psych- trauma, ptsd, and dissociative disorders

trauma

response to an incident or series of events that are emotionally disturbing or life threatening with lasting adverse effects on the individual

risks for trauma in children

at risk for depression, nightmares, inability to trust others, phobias, somatic symptoms, impulsivity, substance misuse, suicide

PTSD in preschool children

reduction in play, repetitive play that includes aspects of traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame or confusion

reactive attachment disorder s.s

inhibited, emotionally withdrawn, inability to form attachments

disinhibited social engagement disorder in children

attaches to anyone, no fear of strangers, willing to go off with people they do not know, hugging/ cuddling unknown adults

assessment of trauma in children with ptsd

nightmares, night terrors, flashbacks, traumatic play, bedwetting

assessment of child with somatic s/s

headache, stomachache, pain

assessment tools

child dissociative checklist, trauma symptoms checklist for children, child sexual behavior inventory, Denver II developmental screening test (infant to 6y)

cognitive behavioral therapy

uses psychoeducation, behavior modification, cognitive therapy, and stress management to help child manage behavior and change maladaptive thoughts and beliefs

eye movement desensitization and reprocessing

[processes traumatic events through an 8 phase protocol; pt thinks of traumatic event while doing specific eye movements, audio tones, or tapping resulting in neurological and physiological changes that help process memories

characteristics of adult with ptsd

flashback, high level of anxiety or arousal, general numbing of responsiveness, intrusive recollections or nightmares, amnesia to certain aspects of the trauma, depression, survivor’s guilt, substance use, anger and aggression, relationship problems

PTSD assessment

screening tools, daily functioning, depression and suicide screening

desired outcomes for PTSD

manage anxiety, increase self esteem, improved coping

PTSD nursing interventions

explain physical s/s as related to the psychological state, listen and validate feelings, teach anxiety reducing strategies, ongoing screening for s/s of PTSD

PTSD treatment

cognitive behavioral therapy, prolonged exposure therapy, group/ family therapy, eye movement desensitization and reprocessing, psychopharmacology

PSTD medication

ssri, snri, tca, clondine

acute stress disorder

immediately after highly traumatic event, diagnosed within a month, if longer than 1 month then it becomes ptsd

acute stress disorder diagnosis

alterations in concentration, anger, dissociative amnesia, headache, irritability, nightmares

consequences of insomnia/ poor sleep

memory impairment, automobile accidents, poor job/ school performance, depression, pain disorders, heart disease, increase hospitalizations, anxiety

imagery distraction

think of an interesting (at the same time), pleasant and relaxing image or activity when an unpleasant thought pops up

relaxation training

meditation, yoga, tai chi, progressive muscle relaxation, biofeedback, hypnosis

zolpidem, zaleplon, ramelteon

decrease time to sleep onset and increase amount of sleep

dissociation

unconscious defense mechanism, protects individual against overwhelming trauma through emotional separation

depersonalization/ derealization disorder

depersonalization- focuses on self

derealization- focus on outside world

dissociative amnesia

the inability to recall important personal information related to a traumatic or personal nature, may assume new identity

dissociative identity disorder

alternate personality blocks traumatic experiences, pt is unaware

comorbidity risk factors

childhood physical, sexual, emotional abuse

dissociative s/s

reduces disturbing feelings and protects the pt from full awareness of the trauma

how to assess dissociative disorder

history (recent injury, early trauma), memory (clarity, short term and long term, gaps in memory, current orientation x3, hx of blackouts), impact on pt and family, suicide risk

dissociative disorder psychoeducation interventions

provide education on illness, educate on coping skills and stress managements, grounding techniques

dissociative disorders pharmacological interventions

nothing specific, depression, anxiety and psychosis meds assist with s.s