module 7 - special populations

chapter 33 and 35

What is the perception of imminent threat to one’s person or livelihood that results in the subjective experiences of feeling afraid and alone?

trauma

What are the aftereffects of violence?

loss of trust, lack of feelings of safety, hyperarousal seen as overreacting, feelings of shame or contamination

What are common responses to violence and trauma?

shock, denial, disbelief, confusion, fear, hysteria, horror, anger, shame, helplessness, vulnerability, physiological responses, distrubed sleeping and eating

What are the three stages of recovery from violence and trauma?

impact, recoil, and reorganization

What are interventions for the impact stage of violence and trauma recovery?

crisis intervention

• provide physical safety and emotional security

• give simple directions

• avoid accusations

  • provide phone number for crisis intervention

What are interventions for the recoil stage of violence and trauma recovery?

support groups and short term counseling

• validation of victim and rights as a victim

• referrals to appropriate therapies and victim groups

What are interventions for the reorganization stage of violence and trauma recovery?

long term counseling if needed for possible anxiety, PTSD, and depression

What are the typical effects of terrorism?

shock, disbelief, fear, anxiety, powerlessness, insecurity, guilt, shame, spiritual distress, unresponsiveness, dissociation, numbness, decreased concentration, confusion, panic, terror, sense of violation, anger, rage, aggression, fantasies of revenge, impulsiveness, helplessness, hopelessness, and despair

What is the main goal of terrorism recovery?

regain a sense of trust, safety, and security, while acknowledging that future terrorist attacks are possible

What is ritual abuse?

organized sexual, physical, and psychological abuse which is systemic and sustained over a long period of time, involves the use of rituals with multiple abusers, premeditated form of torture, victims are often children

What are risk factors for ritual abuse?

poverty, young age, limited education, homelessness, lack of family support, history of physical, emotional, and sexual abuse, living in high crime areas, and experiencing family violence

What are tactics used for ritual abuse?

recruitment into human trafficking may begin as offers of money (to the victims or their families who sell the individual), a promise of a better life, deceptions, threats, coercion, force, or kidnapping

What are the stages of ritual abuse recovery?

• impact stage

  • ongoing but might wax and wane

• recoil stage

  • adaptation difficult due to severity

  • stage will be prolonged with relapses during other life crises

• aftercare

  • ongoing advocacy will be required

What is used to treat ritual abuse?

• cognitive behavioral therapy

• dialectical behavior therapy

• EMDR

• multisystemic therapy

• SSRIs may help with PTSD

What are common disorders of older adults?

depression, manic episodes, psychotic disorders, and substance use

What are patient barriers that older adults may face?

• stereotypes about aging

• seeing mental illness as a weakness

• seeking help may be seen as a loss of control

• fear of institutionalization

• skepticism about mental health professionals

  • transportation

What are provider barriers for care of older adults?

• scarcity of geriatric specialists

• somatic complaints and comorbidity compound the difficult in diagnosis

• ageism (negative stereotyping)

• a belief that mental health problems are a part of the aging process

What are outpatient services needed to provide care for older adults?

• mental health outreach programs

• adult day services

• respite care and caregiver programs

• support groups

• self help groups

What is the treatment of choice for older adults with depression?

electroconvulsive therapy

What are two types of anxiety in older adults that fail to meet diagnostic criteria?

• anxiety due to a general medical condition

• substance and medication induced anxiety disorder

What helps in communication with older adults about mental health?

• allow time to answer

• avoid interruptions

• establish rapport

• face patient and articulate clearly

• provide hearing aid or glasses

• minimize glare and noise

• provide privacy

• match patient vocabulary level

What are guidelines for drug use for mental health in adults?

• start low and go slow

• daily simple dosing

• consider effects of other drugs and conditions

• taper off when stopping