CH19 (1) PTSD

Trauma- and Stressor-Related Disorders

Historical and Epidemiological Data

  • Terminology Evolution: Historical names for post-trauma responses include battle fatigue and trauma neurosis.

  • Recognition of PTSD: Diagnosis of PTSD was first formally included in the DSM-3 (1980).

  • Trauma Incidence: 50% of people experience a traumatic event; however, under 10% develop PTSD.

  • Gender Prevalence: PTSD is more commonly diagnosed in women.

Trauma Definition and Care

  • Definition of Trauma: An extremely distressing experience with potential long-lasting psychological effects.

  • Trauma-Informed Care: A philosophical approach that acknowledges the widespread impact of trauma and aims to help individuals through recovery while preventing further traumatization.

Post-Traumatic Stress Disorder (PTSD)

  • Characteristics: PTSD results from exposure to extreme trauma, such as natural disasters, combat, or violent crimes.

  • Symptoms: Key symptoms include:

    • Reexperiencing the traumatic event

    • High levels of anxiety

    • Numbing of responsiveness

    • Nightmares and intrusive recollections

    • Amnesia regarding aspects of the trauma

    • Depression, survivor’s guilt, substance abuse, anger, relationship issues.

  • Symptom Timeline: Symptoms can start within three months but may also be delayed for months or years.

Acute Stress Disorder (ASD)

  • Relation to PTSD: Similar to PTSD but symptoms are limited to 1 month post-trauma. If symptoms persist beyond 1 month, it becomes PTSD.

Predisposing Factors for Trauma-Related Disorders

  1. Psychosocial Theory: Examines differences in responses to trauma based on individual and environmental factors.

  2. Learning Theory: Explains how avoidance behaviors can reinforce trauma responses.

  3. Cognitive Theory: Suggests individuals are vulnerable to PTSD when core beliefs are shattered, leading to helplessness.

  4. Biological Factors: Endogenous opioid peptides may play a role in maintaining trauma symptoms, and dysregulation in various neurochemical pathways (opioid, glutamatergic, noradrenergic) could contribute to PTSD pathology.

Nursing Diagnosis and Outcome Identification

  • Common Nursing Diagnoses:

    • Post-trauma syndrome

    • Complicated grieving

Outcome Criteria

  • Patients should:

    • Acknowledge the trauma and its impact

    • Demonstrate coping strategies

    • Attend support groups

    • Experience fewer intrusive symptoms and achieve better sleep

Planning and Implementation

  • Nursing care focuses on assuring safety, decreasing maladaptive symptoms, and encouraging adaptive coping strategies.

Evaluation

  • Outcomes are assessed through:

    • Client's ability to discuss trauma without panic

    • Identifying effective coping strategies

    • Noting reductions in flashbacks and nightmares

Adjustment Disorders

  • Definition: Maladaptive reactions to identifiable stressors, producing clinically relevant emotional or behavioral symptoms.

  • Symptoms must arise within three months of the stressor and last no longer than six months.

  • Types of Adjustment Disorders:

    • With depressed mood

    • With anxiety

    • Mixed anxiety/depression

    • With disturbance of conduct

    • Unspecified

Predisposing Factors for Adjustment Disorder

  1. Biological Aspects: Genetic vulnerabilities can increase the risk of developing adjustment disorders.

  2. Psychosocial Theories: Various personal and environmental factors influencing resilience and coping.

  3. Transactional Model: Interaction between individual factors and stressor type.

Nursing Diagnoses for Adjustment Disorders

  • Possible nursing diagnoses include maladaptive grieving, risk-prone health behavior, and anxiety.

Outcome Criteria for Adjustment Disorders

  • Clients should:

    • Demonstrate healthy grieving behaviors

    • Function independently in daily activities

    • Set realistic goals for the future

Treatment Modalities

Trauma-Related Disorders

  • Cognitive therapy

  • Prolonged exposure therapy

  • Group/family therapy

  • Eye movement desensitization and reprocessing

  • Other emerging therapies and psychopharmacology.

Adjustment Disorders

  • Treatment options include:

    • Individual psychotherapy

    • Family therapy

    • Behavior therapy

    • Self-help groups

    • Crisis intervention

    • Psychopharmacology.

Clicker Questions

  1. Case Scenario: A patient with nightmares from a sexual assault, appropriate intervention is staying with the patient until anxiety subsides.

  2. Medication for PTSD: SSRIs like Paroxetine are the first-line treatment for PTSD due to their efficacy and safety ratings.

Reading aloud, often referred to as 'read to me', is a shared activity that fosters literacy skills and enhances comprehension. It allows listeners to engage with the text, demonstrates pronunciation and expression, and builds vocabulary through exposure to spoken language. This practice is beneficial for children, as it promotes listening skills and develops a love for reading. Furthermore, reading aloud can be used as a tool in educational settings to improve group dynamics and stimulate discussion.