trauma and stress mental health lecture one (exam 2)

Trauma and Stressor-Related Disorders

Disorders that can develop after exposure to a traumatic or otherwise stressful event.

Physical Trauma

Physical injury that can result from an accident, self-inflicted damage, or violence perpetrated by others.

Psychological Trauma

An emotional injury caused by an overwhelmingly stressful event that threatens one's survival and sense of security.

Resilience

The capacity to withstand stress and catastrophe. It develops over time and results from multiple internal and external factors.

Types of Trauma- and Stressor-Related Disorders

Reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment disorder.

Posttraumatic Stress Disorder (PTSD)

Occurs following exposure to an actual or threatened traumatic event.

Types of Traumatic Exposure That Can Lead to PTSD

Traumatic events may be directly experienced, witnessed, learned about from others, or experienced through repeated exposure to aversive events.

PTSD Diagnostic Criteria Categories

Intrusion, avoidance and numbing, mood and cognition changes, hyperarousal, hypervigilance, and sleep disturbance.

Intrusion in PTSD

Flashbacks and dreams related to the traumatic event.

Avoidance and Numbing in PTSD

Avoiding people, places, or objects associated with the trauma; may also include dissociation, derealization, and depersonalization.

Mood and Cognition Changes in PTSD

Negative mood and negative thoughts.

Hyperarousal in PTSD

Being on edge, aggressive, irritable, reckless, or self-destructive.

Hypervigilance in PTSD

High arousal and/or anxiety and being constantly on guard.

Sleep Disturbance in PTSD

May include nightmares.

PTSD Duration

Symptoms are present for at least 1 month.

PTSD in Children

May include bedwetting, forgetting how or being unable to talk, being unusually clingy, or acting out the traumatic event during playtime.

PTSD Across the Lifespan

PTSD manifestations can vary across the lifespan, including differences in children and older adults.

Gender Differences in PTSD

Women are approximately twice as likely as men to experience PTSD.

PTSD Prevalence in Veterans Returning From Iraq and Afghanistan

The slide reports prevalence estimates ranging from 0% to 48% in males and 2% to 68% in women returning from Iraq and Afghanistan.

Ethnicity and Culture in PTSD

Ethnicity and culture can influence PTSD, including the role of discrimination.

PTSD Etiology

Biological theories include a combination of neurobiology, genetics, and environmental factors.

Biological Factors in PTSD

A combination of neurobiology, genetics, and environmental factors contributes to PTSD.

Neurobiology of PTSD

Involves the body's stress response.

Brain Areas Associated With PTSD Hyperarousal

Hypothalamus, amygdala, and hippocampus.

Neurotransmitters Increased in PTSD

The slide identifies increased dopamine and norepinephrine.

PTSD Pharmacotherapy

May include SSRIs, atypical antipsychotics, mood stabilizers, and prazosin.

SSRIs Used for PTSD

Sertraline or paroxetine.

Sertraline

An SSRI listed as pharmacotherapy for PTSD.

Paroxetine

An SSRI listed as pharmacotherapy for PTSD.

Atypical Antipsychotics in PTSD

Listed as a possible pharmacologic treatment for PTSD.

Mood Stabilizers in PTSD

Listed as a possible pharmacologic treatment for PTSD.

Prazosin

Listed as a pharmacologic treatment for PTSD.

Benzodiazepines in PTSD

Benzodiazepines are NOT recommended.

Psychotherapy for PTSD

May include psychodynamic psychotherapy, cognitive-behavioral therapy (CBT), EMDR, group therapy, family therapy, and exposure therapy.

Psychodynamic Psychotherapy

A form of psychotherapy listed for the treatment of PTSD.

Cognitive-Behavioral Therapy (CBT)

A form of psychotherapy used in the treatment of PTSD.

EMDR

Eye movement, desensitization, and reprocessing; a psychotherapy listed for PTSD.

Group and Family Therapy

Therapies that may be used as part of PTSD treatment.

Exposure Therapy

A form of psychotherapy listed for PTSD.

Safety Assessment in PTSD

A full risk assessment should determine the patient's risk for self-injury or aggression toward others.

Mental Health Nursing Assessment for PTSD

Assess the patient's trauma.

Physical Health Assessment for PTSD

Assess physical health, sleep, nutrition, medication, substance use, pain, and somatic responses.

Psychosocial Assessment for PTSD

Assess behavioral responses, self-concept, stress and coping patterns, functional status, quality of life, and strengths.

Physical Health Areas to Assess in PTSD

Sleep, nutrition, medication use, substance use, pain, and somatic responses.

Psychosocial Areas to Assess in PTSD

Behavioral responses, self-concept, stress and coping patterns, functional status, quality of life, and strengths.

Priority in Clinical Judgment for PTSD

Safety is the priority.

Major Safety Risk in PTSD

Assess for risk of suicide.

PTSD Recovery Plan

Establish a recovery plan that addresses areas interfering with coping and functioning.

Impulse Control Problems in PTSD

Loss of impulse control can result in angry outbursts or aggressive behavior and can interfere with quality of life and well-being.

Therapeutic Relationship in Trauma Care

The therapeutic relationship is the basis of nurse-patient collaboration.

Who Defines Needs and Safety in Trauma Care?

Needs and safety are defined by the survivor.

Building a Therapeutic Relationship After Trauma

Takes time because trauma can have a lasting effect on a person's ability to trust others and form intimate relationships.

Effect of Trauma on Trust

Trauma can have a lasting effect on the ability to trust others and form intimate relationships.

Coping Behaviors After Trauma

Coping behaviors may be misinterpreted as being "noncompliant," which can lead to negative reactions from healthcare providers.

Mental Health Nursing Interventions for Trauma and PTSD

Establish recovery and wellness goals, provide physical care, use medication interventions, provide psychosocial interventions and trauma-informed care, and provide psychoeducation.

Recovery and Wellness Goals

Establishing recovery and wellness goals is an important mental health nursing intervention.

Physical Care Interventions for PTSD

Sleep enhancement, exercise and yoga, nutrition interventions, and smoking cessation.

Sleep Enhancement

A physical care intervention for patients with trauma- and stressor-related disorders.

Exercise and Yoga

Physical care interventions that may be used for patients with trauma- and stressor-related disorders.

Nutrition Interventions

Part of physical care for patients with trauma- and stressor-related disorders.

Smoking Cessation

A physical care intervention for patients with trauma- and stressor-related disorders.

Medication Interventions for PTSD

Medication interventions may be used as part of mental health nursing care.

Substance Abuse in PTSD

Substance abuse is a potential complication that should be managed as part of nursing care.

Trauma-Informed Care

Psychosocial care that focuses therapeutic interactions on understanding what happened to the person.

Therapeutic Interactions in Trauma-Informed Care

Focus on understanding what happened.

Cognitive Functioning Interventions for PTSD

Distraction, thought stopping, meditation, relaxation, and deep breathing can be used to enhance cognitive functioning.

Distraction

A strategy that may be used to enhance cognitive functioning in trauma-related disorders.

Thought Stopping

A strategy that may be used to enhance cognitive functioning in trauma-related disorders.

Meditation

A strategy that may be used to enhance cognitive functioning in trauma-related disorders.

Relaxation

A strategy that may be used to enhance cognitive functioning in trauma-related disorders.

Deep Breathing

A strategy that may be used to enhance cognitive functioning in trauma-related disorders.

Psychoeducation for Trauma-Related Disorders

Includes teaching about symptoms, wellness strategies, and providing family education.

Adjustment Disorder

A maladaptive reaction to an identifiable stressor or stressors that results in clinically significant emotional or behavioral symptoms.

Onset of Adjustment Disorder Symptoms

Symptoms occur within 3 months of the stressor.

Duration of Adjustment Disorder

Symptoms last no longer than 6 months.

Who Is Adjustment Disorder More Common In?

Women, unmarried persons, and adolescents.

Age Range for Adjustment Disorder

Can occur at any age, from childhood to senescence.

Adjustment Disorder Specifiers

With depressed mood, with anxiety, with mixed anxiety and depressed mood, and with disturbance of conduct.

Adjustment Disorder With Depressed Mood

The most diagnosed adjustment disorder; symptoms include depressed mood, tearfulness, and feelings of hopelessness that exceed the expected or normative response to an identified stressor.

Most Diagnosed Adjustment Disorder

Adjustment disorder with depressed mood.

Symptoms of Adjustment Disorder With Depressed Mood

Depressed mood, tearfulness, and feelings of hopelessness that exceed an expected or normative response to the identified stressor.

Adjustment Disorder With Anxiety

Symptoms include nervousness, worry, and jitteriness.

Adjustment Disorder With Anxiety vs. Other Anxiety Disorders

Adjustment disorder with anxiety may be difficult to differentiate from another anxiety disorder.

Adjustment Disorder With Mixed Anxiety and Depressed Mood

A specifier of adjustment disorder involving both anxiety and depressed mood.

Adjustment Disorder With Disturbance of Conduct

Involves conduct in which there is violation of the rights of others.

Examples of Disturbance of Conduct in Adjustment Disorder

Truancy, vandalism, reckless driving, fighting, and defaulting on legal responsibilities.

Acute Stress Disorder

Similar to PTSD except that it resolves within 1 month of the traumatic event.

Acute Stress Disorder vs. PTSD

Acute stress disorder resolves within 1 month of the traumatic event, while PTSD symptoms are present for at least 1 month.

Reactive Attachment Disorder

A trauma- and stressor-related disorder in which a child displays inhibited, emotionally withdrawn behavior toward an adult caregiver.

Disinhibited Social Engagement Disorder

A trauma- and stressor-related disorder in which a child is overly familiar with others in ways that are uncharacteristic of cultural norms.

Dissociative Disorders

The slide includes dissociative amnesia, depersonalization/derealization disorder, and dissociative identity disorder.

Dissociative Amnesia

Inability to recall important yet stressful information.

Localized Dissociative Amnesia

The most common type of dissociative amnesia.

Selective Dissociative Amnesia

Inability to recall specific aspects of an event or some events within a period of time.

Depersonalization/Derealization Disorder

Involves a feeling of being detached from one's mental processes.

Dissociative Identity Disorder (DID)

A dissociative disorder involving the presence of at least two distinct personality or identity states.

Former Name for Dissociative Identity Disorder

Multiple personality disorder.

Key Feature of Dissociative Identity Disorder

Presence of at least two distinct personality or identity states.