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39 Cards in this Set
- Front
- Back
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What is trauma-informed care? |
understanding vulnerabilities of Pt with history of violence, abuse, victimization, or other traumatic experiences * direct association between trauma and mental health disorders & physical health conditions * |
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What is medically-induced trauma? |
unexpected outcome that occurs during medical/surgical care that affects the well-being of the Pt, family, or clinician |
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What is the purpose of trauma-specific intervention and what are examples? |
Purpose: assess for & address the client-centered consequences of trauma & facilitate healing Example: education on trauma & sx of trauma = anxiety, substance abuse, heart disease, HTN |
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What is the "DEF" assessment after "ABC"? |
D: reduce DISTRESS E: EMOTIONAL SUPPORT F: remember the FAMILY |
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What are some points for assessment and general screening for trauma disorders? |
Assessment of anxiety sx Physical assessment & neurological exam Assess risk of suicide Psychosocial screening |
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What are DSM-V criteria for all anxiety disorders? |
Prominent: anxiety attacks, panic attacks, obsessions/compulsions, causes significant distress & compulsions Cannot be directly due to medical condition Cannot be exclusive to a delirium episode Cannot be better explained by another mental disorder |
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Which groups are most likely to have PTSD? |
Women Combat veterans Anyone subjected to natural or man-made disasters, violence, terrorism People with comorbid dx of depression substance abuse, other anxiety disorders |
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What are psychosocial theories and/or components of PTSD? |
Distorted appraisal = perceive danger in neutral situations Shattered assumption theory = loss of assumptive beliefs that ground a person like loss of faith after a traumatic experience conditioning and sensitization = made to expect fear after traumatic experiences |
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What are some risk factors that for PTSD? |
Very young or very elderly Assault/witness to assault Hx of abuse Substance abuse or other poor coping Pre-existing emotional/behavioral difficulties |
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What are the sorts of events that cause PTSD? |
Actual or threatened death/serious injury Outside range of usual experience * initial response = fear or horror * |
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What are the diagnostic indicators & sx of PTSD? |
PERSISTENT: re-experience trauma avoidance numbing of responsiveness sx of increased arousal * MUST BE PERSISTENT* |
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What are some associated difficulties experienced by PTSD patients? |
substance abuse Domestic violence Lack of intimacy Interpersonal, social, & occupational difficulties |
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What are long-term PTSD interventions? |
Group: Grief therapy Support groups Individual therapies including CBT Exposure therapy EMDR PHARM: TCA & MAOI = most helpful SSRIs *benzos NOT recommmended * |
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What are some client outcomes that are measurable? |
Recognition of sx Demonstrate anxiety reducing techniques Decrease number/occurrence of sx restful sleep increased social support Fulfilling role social roles |
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What is a dissociative disorder? |
Disruption of consciousness, perception, memory, identity * can be sudden, gradual, transient, or chronic * |
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What are biological theories of dissociative disorders? |
Possibly 5HT or limbic system Effect of a neurological disease |
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What are psychosocial theories of dissociative disorders? |
Learning theory Conscious avoidance and/or unconscious DM * TRAUMA TRAUMA TRAUMA * |
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What are presentations of depersonalization disorder? |
Feeling detached from body, parts of body, or mental process * 1/3 of them experience life-threatening danger |
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What are presentations of dissociative amnesia? |
inability to recall important personal information (usually traumatic information) * memory loss is reversible* * often more than one episode* |
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What are presentations of dissociative fugue? |
sudden & unexpected travel without remembering the past usually single episode & rapid recovery * confusion of identity or RARELY a new identity* * may have amnesia of past traumas* |
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What is presentation of dissociative identity disorder? |
Presence of 2 or more distinct personalities At least 2 of these identities control the person's behavior cannot recall extensive important info *considered identity fragmentation rather than separate personalities* |
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What are sx assessment techniques/focuses for dissociative disorders? |
Examine identity & memory Focused hx questions mood substance abuse How does this impact functioning? suicide |
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what are psychosocial interventions for dissociative disorders? |
re-orient as needed use name to confirm identity of Pt use simple structure & routine encourage independence positive reinforcement of non-dissociative coping & stress reduction *non-dissociative strategies = distraction* |
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what are the focus of our therapies for dissociative disorders? |
identify triggers to prevent another episode |
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What are goals/ECOs of dissociative disorders? |
Safety Reduce anxiety Positive coping handle stress without dissociating |
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What are similarities of somatic symptom disorder & dissociative disorder? |
Both have: respond to physical S&S with abnormal thoughts, feelings no physical medical findings extreme distress as a result |
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What does is the difference between psychosomatic and somatoform? |
Psychosomatic: general medical conditions affected or exacerbated by psychobiological factors Somatoform: sx SUGGEST a medical disorder but not physical changes are found |
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What are some biological theories for somatic sx disorders? |
First degree relative increases risk Some CNS arousal or disturbance Disruption of neuronal & perceptual pathways/signals * particular to pain sx disorders = changes in limbic structure & decreased 5HT + endorphins* |
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What are the four types of somatic sx disorders? |
Somatic symptom disorder Illness anxiety disorder Body dysmorphic disorder Conversion disorder |
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What are the qualifications for somatic symptom disorder? |
1. One or more somatic sx that are distressing or result in significant disruption of daily life 2. excessive thoughts or feelings as manifested by: a. disproportionate & persistent thoughts about seriousness of sx b. persistently high level of anxiety about health/sx c. excessive time/energy devoted to these sx |
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What are some associated features and the specifier for somatic symptom disorder? |
Inconsistent historians several concurrent physicians commonly undergo multiple exams, tests hospitalizations, & sometimes surgeries May be impulsive & antisocial specifier = with predominant pain *common to have prominent anxiety & depressive symptoms * |
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What are characteristics and specifiers for illness anxiety disorder? |
Preoccupation with having or acquiring a serious illness High levels of anxiety about health Excessive health-related behaviors illness preoccupation for 6+ months somatic sx are mild if present specifier = care-seeking or care-avoidant |
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What are characteristics of body dysmorphic disorder? |
Preoccupation with imagined defect or excessive concern significant distress/impairment Frequent checking of the "defect" May alternate with avoidance May seek surgical or dental interventions Some use excessive exercise, dieting, changing clothes |
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What are characteristics of conversion disorder? (also called Functional Neurological Symptom disorder) |
Symptoms or deficit that suggest a neurological disorder One or more symptoms of altered voluntary motor or sensory functions Sx may change with suggestion Present in histrionic/dramatic function or show la belle indifference Most often occurs after extreme stress * evidence that sx & recognized conditions are not compatible * |
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What does voluntary control of symptoms tell us when assessing for somatic disorders? |
NO voluntary control = somatoform (deceives self) YES voluntary control = factitious or malingering (deceives others) |
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What does secondary gain mean with respect to assessment of somatic disorders? |
Secondary gain = personal benefit derived from symptoms EXAMPLES: miss work, avoid military service, obtain drugs, avoid a jail sentence |
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What are communication strategies for therapeutic management of somatic disorders? |
Avoid reinforcing the DO once a symptom has been assessed Don't imply sx aren't real Shift focus from physical complaints to feelings Be matter-of-fact Positive reinforcement of strengths |
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What are therapies and coping strategies for somatic disorders? |
Therapy: insight-oriented, cognitive, family Coping skills: self-care, body knowledge, relaxation, assertiveness, exercise insight-oriented = understand/express feelings, motivations, beliefs, fears, desires |
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What are goals/ECOs for somatic disorders? |
Increase adaptive skills Realistic appraisal = awareness of things as they actually are Articulate feelings |
