MH unit4

Individual Impact: Trauma can affect individuals on a personal level. Examples include: * Personal illnesses. * Physical assault.
Collective Impact: Trauma also affects groups, communities, or larger populations. Examples include: * Natural disasters seperti tornadoes and hurricanes. * Global or regional health crises such as pandemics.
Recovery and Progression: While most people recover from traumatic events over time, those who do not may develop specific psychological disorders, including: * Post-Traumatic Stress Disorder (PTSD). * Adjustment Disorders. * Dissociated Disorders. * Acute Stress Disorder.

General Definition: PTSD is a disorder occurring after an individual experiences or witnesses a traumatic event involving threatened or actual death, serious injury, or violence.
Triggering Events: * Combat experience. * Physical assault. * Natural disasters.
Psychological Response to Triggers: The initial response to these triggers often includes: * Intense fear. * Helplessness. * Terror.
Assessment Tools: Box 13.1 contains a "Life Events Checklist" used by clinicians to determine exposure to trauma. It asks the patient to identify events by the following categories: * Did it happen to you directly? * Did you witness the event? * Did you learn about the event occurring to someone else? * Not sure or doesn't apply.

General Observation: Patients with PTSD often present as "hyper-alert." They may have "squirrel moments" where they are easily distracted or startle easily.
Emotional State: * Extreme anxiety. * Fearfulness. * Anger and aggressiveness.
Cognitive and Perceptual Symptoms: * Flashbacks: Reliving the trauma as if it is happening in the present moment. * Intrusive Thoughts: Unwanted and distressing memories of the event. * Delusions: Being out of touch with reality, such as believing they are back in the traumatic environment (e.g., a combat zone).
Associated Psychosocial Factors: * Survivor's Guilt: Intense guilt for surviving when others did not. * Suicidal Ideation: High risk for suicide and self-harm. * Sleep Disturbances: Significant struggle with poor sleep, insomnia, and nightmares. * Low Self-Esteem: Persistent negative view of self. * Social Isolation: A tendency to distance oneself from others. * Substance Abuse: Dabbing into alcohol or drug use as an ineffective coping mechanism.

1. Re-experiencing: * Includes flashbacks. * Nightmares. * Intrusive thoughts.
2. Avoidance: * Avoidance of people, places, and situations that are triggering (e.g., avoiding Fourth of July celebrations due to fireworks/loud noises). * Actively avoiding thinking about the traumatic event. * Social isolation.
3. Negative Thoughts and Mood: * Feelings of shame, anger, or detachment. * Survivor’s guilt. * Loss of interest in previously enjoyed activities.
4. Hyperarousal: * Being constantly "on guard." * Easily startled. * Being in a perpetual "fight or flight" physiological state. * Irritability. * Persistent sleep problems.

Acute Stress Disorder (ASD): * Symptoms occur immediately after the trauma. * Duration: Symptoms last between $3\text{ days}$ and $1\text{ month}$ .
Post-Traumatic Stress Disorder (PTSD): * Onset: Symptoms typically begin $3\text{ months}$ after the traumatic event, though onset can be delayed for months or even years. * Nature: It is a chronic condition that may experience flare-ups during times of high stress.
Risk Factors for PTSD Severity: * Severity of the initial trauma. * Whether the person was directly involved. * Presence or absence of support systems. * Repeated trauma exposure, which can compromise and deplete coping skills.

Primary Goal: The primary focus of treatment is Trauma Processing, which aims to reduce flashbacks, anxiety, and avoidance behaviors.
Cognitive Behavioral Therapy (CBT): Highly effective; focuses on changing negative thoughts and maladaptive behaviors.
Exposure Therapy: Gradual confrontation of traumatic memories to reduce avoidance behaviors.
Cognitive Processing Therapy: Aimed at correcting cognitive distortions related to the trauma.
Adaptive Disclosure: * Used specifically for military personnel. * A short, intensive trauma therapy. * Combines exposure therapy with the "Empty Chair Technique," where the patient expresses feelings to an empty chair as if a person (alive or deceased) is sitting there. This allows for closure or saying "goodbye" in cases of sudden death during battle.

Antidepressants (First Line): * SSRIs: Examples include terazolam (verbatim), teroxetine (verbatim), and fluoxetine. * SNRIs: Example includes venlafaxine.
Sleep Medications: Used to address insomnia and nightmares.
Antipsychotics: May be used to manage symptoms of hyperarousal.
Benzodiazepines: Not strongly recommended due to limited evidence of efficacy for PTSD.
Hierarchy of Treatment: Therapy treats the underlying disorder and trauma, while medications only manage the symptoms. Therapy should be prioritized over medication alone.

Safety (Top Priority): * Monitor for suicidal ideation and self-harm risk. * Remove harmful items from the patient’s environment. * Develop a formal safety plan.
Nurse-Patient Interaction: * Avoid quick movements when approaching the patient. * Do not touch or grab the patient without explicit permission, as they may become combative or feel triggered.
Psychosocial Support: * Improve Self-Esteem: Assist the patient in shifting their identity from a "victim" to a "survivor." * Reinforce Strengths: Encourage positive self-perception and personal growth. * Encourage Social Support: Facilitate family involvement, participation in support groups, and the use of crisis hotlines.

Question (Student): For adaptations, like the military-specific ones, can civilian psychologists or therapists do them or does it have to be military?
Response (Instructor): The practitioner would need to be effectively trained. It is often recommended to use military-specific therapists because civilians may not be able to relate to certain experiences. While a civilian could technically do it, specialized training is essential.