Your SlideShare is downloading. ×
Acute Stess Disorders and Post-traumatic Stress Disorders
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.


Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

Acute Stess Disorders and Post-traumatic Stress Disorders


Published on

Published in: Education, Health & Medicine

  • Be the first to comment

  • Be the first to like this

No Downloads
Total Views
On Slideshare
From Embeds
Number of Embeds
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

No notes for slide


  • 1. Presented by: Eric F. Pazziuagan, RN, MAN
  • 2. Disorders that can develop after exposure to a clearly identifiable traumatic event that threatens the self, others, resources, and/or sense of control or hope. The event overwhelms the individual’s coping strategies.
  • 3.  Community violence, war, terrorist attack, being a hostage or POW, torture, disasters, bombings, f atalities in fires or accidents, catastrophic illness, gross injury to self or others, childhood sexual abuse, chronic abuse as a child or adult, rape, assault, and sudden or major personal losses.
  • 4. 7.8 to 8% of American adults Women are twice likely to have PTSD
  • 5.  Individual’s pre-existing characteristics and conditions  Usual coping style and defense mechanisms  Personal and social resources  Previous exposure to trauma  Meaning of the event to the individual
  • 6.  ASD: dissociative symptoms during or immediately after the distressing event: amnesia, depersonalization, derealization , decreased awareness of surroundings, numbing, detachment, or lack of emotional response,  PTSD: not made because of initial reactions at the time of the trauma but is based on characteristic symptoms that occur 1 month after the trauma.
  • 7.  PTSD may be unrecognized for years (even 10-20 years).  Persistent attempt to avoid situations, activities, and sometimes even people who might evoke memories of the trauma.  Denial, repression, and suppression are common in both disorders.  Constricted or blunted affect, or a limitation in the range of feelings might occur.  Might feel detached or estranged from family and friends.  Inability to trust might lead to withdrawal.  Interest to activities is often lost.  Perceptions of the future might change.
  • 8.  Might be in the form of intrusive, unwanted memories, upsetting dreams or nightmares, illusions, or suddenly the feeling as if the event were recurring (flashbacks).  PTSD: hallucination related to the event.  Might have obvious connections to the trauma or might not resemble the original situation at all.  Latter case, patients might try to avoid all activities and people in an effort to prevent reexperiencing the flashback.
  • 9.  Increased arousal, anxiety, restlessness, irritab ility, disturbances in sleep, and impairment in memory or concentration.  PTSD: occasional outbursts of anger or rage and survivor guilt- guilt about surviving or the actions to survive.
  • 10.  Psychological and physiologic symptoms that develop during exposure to situations resembling the original trauma (e.g., anxiety, panic attacks, GI disorders, headache)  Problems with grief, depression, suicidal ideations and attempts, impulsive selfdestructive behaviors, anxiety-related disorders, and substance abuse.  Might appear avoidant, schizoid, schizophrenic, paranoi d or even manic (which complicate treatment).
  • 11.  Preexisting psychiatric disorders, including personality disorders can increase the risk.  History of previous traumas leads to an increased risk for PTSD after later traumas.  Events in later life might trigger previously unrecognized PTSD.  Some difficulties: arrests, unemployment, homelessness, abusi veness, divorce and paranoia toward authority figures or others whom the patient sees as directly or indirectly responsible for not helping with the original traumatic situation.
  • 12.  Common: mistrust, isolation, abandonment fears, workaholism, focusing on the need of others, feelings of inadequacy, anger toward God, unresolved grief, and fear of losing control of emotions.  Family members, friends, and co-workers might develop problems as well, as “secondary victims.”
  • 13. Effective approach: prevent or minimize symptoms.  Application of critical incidence stress management (CISM) principles to disaster situations:         Precrisis preparation Large-scale demobilization procedures Individual acute crisis counseling Brief small group discussions (defusings) Longer small group discussions (critical incident stress debriefings or CISDs) Family crisis intervention techniques Follow-up procedures and/or referral for psychological assessment or treatment
  • 14. Goals of treatment:  Progressive, intensive review of the traumatic experiences (exposure therapy)  Integration of the feelings and memories, often from the least to the most painful.  Moving from a victim status to a survivor status, from “I can’t go on because of this” to “I have learned from it and can go on with life.”  Potential for growth and development of improved coping skills, appreciation of value of life, and enhanced relationships. 
  • 15.  First priority: development of trust; might be difficult.  Other priorities: safety and security (risk of suicide and aggression).  Patients need to hear that they are not crazy but are having typical reactions to a serious trauma (teach about dynamics of ASD and PTSD).  Be prepared to hear horror stories about hideous injuries, unpredicted behaviors, and gross destruction.
  • 16.  Gently clarify connections between original trauma and current feelings and problems.  Patients need to evaluate their past behaviors according to the original context of the situation, not by current values and standards.  Specific techniques: exposure therapy (imaginal or in vivo), systematic desensitization, CBT, eye movement desensitization and reprocessing.  Safe verbalization of feelings, particularly anger, that have been ignored or repressed.  Writing a journal, expressive therapt (art,music or poetry).
  • 17.  Empathy and reassurance that they will be safe and need to be taught relaxation techniques, so they are not overwhelmed of the anxiety.  Take time to focus on emergent problems and potential solutions.  Encourage adaptive coping skills and use of relaxation strategies.  Discourage dysfunctional activities.  Develop interpersonal skills and reestablish relationships that provide and support and assistance.  Couple or family education and counselling.
  • 18.  Benzodiazepines (e.g., clonazepam) to reduce levels of conditioned fear and anxiety symptoms; might help with sleep disturbances and nightmares; risk of dependence.  Clonidine and propranolol: diminish peripheral autonomic response associated with fear, anxiety, and nightmares.  Valproic acid or carbamazepine: mood swings, explosive outbursts and intense feelings of being out of control; dcreases hyperarousal, startle response, and nightmares.
  • 19.  SSRI (paroxetine, escitalopram, and sentraline): reverse continued emergency responses and decreased repetitive behaviors, disturbing images, and somatic states.  TCAs: depression, anhedonia, sleep disturbances.  Antipsychotics: if with psychotic thinking; hyperarousal and sleep disturbances; respiradone or quetiapine to c=decrease flashbacks and nightmares.
  • 20.  Social activities can help rebuild social skills that have been damaged by suspiciousness and withdrawal.  Recreational and exercise programs can help reduce tension and promote relaxation.  Groups: self-esteem, decision making, assertiveness, anger management, stress management, relaxation techniques.  Group meetings for victims.
  • 21.  Be nonjudgmental and honest; offer empathy and support; acknowledge any unfairness or injustices related to the trauma.  Assure patients that their feelings and behaviors are typical reactions to serious trauma.  Help patients recognize the connections between the trauma experience and their current feelings, behaviors, and problems.  Help patients evaluate past behaviors in the context of the trauma, not in the context of current values and standards.
  • 22.  Encourage safe verbalization of feelings, especially anger.  Encourage adaptive coping strategies, exercise, relaxation techniques, and sleeppromoting strategies.  Facilitate progressive review (imaginal or in vivo) of the trauma and consequences.  Encourage patients to establish or reestablish relationships.