Summary PYC4802 Exam Prep Notes.

PYC4802 Exam Prep Notes. Trauma and Stressor-Related Disorder Etiology – trauma Prognosis – Chemical make-up of the brain and the responses intrusion, avoidance, and arousal young people of different cultures following their exposure to war Combination • Fear • Anxiety • Stress Define Acute Stress Disorder ASD Acute stress disorder involves symptoms that last from three days to one month following exposure to one or more traumatic events. Symptoms develop after an individual experiences or sees an event involving a threat or actual death, serious injury, or physical violation to the individual or others. Symptoms fall into the five general categories of intrusion, negative mood, dissociation, avoidance, and arousal, and begin or worsen after the trauma occurred. People might exhibit PTSD-like symptoms for a short period immediately after a trauma. In psychiatry, trauma has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, and which often results in lasting mental and physical effects. It is believed that the more direct the exposure to the traumatic event, the higher the risk for mental harm. Identify individuals who are suffering from Acute Stress Disorder People living a very stressful life resulting in an acute stress reaction, and the symptoms characterize it as a d/o Distributing prohibited | Downloaded by Nandi Love () lOMoARcPSD| 2 Diagnostic criteria for Acute Stress Disorder (ASD) Derealization, depersonalization and detachment from the details of the event. Code 308.3 " Criterion A. Exposure to actual or threatened death, serious injury, or sexual violation in one (or more) of the following ways: Directly experiencing the traumatic event(s). Witnessing, in person, the events(s) as it occurred to others. Learning that the traumatic events(s) occurred to a close family member or close friend. Note: In cases of actual or threatened by death of a family member or friend, the events(s) must have been violent or accidental. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: This does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related. Criterion B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred: Intrusion symptoms - Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. Recurrent distressing dreams in which the content and/or affect of the dream are related to the events(s). Note: In children older than 6, there may be frightening dreams without recognizable content. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). Note: In children, trauma-specific reenactment may occur in play. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic events. Negative Mood - Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). Dissociative Symptoms - An altered sense of the reality of one's surroundings or oneself (e.g., seeing oneself from another's perspective, being in a daze, time slowing.) Inability to remember an important aspect of the traumatic events(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). Avoidance symptoms - Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Arousal symptoms - Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep) Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical Distributing prohibited | Downloaded by Nandi Love () lOMoARcPSD| 3 aggression toward people or objects. Hypervigilance Problems with concentration Exaggerated startle response Criterion C: The duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria. Criterion D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion E: The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or other medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder How to identify individuals who are suffering from ASD Symptoms fall into the five general categories of intrusion, negative mood, dissociation, avoidance, and arousal, and begin or worsen after the trauma occurred. People might exhibit PTSD-like symptoms for a short period immediately after a trauma. Trauma has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, and which often results in lasting mental and physical effects. • Intrusion symptoms (involuntary and intrusive distressing memories of the trauma or recurrent distressing dreams) • Negative mood (persistent inability to experience positive emotions such as happiness or love) • Dissociative symptoms (time slowing, seeing oneself from an outsider's perspective, being in a daze) • Avoidance symptoms (avoidance of memories, thoughts, feelings, people, or places associated with the trauma) • Arousal symptoms (difficulty falling or staying asleep, irritable behavior, problems with concentration) Only 1 of the DSM-V criteria need to be met Distributing prohibited | Downloaded by Nandi Love () lOMoARcPSD| 4 Diagnostic criteria for Post Traumatic Stress Disorder (PTSD) The criteria below are specific to adults, adolescents, and children older than 6 years. Diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition. Two specifications are noted including delayed expression and a dissociative subtype of PTSD, the latter of which is new to DSM-5. Criterion A: Stressor The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (1 required) 1. Direct exposure. 2. Witnessing, in person. 3. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental. 4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect nonprofessional exposure through electronic media, television, movies, or pictures. Criterion B: Intrusion symptoms The traumatic event is persistently re-experienced in the following way(s): (1 required) 1. Recurrent, involuntary, and intrusive memories. Note: Children older than 6 may express this symptom in repetitive play. 2. Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s). 3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play. 4. Intense or prolonged distress after exposure to traumatic reminders. 5. Marked physiologic reactivity after exposure to trauma-related stimuli. Criterion C: avoidance Persistent effortful avoidance of distressing trauma-related stimuli after the event:(1 required) 1. Trauma-related thoughts or feelings. 2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations). Criterion D: negative alterations in cognitions and mood Negative alterations in cognitions and mood that began or worsened after the traumatic event: (2 required) 1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs). Distributing prohibited | Downloaded by Nandi Love () lOMoARcPSD| 5 2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous."). 3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences. 4. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt or shame). 5. Markedly diminished interest in (pre-traumatic) significant activities. 6. Feeling alienated from others (e.g., detachment or estrangement). 7. Constricted affect: persistent inability to experience positive emotions. Criterion E: alterations in arousal and reactivity Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (2 required) 1. Irritable or aggressive behavior. 2. Self-destructive or reckless behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. Problems in concentration. 6. Sleep disturbance. Criterion F: Duration Persistence of symptoms (in Criteria B, C, D and E) for more than one month. Criterion G: Functional significance Significant symptom-related distress or functional impairment (e.g., social, occupational). Criterion H: Attribution Disturbance is not due to medication, substance use, or other illness. Specify if: With dissociative symptoms. In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli: 1. Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream). 2. Derealization: experience of unreality, distance, or distortion (e.g., "things are not real"). Specify if: With delayed expression. Full diagnosis is not met until at least 6 months after the trauma(s), although onset of symptoms may occur immediately. How to identify individuals who are suffering from PTSD Criterion A: 1 required for 1 month Criterion B: 1 required for 1 month Distributing prohibited | Downloaded by Nandi Love () lOMoARcPSD| 6 Criterion C: 1 required for 1 month Criterion D: 2 required for 1 month Criterion E: 2 required for 1 month Criterion G: social or work impairment Criterion H: not related to other medication or alcohol + depersonalization or derealization (delayed expression) Distributing prohibited | Downloaded by Nandi Love () lOMoARcPSD| 7 PTSD children and adolescents Clinical characteristics, assessment, and treatment of PTSD in children and adolescents Fears of the dark, bad dreams, nightmares, and waking through the sleep cycle are particularly prevalent in young children Separation anxiety is also common in young children and may even be found among teenagers. For the first few days children may not want to let their parents out of sight, even reverting to sleeping in the parents' bed. While some child survivors often experience a pressure to speak about the trauma, paradoxically, they also and it very difficult to talk with parents and peers. Often they do not want to upset the adults and so parents may not be aware of the full extent of their children's suffering. cognitive changes have been observed in traumatized children and adolescents. They often report difficulties in concentration, especially in schoolwork Survivors often learn that life is quite fragile, particularly if they sustained any permanent injury or witnessed a death. This can lead to a sense of a foreshortened future that is often expressed as a loss of thoughts about the future. Life priorities may also change in response to trauma; some feel that they should live each day fully and not plan for the future, whereas others realize that they have been too concerned with materialistic or petty matters and resolve to rethink their values, frequently taking on the image of themselves as a helper to others Behavior disorders develop because PTSD lessens the child's ability to control aggressive and angry impulses Behavior disorders are more likely to occur as a consequence of physical abuse Adolescent survivors often report high levels of depression, some becoming clinically depressed, having suicidal thoughts, and taking overdoses in the year after a disaster. Others have noted that adolescents exposed to repeated trauma are also likely to exhibit dissociative features, self injurious behaviors, aggression, and substance abuse