mental health chapter 13

Risk factors of PTSD include

- Directly involved in the traumatic event - Experiences of physical injury - Loss of loved one(s) - Lack of social supports - Previous psychiatric history or personality factors

Psychiatric problems related to trauma/stress include

-adjustment disorder - depression - complicated grieving - acute stress disorder - PTSD - Dissociative disorder

The goals of dissociative disorder treatment include

1. improve quality of life 2. improve functional abilities 3. decrease symptoms

What are the three major elements of PTSD?

1. reexperiencing the trauma through dreams or recurrent and intrusive thoughts 2. showing emotional numbness such as feeling detached from others 3. being on guard, irritable, or experiencing hyperarousal

____ % of all victims of physical assault develop PTSD

25

In PTSD, the symptoms occur ____ after the trauma, which distinguishes PTSD from acute stress disorder

3 months or more

____ % of victims or rape develop PTSD

70

physiologic concerns for trauma and stressor-related assessments include

Disturbed sleep Change in appetite Alcohol and drug use

For a trauma and stressor-related assessment, the patient's thought process/content may be ____

Experience nightmares, flashbacks, intrusive thoughts, hallucinations, self-destructive thoughts, fantasies

Persons who witness a traumatic event are likely to develop posttraumatic stress disorder (PTSD). True or false?

False Not all people, nor even most people, who witness a traumatic event will develop posttraumatic stress disorder (PTSD). Those most likely to develop PTSD are those who were directly involved in the event, not just merely witness to the event; those who experienced physical injury or loss of a loved one; those with a lack of social supports; or previous psychiatric history/repeated trauma.

For a trauma and stressor-related assessment, there is a focused assessment of ___

History of trauma/stress or abuse When trauma/stress/abuse occurred Observation of the patient's appearance and motor behavior, specifically: hyperalertness, anxiety, restlessness, increased personal space, or fetal positioning

____ occurs after a traumatic event and is characterized by reexperiencing, avoidance, and hyperarousal that occur from 3 days to 4 weeks following a trauma. It can be a precursor to PTSD.

acute stress disorder

____ = is a reaction to a stressful event that causes problems for the individuals. Typically, the person has more than the expected difficulty coping with or assimilating the event into his or her life. Financial, relationship, and work-related stressors are the most common events. The symptoms develop within a month and last no more than 6 months. Outpatient counseling or therapy is the most common and successful treatment

adjustment disorder

____ are more likely to develop PTSD than children or adults

adolescents

PTSD can lead to ___ behavior, or trying to avoid any places or peole or situations that may trigger memories of the trauma

avoidance

PTSD is ___ in nature with periods of exacerbation during increased stress

chronic

____ = the client has a persisitent or recurrent feeling for being detached from his or her mental processes or body (depersonalization) or sensation of being in a dream-like state where the environment seems foggy or unreal (derealization). the client is not psychotic or out of touch with reality

depersonalization/derealization disorder

PTSD can lead to other psychiatric disorders such as ____

depression / anxiety / substance abuse

____ is a subconscious defense mechanism that helps a person protect his or her emotional self from recognizing the full effects of some horrific or traumatic event by allowing the mind to forget or remove itself from the painful situation or memory

dissociation

____ = the client cannot remember important personal information (usually of a tarumatic or stressful nature). This includes a fugue experience where the client suddenly moves to a new geographic location with no memory of past events, and often the assumption of a new identity

dissociative amnesia

_____ is characterized by: - Disruption in integration of consciousness, memory, identity, and environmental perception. - People with this use dissociation, a defense mechanism, pathologically and involuntarily

dissociative disorder

_____ = the client displays two or more distinct identities or personality states that recurrently take control of his or her behavior. this is accompanied by the inability to recall important personal information

dissociative identity disorder

____ examples of trauma/stressors = war, natural disaster, community loss (death of a prominent citizen)

group

____ examples of trauma/stressors = abuse, illness, victim of a crime (robbery, etc)

individual

Dissociative disoder treatment options include ___

individual therapy, group therapy (focus in therapy is on reassociation), and medications (antidepressants, anxiolytics)

For trauma and stressor-related events patients refer to them as a

survivor, rather than victim

Trauma and stressor-related nursing dianoses may include

Risk for suicide/self-mutilation Ineffective coping Posttrauma syndrome Powerlessness Chronic low self-esteem Risk for self- or other-directed violence

PTSD treatment options include

Psychotherapy (individual or group) Medications (antidepressants, anxiolytics, sleep aids) Self-help groups Exposure therapy Relaxation techniques Adaptive disclosure Cognitive processing therapy

Characteristics of stress/trauma include

- Poor coping - Difficulty managing stress - Emotional difficulties - Difficulty resuming activities of daily life - Anxiety - Insomnia - Grief

Adolescents Suffering from PTSD Have Increased Risk for:

- suicide - substance abuse - poor social supports - academic problems - health concerns

Traumatic events or stressors have characteristics including ___

- the experiences that are extraordinary in intensity or severity - The stressors are well beyond the stress of daily life.

Which person is most likely to experience a dissociative disorder? A. A survivor of a car accident B. A survivor of childhood sexual abuse C. A survivor of a natural disaster D. A patient with a sudden, severe illness

B. A survivor of childhood sexual abuse Rationale: Dissociative disorders are most prevalent among those persons with a history of childhood physical and/or sexual abuse. Dissociative disorders are relatively rare in the general population.

For a trauma and stressor-related assessment, the patients mood and affect ___

Can range from passive to angry, frightened, agitated, hostile

_____ is a disturbing pattern of behavior demonstrated by a someone who has experienced, witnessed, or been confronted with a traumatic event such as natural disaster, combat, or an assault. The person was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror

PTSD

people with ____ often experience dissociative symptoms

PTSD

____ occur before the age of 5 years in response to the trauma of child abuse or neglect, called grossly pathogenic care. The child shows disturbed, inappropriate social relatedness in most situations.

reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED)

dissociative disorder leads to disturbance in ___

relationships, ability to function, and ability to cope

Trauma and stressor-related outcomes and interventions focus on improving the patients

self esteem and to promote empowerment

Diagnoses related to ____ may include Anxiety Fear Disturbed sensory perception Sleep deprivation/disturbed sleep pattern Sexual dysfunction Spiritual distress Social isolation

trauma and stressor-related events