Emotional?
Damage to the HPA Axis will cause toxic effects of….
Cortisol
Impaired emotional regulation & problems with memory
3 brains
1st brainstem
2nd Midbrain and limbic area
3rd Cortical brain
Describe
1st brainstem: Survival, Sensory motor input
2nd Midbrain and limbic area: Attachment & emotional development
3rd Cortical brain: Thinking, learning, language, inhibition
Clinical outcomes for severe early abuse
Chronic depression
Borderline PD
Attachment problems
Substance abuse
PTSD
To what degree of certainty is a nurse a mandatory reporter
Suspected
TEN-4-FACESp
Braising clinical decision rule for children <4
What does it stand for….
TEN: Torso, Ears, Neck
FACES:
Frenulum (Cord-like structure that attaches 2 body parts)
Angle of jaw
Cheeks
Eyelids
Subconjunctivae
4 months or younger - bruising anywhere
Patterned bruising: Slap, Grab, Electric cord
Example of grounding tech that can help manage intrusive thoughts when reminded of our traumatic experiences
5,4,3,2,1
5 things you can see
4 things, touch
3 things, hear
2 things, smell
1 thing, taste
Trauma intervention for PTSD child.
Priority intervention
Establish trust and safety in therapeutic relationship.
Teach relaxation tech before trauma exploration.
Use art & play therapy
Would you invite an abuseive father to have 1:1 play time with his child as part of therapy
No
Eye movement desensitization and reprocessing (EMDR) is….
Psychotherapy technique
help people heal from trauma and other distressing experiences.
It involves moving the eyes in a specific pattern while processing memories
Immediately after highly traumatic event.
Symptoms last 3 days
Diagnosis within 1 month
After 1 month: Resolution or PTSD
DIAGNOSIS IS POSTTRAUMA SYNDROME
Name the disorder
Acute stress disorder
Acute Stress Disorder
Immediately after highly traumatic event.
Symptoms last 3 days
Diagnosis within 1 month
After 1 month: Resolution or PTSD
DIAGNOSIS IS POSTTRAUMA SYNDROME:
Name effective treatments
CBT & EMDR Eye movement desensitization and reprocessing
Acute stress disorder
Must display ____ symptoms out of 14 during or after traumatic event
- Sense of numbing
- Derealization
- Inability to remember 1 important aspect
- Intrusive memories
- Nightmares
- Feels the event is recurring
- Intense Prolonged reactivity
- Avoidance of thoughts or feelings about the event
- Sleep Disturbances
- Hypervigilamce
- Irritable
- Angry
- Exaggerated startle response
8 out of 14
This disorder
Is precipitated by a stressful event Not as severe or considered a Traumatic event.
Debilitating cognitive, emotional, and behavioral symptoms that impact normal functioning
Treatment….
Adjustment disorder
Treatment: SSRI
Average age of onset for PTSD
23
Women or men more likey for PTSD
Women 2x more likely
PTSD
Short-term dissociation may be adaptive
True or false
True
NSESS vs CAPS 5
NSESS is a quick self-assessment tool, while CAPS-5 is a more thorough clinician-administered interview for diagnosing PTSD.
Psychopharmacology for PTSD
SSRI / SNRI
Clonidine (Catapress) / Prazosin (Minipress) - centrally acting Alpha agonist. Used for hyperarousal & intrusive symptoms
Propranolol (Inderal) betablocker
Prazosin- decreases nightmares
Prazosin
decreases nightmares
PTSD
Joseph P. Dryer project is…
Peer to peer veterans help
Characterized by disruptions or alterations in consciousness, memory, identity, or perception.
Response to trauma or stress, serving as a coping mechanism to detach from painful experiences.
Dissociative disorders
Dissociative Disorders (3)
Depersonalization/ derealization disorder
Dissociative amnesia
Dissociative identity disorder
Depersonalization disorder
Dissociative amnesia
Dissociative fugue / identity disorder
Describe
Depersonalization disorder: disconnected from mind or body
Dissociative amnesia: Ability to integrate memories is Impaired
Dissociative fugue / identity disorder:
Unable to maintain identity
Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.
5 types
Localized:
Selective:
Generalized:
Continuous:
Systematized:
Localized: Can’t remember event that took place during specific period of time (after trauma)
Selective: Only recall some part of the event
Generalized: Prolonged memory loss - Lifetime
Continuous: Forgets all events from a given time forward to the present
Systematized: Limited to specific type of information
Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.
5 types
Localized:
Selective:
Generalized:
Continuous:
Systematized:
Localized: Can’t remember event that took place during specific period of time (after trauma)
Selective: Only recall some part of the event
Generalized: Prolonged memory loss - Lifetime
Continuous: Forgets all events from a given time forward to the present
Systematized: Limited to specific type of information
Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.
5 types
Localized:
Selective:
Generalized:
Continuous:
Systematized:
Localized: Can’t remember event that took place during specific period of time (after trauma)
Selective: Only recall some part of the event
Generalized: Prolonged memory loss - Lifetime
Continuous: Forgets all events from a given time forward to the present
Systematized: Limited to specific type of information
Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.
5 types
Localized:
Selective:
Generalized:
Continuous:
Systematized:
Localized: Can’t remember event that took place during specific period of time (after trauma)
Selective: Only recall some part of the event
Generalized: Prolonged memory loss - Lifetime
Continuous: Forgets all events from a given time forward to the present
Systematized: Limited to specific type of information
Dissociative amnesia: Inability to recall important personal information of a traumatic or stressful nature.
5 types
Localized:
Selective:
Generalized:
Continuous:
Systematized:
Localized: Can’t remember event that took place during specific period of time (after trauma)
Selective: Only recall some part of the event
Generalized: Prolonged memory loss - Lifetime
Continuous: Forgets all events from a given time forward to the present
Systematized: Limited to specific type of information
Dissociative fugue….
Inability to recall identity & information from the past and accompanied by travel away from customary locale
Dissociative Identity Disorder….
Personality is split into “parts” with distinct memory and behavior.
One part maybe the child, protector, day-to-day Personality.
It’s not Multiple Personality Disorders, All same Personality just different aspects of it
Mental comorbidities with Dissociative Disorders
Depression
Panic attacks
Eating disorders
PTSD,OCD,ADD, SUD
What is Conversion disorder….
Physical symptoms from stress or trauma
_____ maybe present with conversion disorder or personality disorder
Dissociative amnesia
Dissociative fugue may cooccur with…
PTSD
Dissociative identity disorder
May also have;
PTSD
BPD
Sexual/ Eating disorders
And….
Sleep disorder
Depersonalization disorder may cooccur with
Hypochondriasis
Mood anxiety disorder
OCD
And…
Schizophrenia
Depersonalization disorder believed to be related to childhood trauma has these biological factors… (3)
Epilepsy, brain Tumors, & schizophrenia
Dissociative Disorders Etiology:
Primitive ego defense mechanism.
Different parts of their personality not fully integrated with eachother
T or F
T
Some culture bound Disorders look like dissociative disorders
T or F
T
Which dissociative disorders may function well in an undemanding job / social situation
Fugue
Treatment goal for Dissociative disorders
Integration of parts into single personality
Grounding tech for Dissociative Disorders.
Patient can learn triggers to dissociation and interrupt by….
Singing
Playing an instrument
Talking to someone
Ice on hands
Dramatic memory retrieval can be accomplished through….
IV Benzodiazepine/ Barbiturates
Advanced Practice Nurse Interventions:
CBT,Psychotherapy, exposure therapy, EMDR,hypnotherapy, neurofeedback.
Sensorimotor therapy combines talk therapy with body centered Interventions: Dance, body awareness, mindfulness
Goal……
Reduce symptoms, integrate traumatic memory, restore ability to Stay in the Moment
Feeling of a dreamlike state or of being detached observer typically can occur in a patient experiencing which of the following.
Dissociative fugue
Dissociative amnesia
Depersonalization disorder
DID
Depersonalization disorder
Dissociative Disorders are a spectrum of severity.
Name least to most severe
Depersonalization/ derealization disorder
Dissociative amnesia
Dissociative Identity Disorders
Most common type of Dissociative amnesia
Localized: Trouble recalling traumatic event or months / years surrounding event
Dissociative amnesia
Generalized
Describe absence of memory time frame….
Onset…..
Wandering/ Travel may happen called….
Can’t remember any of their past
Onset Sudden, Stress-Induced
Dissociative fugue
Dissociative amnesia
Systematized
Describe….
Forgets a Category of information associated with the trauma
Eg person, location
Dissociative amnesia
Continous
Describe
Forgets each new event after it happens
Retains nothing but Present Moment
Dory from Finding Nemo
DID
Sudden & dramatic shifts in way they:
Perceive
Think
Feel
Usually Aware that it is unusual
May hear other personality speaking to them
Disoriented, Powerless to understand their moods & behavior
Covert
DID
Outright Assume 2 or more personalities / alters (alter ego)
Not always aware it is happening
Forgets portions of their day
FUGUE
MORE DANGEROUS OF THE 2 TYPES
Overt
Anxiety Disorders can impair sense of: Identity, Time, Sensation
What is the difference between this and DID
The time length
Anxiety = minutes/ hours
DID = Years
What did Harlows monkey experiment demonstrate.
That need for Maternal care is separate from food and warmth.
How, gave orphan baby monkey 2 fake mommies to chose from .
1 made of wire that produced heat and had milk giving nipples
1 made of cloth and fur. The baby chose the furry one
Results from trauma, with symptoms persisting longer than 1 month, including re-experiencing, avoidance, negative thoughts, and hyperarousal.
Occurs shortly after trauma, with similar symptoms to PTSD but lasts between 3 days and 1 month
Triggered by a less severe life stressor (not necessarily trauma), with emotional and behavioral symptoms starting within 3 months and typically resolving within 6 months.
Adjustment Disorder, PTSD, Acute stress
PTSD: Results from trauma, with symptoms persisting longer than 1 month, including re-experiencing, avoidance, negative thoughts, and hyperarousal.
ASD: Occurs shortly after trauma, with similar symptoms to PTSD but lasts between 3 days and 1 month.
Adjustment Disorder: Triggered by a less severe life stressor (not necessarily trauma), with emotional and behavioral symptoms starting within 3 months and typically resolving within 6 months.
Therapy for PTSD
Meds…
Exposure
Group
Meds.
SSRI
Antisocial anxiety (according to video not powerpoint)
Clonidine/ Catapress
Propranolol
Antinightmare med
Crisises 3 types
Maturational
Situational
Adventitious
Maturational: Life changing event that is a normal part of life. Marriage, Retirement, Kids growing up
Situational: Loss of a job, death of a loved one.
Adventitious: Natural disaster, Terrorist attack, Violent crime
2 types of loss
Actual loss: Tangible- Loss of a loved one
Perceived loss: Not felt by others - Loss of mental acuity
Greif 5 stages
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
DABDA
Types of grief
Complicated greif / Prolonged: >1yr affects daily functioning
Anticipatory greif: A patient given a terminal diagnosis
Disenfranchised greif: Not publicly announced- A hidden miscarriage
Which intervention in the emergency room was shown to reduce the amount of intrusive memories…
Video games
Box 296
6 F’s reactions
Fight, flight, freeze, faun, fine, faint
(This part of the brain) sounds the alarm. Too much alarm sounding, and it increases in size leading to heightened stress response
Amigdala
Rapid phase of brain dev happens during ____ years of life and brain is more vulnerable to adverse effects
5
Personality Disorders related to severe early abuse of a child
Borderline
Priority nursing diagnosis in PTSD
Others
Post trauma response
Anxiety, Impaired coping, isolation, insomnia, HOPELESSNESS,
How long does CPS have to call you back after reporting…
30 days
Nurses ARE required to report instances of child abuse to CPR
Yes
Implementation of stages (3)
- Provide safety
- Reduce arousal & regulate emotion through symptom reduction
- Catch up on dev & social skills, dev a value system
Adjustment Disorder symptoms maybe treated with this medication
Antidepressants
Seroquel for PTSD in adults. Increases sleep & ____ watch out for metabolic syndrome
BDNF
Brain derived Neurotrophic Factor
BDNF: Neuronal function, plasticity, and overall brain resilience.
What type of communication will a nurse engage in during times of crisis that they would not normally do
Give advise
Tertiary care is…
Hospital or ER
Primary = Prevention
2nd = minimize symptoms of active anxiety
Phase model treatment is most effective. Describe the 3 phases
Phase 1.
Safety & Stabilization (emotional too)
Teaching Stabilization tech
Address basic needs: Medical, Housing
Phase 2
Trauma processing
Phase 3
Integration and Reconnection – Helping the individual integrate their experiences, reconnect with a sense of purpose, and focus on future goals and personal growth.
Evidence based treatments for Trauma are…
CBT & EMDR
