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39 Cards in this Set

  • Front
  • Back

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 *

What is medically-induced trauma?

unexpected outcome that occurs during medical/surgical care that affects the well-being of the Pt, family, or clinician

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

What is the "DEF" assessment after "ABC"?

D: reduce DISTRESS


F: remember the FAMILY

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

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

Which groups are most likely to have PTSD?


Combat veterans

Anyone subjected to natural or man-made disasters, violence, terrorism

People with comorbid dx of depression substance abuse, other anxiety disorders

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

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

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 *

What are the diagnostic indicators & sx of PTSD?


re-experience trauma


numbing of responsiveness

sx of increased arousal


What are some associated difficulties experienced by PTSD patients?

substance abuse

Domestic violence

Lack of intimacy

Interpersonal, social, & occupational difficulties

What are long-term PTSD interventions?


Grief therapy

Support groups

Individual therapies including CBT

Exposure therapy


PHARM: TCA & MAOI = most helpful


*benzos NOT recommmended *

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

What is a dissociative disorder?

Disruption of consciousness, perception, memory, identity

* can be sudden, gradual, transient, or chronic *

What are biological theories of dissociative disorders?

Possibly 5HT or limbic system

Effect of a neurological disease

What are psychosocial theories of dissociative disorders?

Learning theory

Conscious avoidance and/or unconscious DM


What are presentations of depersonalization disorder?

Feeling detached from body, parts of body, or mental process

* 1/3 of them experience life-threatening danger

What are presentations of dissociative amnesia?

inability to recall important personal information (usually traumatic information)

* memory loss is reversible*

* often more than one episode*

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*

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*

What are sx assessment techniques/focuses for dissociative disorders?

Examine identity & memory

Focused hx questions


substance abuse

How does this impact functioning?


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*

what are the focus of our therapies for dissociative disorders?

identify triggers to prevent another episode

What are goals/ECOs of dissociative disorders?


Reduce anxiety

Positive coping

handle stress without dissociating

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

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

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*

What are the four types of somatic sx disorders?

Somatic symptom disorder

Illness anxiety disorder

Body dysmorphic disorder

Conversion disorder

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

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 *

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

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

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 *

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)

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

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

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

What are goals/ECOs for somatic disorders?

Increase adaptive skills

Realistic appraisal = awareness of things as they actually are

Articulate feelings