trauma and stressor related disorders

what causes trauma or stress related disorders

extreme stressors

ex. school, code blues, etc.

for health care staff what can we do?

during the event

- help triage pts and staff: assign more experienced staff to higher acuity pts

after the event

- debreif with staff

adjustment disorder

stressors trigger a change in mood/dysfunction in usual activites

- ex. arguing with others or driving erratically

less severe compared to ASD/PTSD

can progress to ASD

ex. caused by moving states, losing job, breakup, etc.

acute stress disorder (ASD)

lasts 3 days to a month until progressed to PTSD

manifestations occur days after traumatic event

PTSD

lasts 1+ month or for a lifetime

usually no paranoid delusional statements like those with schizophrenia

schizophrenia and PTSD can be tied together

- hallucinations can be another stress related effect during PTSD

ASD and PTSD characteristics

flashbacks

avoiding thinking about the event

trying to avoid thinking about the event

anger

guilt/shame about event

sleep disturbances

usual behavior seen in adjustment disorder, ASD, and PTSD

anger

aggressiveness

irritation

dissociative disorders

depersonalization/derealization

dissociative amnesia

depersonalization/derealization

reports of feeling detached from one's own body or of feeling that one's personal environment is unreal

temporary change in awareness

can be both

there can be delusions with derealization

ex. pt states that the furniture in the room seems to be small and far away

dissociative amnesia

lack of memory that can range from name or date of birth to the client's entire lifetime

disconnect from reality

so stressed your brain wipes your memory

- can be lost starting from traumatic event or starting from birth

dissociative fugue

amnesia when traveling

- cant recall identity

- cant recall past

will last weeks to months

remember with "where the fugue am I?"

dissociative identity disorder

aka split personality, multiple personality disorder

different personalities exist on a different plane of reality

personalities can switch based on a situation they are in at any given moment

risk factors for depersonalization/derealization disorders

trauma

poor coping mechanisms

PTSD is a risk factor for depression, which leads to feeling hopeless, which may result in suicide

depersonalization/derealization disorders treatment

CBT

- helps develop better coping mechanisms

nursing care for adjustment disorder, ASD, and PTSD

grounding techniques

- ex. stomping feet, clapping hands, touching physical objects

safe environment

assess for SI

theraputic communication

what if pt is a child?

involve parents and teachers

use play therapy

- goal is to decrease anxiety

dissociative disorder nursing care

encourage independence

use grounding techniques

avoid giving too much info on the past

- that will cause anxiety

meds for ASD and PTSD

antidepressants

- decrease depression and anxiety

- review: TCA and SSRI

beta blockers

- propanolol

are meds used for adjustment and dissociative disorders?

no, usually just CBT is used to treat

somatic symptoms and related disorders

4 types

- somatic symptoms disorder

- illness anxiety disorder

- conversion disorder

- factitious disorder

somatic symptom disorder

usually seen in primary care settings

somatization

- psychological stress manifests as physical symptoms

leads to long term use of healthcare system

spends significant time worrying about physical manifestations

usually always seeking second opinions

rejects the idea of a psychological issue being the cause of their issues

somatic symptoms disorder risk factors

first degree relative

decreased neurotransmitters

- low endorphins

- low serotonin

depression, anxiety

trauma

labs and diagnostics for somatic symptoms disorder

blood work

CT, MRI

* rules out physical illness

somatic symptoms disorder assessment

pt may have

- abdominal pain

- back pain

- menstruation problems

- HA

- chest pain

- constipation/diarrhea

- lethargy

- insomnia/oversleeping

- fainting

- dizziness

somatic symptoms disorder treatment

do not treat with antipsychotics

fix coping skills

goal is symptom management

somatic symptoms disorder nursing care

assess for safety

limit time to talk about somatic symptoms

educate on coping mechanisms

encourage daily exercise

- releases endorphins, which they are low on

illness anxiety disorder

misinterprets physical manifestations as evidence of a more serious disease

- ex. I have a HA, it must mean I have a brain tumor

pts are certain they have an underlying, undiagnosed, serious illness

pt will constantly examin themselves

illness anxiety disorder risk factors

low self esteem

major life stressor

childhood trauma

prior loss, dissappointments

illness anxiety disorder behaviors

angry, agitated, anxious

pre occupation with performance of behaviors that are health related

- ex. performing breast examination every day in fear of breast cancer

types of illness anxiety disorder

health seeking

- frequently seeking medical care and diagnostic tests

care avoidant

- avoids all contact with providers due to the correlation with increased levels of anxiety

illness anxiety disorder treatment

diagnostics to rule out anything underlying

meds

breif but frequent office visits

meds for illness anxiety disorder

antidepressants

anoxiolytics

conversion disorder

pts anxiety causes a neurological response but theres no evidence of a neurological problem

ex. blindness, paralysis, seizure, gait disorders, hearing loss (if being yelled at)

conversion disorder risk factors

trauma

female

younger age

- bc worse coping skills

poverty

conversion disorder nursing care

decrease the trigger will solve issue

ensure safety

look for cause

remission occurs without intervention in approximately 95% of clients, especially if the onset of manifestations is due to an acute stressful event

relapse rate is approximately 20% usually within 1 year of initial diagnosis

meds for conversion disorder

antidepressants

anoxiolytics

fictitious disorder

aka munchausen syndrome

conscious decision by pt to reports physical manifestations

pts may hurt themselves / poison themselves to gain medical attention

fictitious disorder imposed by another

manchausen syndrome by proxy

someone purposefully tries to get medical attention for someone close to them

- ex. mother poisons daughter for medical attention

we must separate the two for safety of the person being hurt

mailngering

acting sick or pretending someone else is sick for personal gain

nursing care for fictitious disorder

ensure safety of victim of munchausen by proxy

communicate openly with health care team to reduce time wasted, medical costs, and uneccessary tx and sx

why is it difficult to diagnose mental health illness in children

they have magical thinking

they have imaginary friends

they have different vocabulary than us

who is the primary source of information when conducting and interview with a child

the child

if the child is nonverbal, then the parents, teachers, siblings

- whoever is regularly wittnessing the symptoms

why is it important to identify mental illness in children

because early identification reduces effects into adulthood

as a child grows up, what are some issues or situations that may put them at risk for developing mental illness

abuse

violence

anxiety disorder

- PTSD

- separation anxiety

anxiety disorders in children

separation anxiety

PTSD

impulse control disorders

oppositional defiant

disruptive mood disregulation

intermittent explosive

conduct

where do impulse control disorders usually begin

at home

will travel to their classroom

comorbid disorders with impulse control disorders

ADHD

ADD

autism

what impulse control disorders worsens in class

oppositional

what impulse control disorders worsens on the playground

conduct

oppositional defiant characteristics

negative attitude

disobedience

hostility

defiant bx

argumentative

limit testing

refusal to accept responsibility

who are oppositional defiant pts defiant towards

any figure of authority

do oppositional defiant pts see themselves as defiant

no

how are oppositional defiant pts frustration thresholds

very low

what can oppositional defiant lead to

conduct disorder

disruptive mood dysregulation

frequent severe anger outbursts

- does not correlate to any situation: is random

- physical or verbal

- not appropriate for childs age

- age ranges from 6-18

intermittent exposive

recurrent violence and aggressive behavior

- can hurt others, animals, property

- more common in males and older kids (teens)

aggressive overreaction to a trigger followed by guilt and shame for behavior

- prevents pt from developing relationships and maintaining a job

conduct disorder

aggressive to people and animals

- destruciton of property

- deceiftulness or theft

- serious violation of rules

more common in males

usually develops a criminal record

low attendance at school

conduct disorder characteristics

bullies

threatens people

believes aggression is justified

SI

runs away from home

neurodevelopmental disorders

ADHD

autism

intellectual development disorder

specific learning disorder

ADHD

attention deficit hyperactivity disorder

short attention span

- poor grades

hyperactivity

- cant sit still

impulsivity

- high risk for injury

autism spectrum disorder

neurodevelopmental disorder

- genetic

- language and cognition delayed

autism characteristics

poor eye contact

repetitive actions

likes routine almost like OCD

can have physical difficulties

risks for seizures

- usually on VPA

ranges of functioning from low to high

- considered high if can perform ADLs

intellectual development disorder

intellectual deficits with mental abilities

overall difficulty in life

- reasoning

- abstract thinking

- academic learning

- learning from prior experience

impaired ability to maintain personal independence and social responsibility, including ADLs, social participation, and the need for ongoing support at school

specific learning disorder

difficulty in aquiring skills in

- reading

- writing

- math

at school

- performs well below standard

IEP

usually for specific learning disorder pts

individualized education plan

- extra classes based on weaknesses

ex. extra reading classes, ASL classes

neurodevelopment disorders treatment

CBT with meds

- time out

- quiet room

- rewards/punishment

ex. sticker charts at elementary school

meds for ADHD

CNS stimulants

- methylphenidate

can also give these which do the same thing as methylphenidate

- amphetamine mixture

- dextroamphetamine

- dexmethylphenidate

- lisdexamfetamine dimesylate

methylphenidate

increases levels of dopamine and norepinephrine

- cruicial neurotransmitters for focus, attention, and motivation

methylphenidate considerations

can cause insomnia and restlessness

- give patch in morning and pill by 4pm

- rotate site of patch

weight pt every other day

- increases metabolism

- decreases appetite

pt with heart arrhythmias can cause sudden death

things to avoid while on methylphenidate

caffiene

OTC common cold and decongestant meds

phenobarbitol, warfarin, phenytoin

MAOIs

other meds for ADHD

antidepressants

anxiolitics

nursing care for ADHD

get full PMH

- including in-utero history

get kids attention before giving directions

set limits

be consistent

use reward system

focus on kids strengths

assist with coping mechanisms

encourage participation in group therapies

- allows kid to see good modeling behavior