whats PTSD symptoms and diagnosis
A: Exposure to actual or threatened death, serious injury, or sexual violence.
B: Presence of 1 or more intrusion symptoms associated with the traumatic event/s beginning after the event
C: Persistent avoidance of stimuli associated with the traumatic event/s beginning after the event
D: Negative alterations in cognitions and mood associated with the traumatic event/s beginning after the event evidenced by 2 or more of….
E: Marked alterations in arousal and reactivity associated with the traumatic event/s beginning or worsening after the event – 2 or more of….
F: Duration of the disturbance (Criteria BCDE) more than 1 month
G The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning
H:The disturbance is not attributable to the physiological effects of substance (medication or alcohol) or other medical condition
types of post traumatic responses
Existential impact – profound emptiness, loss of connection with one’s spirituality [self], disruption to the ability to hope, trust, or care about oneself or others
Depression – mild to severe psychotic depression
Complicated or traumatic grief
Anxiety – generalised anxiety, panic, phobic anxiety
Stress disorders –Acute stress disorder, PTSD
Dissociation – “a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behavior”
whats resilience
Resilience: Resilience is fundamentally a property that gives individuals, social institutions, organisations and/ or ecosystems the ability to cope with shocks without losing their essential functions, characteristics and identity (Walker and Salt 2006)
- a resilient individual is not invincible to all life events but has the capacity to endure in most circumstances.
- Clients who sustain traumatic injuries or witness traumatic events have a greater vulnerability to stress disorders like posttraumatic stress disorder (PTSD).
- Without resilience, communities are not likely to recover after disaster.
PTSD sleep
- Hyperarousal → problems with sleep transition
- REM arousal due to intrusive dreams
- REM behaviour disorder due in older sufferers
- Evidence of increased activation of amygdala in REM
Catecholamine disturbance
Increased CRF levels
Orexins (circadian peptides in hyper thalamus)
Neurobiology of PTSD
Chronic PTSD
- Increased circulating levels of Noradrenaline
- Increased reactivity of α 2-adrenergic receptors, blood vessel reactivity
- Increased thyroid hormone levels
- Explains some of the somatic symptoms
- Increased catecholamine levels potentiate threat response of AMYGDALA
- Differences in hippocampal function have been reported – important in memory formation
- Hippocampus lower volume in PTSD – twin studies
- Alterations in limbic and paralimbic areas – perception and mood
- May be neuroanatomical correlate for the intrusive memories and other cognitive problems.
- It has been reported that cortisol levels are low in PTSD
predisposing factors PTSD
- In normal subjects Cortisol exerts strong negative feedback effects on CRF – homeostatic levels
- Major depression – less feedback
- PTSD – especially strong negative feedback effect leads to low cortisol response to stressors
- Failure of biological stress protection?
o Decreased cortisol levels at the time of stress could prolong availability of noradrenaline in periphery and brain
o Animal studies suggest that adrenergic arousal with low cortisol facilitates learning
o Thus, memories and perception of the traumatic event may be heightened or laid down in a different form in PTSD
Skills in psychological recovery (SPR):
- Systematically work through a manualised approach to delivering SPR
- A manualised approach is not a “cookbook”
- Vital issues such as empathy, rapport, and building a therapeutic alliance are assumed and not covered in the manual.
- It is expected that the SPR interventions would be delivered in a compassionate, flexible and responsive manner
- This is necessary to facilitate appropriate engagement and to adequately identify and meet the needs of survivors
Basics of Psychological First Aid (PFA) whos it for
Individuals experiencing acute stress reactions or who appear to be at risk for significant impairment in functioning
Basics of Psychological First Aid (PFA) who is it delivered by
Disaster response workers who provide early assistance
Basics of Psychological First Aid (PFA) When is it intended to be delivered?
Immediate aftermath
Basics of Psychological First Aid (PFA)
A broad range of emergency settings, in either single or multiple sessions
Goals of SPR
Acceleration of recovery
Secondary prevention of mental health problems
Support for post-disaster role functioning
Prevention of maladaptive behaviors
Flexible delivery suited to needs of survivors
Referral to more intensive mental health interventions
interventions for PTSD
- Strategies need to be embedded in relationship psychotherapy (therapeutic relationship)
- Teach the person mindfulness and self-care strategies
- Mental health centre clients are often more complex
- Existing clinical trial evidence often based on screened high functioning populations with high attrition (e.g. supporting cognitive therapy approaches, look for high drop out rates
Guidelines for talking with a person following a traumatic event
4 phases of debriefing used for professional helpers who may have been involved in multiple traumatic situations
- Description of factual event
- Expression of feelings and reactions
- Discussion and validation of coping strategies
- Termination
Describe and explain how an occupational therapist may work during the disaster
Occupational therapy practitioners can provide a variety of services to individuals and families who have evacuated their homes and workplaces and are living in emergency shelters, or who are sheltering in a new place.
Using a client-centred approach, occupational therapy practitioners can evaluate the needs of people in the shelter and provide appropriate services. Interventions might include;
• Providing structure in daily routines
• Identifying and emphasizing people’s strengths
• Coordinating age-appropriate play for children
• Providing opportunities for stress management
Describe and explain how an occupational therapist may work Recovering from the disaster
- First, OT clinical practise includes assessment, mental health services, engagement in meaningful occupations and other services after a disaster. Based on the results of these assessments, OTs can apply their clinical skills to release the psychological distress of survivors and their families.
- Another clinical skill that OTs have is to help survivors engage in meaningful activities. OTs can train survivors in ADLs and strive to establish the occupational balance of survivors in work, leisure and social participation.
- Occupation and activity can help clients cope with traumatic stress and meet survival needs. Occupational engagement provides diversion from stressful events and helps re-establish a sense of mastery in a situation in which a person feels a loss of control. Participation in occupation facilitates restoration of adaptive habits, supports a person’s sense of identity, and helps establish a spiritual connection in the disaster situation
- Educating and training local personnel, volunteers and caregivers
Outline the State Emergency Management Plan
- Understand the context: successful recovery is based on the understanding of the community context, with each community having its own history, values, and dynamics
- Recognise complexity: Successful recovery is responsive to the complex and dynamic nature of both emergencies and the community
- Use community led approaches: Successful recovery is community-centres, responsive and flexible, engaging with community and supporting them to move forward
- Coordinate all activities: successful recovery requires a planned, coordinated, and adaptive approach, between community and partner agencies, based on continuing assessment of impacts and needs.
- Communicate effectively: successful recovery is built on effective communication between the affected community and other partners
- Recognise and build capacity: successful recovery recognises, supports, and builds on individual, community and organisational capacity and resilience.
occ issues with suriviroes of a bushfire disaster
Occupational issues
- self care: affected due to level of burns
• Productivity: role loss, loss of job etc, overwork
• Loss of patterns, habits and roles
• Lose access to leisure facilities (park/sports centre)
Occupational Performance Model (Australia)
occupational role
occupational performance
core elements of occupational performance
components of occupational role
- self-maintenance (habitual routines such as dressing may be affected due to loss of home and clothes. Normal meals may be different at different times, prepared by health workers, or other members of community, medication may be managed by someone else, disability may mean they need assistance with self-maintenance – burns, mental disorders)
- rest (less time devoted to sleep due to stress, anxiety or depression or disability. This occupation may not be deemed important.)
- leisure (entertainment, creativity and celebration may not be as meaningful for client. May not get as much joy out of the activity or prioritise other things over leisure or ‘fun’. Disability may also affect the ability to do these things.
- productivity (parents may not be able to provide support for self, family or community due to loss of home and / or income, disturbance in mental health may mean they cannot work / study – loss of goods and services within community, loss of productivity due to disability caused by fire.)
components of occupational performance
- Biomechanical
- Sensory – motor
- Cognitive – mental processes during task performance (thinking, perceiving, recognising, remembering, judging, learning etc) – tasks may appear more complex to someone experiencing major life changes eg. Can’t think straight, OR , thinking about other things that deem more important. What kind of impact does this have on productivity?
- Intrapersonal – internal psychological processes (emotions, self-esteem, mood, rationality) People affected by fires may have a low attitude, loss of emotion, heightened emotions, distraught, feelings of distress, anxiety and depression. Low self-esteem due to loss of house, income or suffered serious injury. How would this affect someone’s ability to communicate with others?
- Interpersonal – interaction between a person and others during task performance (partners, families, communities) Interactions with others may be different, especially if loss or family or friend.
core elements of occ performance
- Body – tangible physical elements of human structure
- Mind – defined as the core of our conscious and unconscious intellect that forms the basis of ability to understand and reason.
- Spirit – defined as aspects of humans with seeks as a sense of harmony within self and between self, nature, others as well as hope and meaning
what are AUSTRALIAN GUIDELINES FOR TREATEMENT OF ACTURE STRESS AND POSTTRAUMATIC STRESS DISORDER
These Guidelines provide recommendations on the best interventions for children, adolescents and adults who have been exposed to potentially traumatic events as well as those who have developed acute stress disorder (ASD) or posttraumatic stress disorder (PTSD).
good practice points from Australian guidelines
GPP15 Mental health practitioners are advised to note the presence and severity of comorbidities in their assessments, with a view to considering their implications for treatment planning.
GPP16 Residual symptomatology should be addressed after the symptoms of PTSD have been treated.
GPP17 The development of a robust therapeutic alliance should be regarded as the necessary basis for undertaking specific psychological interventions and may require extra time for people who have experienced prolonged and/or repeated traumatic exposure. GPP18 Mental health practitioners should provide a clear rationale for treatment and promote realistic and hopeful outcome expectancy.
GPP19 Mental health practitioners and rehabilitation practitioners should work together to promote optimal psychological and functional outcomes.
GPP20 In most circumstances, establishing a safe environment is an important precursor to commencement of trauma-focussed therapy, or indeed, any therapeutic intervention. However, where this cannot be achieved (for example, the person is seeking treatment for their PTSD whilst maintaining a work role or domestic situation that may expose them to further trauma), some benefit may still be derived from trauma-focussed therapy. This should follow careful assessment of the person’s coping resources and available support
GPP21 The practitioner should assess immediate needs for practical and social support and provide education and referrals accordingly.
GPP22 Appropriate goals of treatment should be tailored to the unique circumstances and overall mental healthcare needs of the individual and established in collaboration with the person.
GPP23 From the outset, there should be a collaborative focus on recovery and rehabilitation between the person and practitioner, and where appropriate, family members.
GPP24 Recommended treatments for PTSD should be available to all Australians, recognising their different cultural and linguistic backgrounds.
GPP25 Wherever possible, family members should be included in education and treatment planning, and their own needs for care considered alongside the needs of the person with PTSD.
