Lecture № 7 Post - traumatic stress disorder. S tress - related psychosis. Psychiatry of catastrophes and natural calamities. Lecturer Savka S . D.
Diagnostic criteria for p osttraumatic stress disorder <ul><li>A.Existence of a recognizable stressor that would evoke significant symptoms of distress in almost everyone. </li></ul><ul><li>B.Reexperiencing of the trauma as evidenced by at least one of the following: </li></ul><ul><li>1.Recurrent and intrusive recollections of the event. </li></ul><ul><li>2.Recurrent dreams of the event. </li></ul><ul><li>3.Sudden acting or feeling as if the traumatic event were recurring, because of an association with an environmental or ideational stimulus. </li></ul>
Diagnostic criteria for p osttraumatic stress disorder <ul><li>C. Numbing of responsiveness to or reduced involvement with the external world, beginning some time after the trauma, as shown by at least one of the following: </li></ul><ul><li>1.Markedly diminished interest in one significant activities. </li></ul><ul><li>2.Feeling of detachment or estrangement from others. </li></ul><ul><li>3.Constricted affect. </li></ul>
Diagnostic criteria for p osttraumatic stress disorder <ul><li>D. At least 2 of the following symptoms that were not present before the trauma: </li></ul><ul><li>1Hyperalertness or exaggerated startle response. </li></ul><ul><li>2 Sleep disturbance. </li></ul><ul><li>3 Guilt about surviving when others have not, or about behavior required for survival. </li></ul><ul><li>4 Memory impairment or trouble concentrating. </li></ul><ul><li>5 Avoidance of activities that arouse recollection of the traumatic event. </li></ul><ul><li>6 Intensification of symptoms by exposure to events that symbolize or resemble the traumatic event. </li></ul>
Psychosis <ul><li>(from the Greek ψυχή "psyche", for mind/soul, and -ωσις "-osis", for abnormal condition) means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". People suffering from psychosis are said to be psychotic. </li></ul><ul><li>People experiencing psychosis may report hallucinations or delusional beliefs, and may exhibit personality changes and thought disorder . Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out the daily life activities. </li></ul>
Karl Jaspers’s diagnostic criteria <ul><li>1) the disorder develops following a psychological trauma; </li></ul><ul><li>2) the contents of the patient's experiences proceeds from the nature of the stressful event and there is psychologically understandable association between them; </li></ul><ul><li>3) all the course of the disorder is associated with the traumatic situation, and its disappearance or de-actualization promotes the cessation (or improvement) of the disorder. </li></ul>
Twilight state <ul><li>For the twilight state of consciousness is characteristic outbreak, briefness and rapid (critical) exit from him, shows up disorientation, often with ability to execute enough difficult, but inadequate actions. Delusions and hallucinations under act of which a patient can have the flashes of aggressively-destructive excitation is possible. Takes place complete amnesia of period of stupefaction of consciousness. </li></ul><ul><li>T wilight state – appears on the background of fear with mimic and vegetative signs, panic flight from place, where happened any unhappy event (catastrophe, traffic accident, place of death). It has duration from 1 hour to 1 day. </li></ul>
Twilight state <ul><li>Orientation - deep disorientation in time, space and self; </li></ul><ul><li>Perception - high thresholds of sensitivity, panoramic hallucinations; </li></ul><ul><li>Memory - no fixation of events, no recollections of events, which had occurred during the twilight state; </li></ul><ul><li>Thinking - incoherence, fragmentary delusions; </li></ul><ul><li>Affects - anxiety, rage, disforia; </li></ul><ul><li>Motor activity - aimlessness, purposelessnessa. </li></ul>
Objective signs of hallucinations <ul><li>Anxious look. </li></ul><ul><li>Expression of horror on face. </li></ul><ul><li>Attempts from someone to be hidden laying of surrounding to the improper talks about him and others like that. </li></ul><ul><li>Stopping ears at auditory hallucinations, deleting from the apartment of radio receiver. </li></ul>
Reactive stupor <ul><li>Stupor is state from oligokinesia to total absence of movements. Stupor refers to a state in which the person is mute, immobile, and unresponsive, but appears to be conscious because the eyes are open and follow external objects. Mutism (muteness) is revealed often too. It has duration from several hours to 3 days. </li></ul>
Reactive confusion <ul><li>Acute reactive confusion is state twilight disorder of consciousness with psychomotor excitement, fear, constantly verbal production. </li></ul>
Reactive paranoid <ul><li>Acute reactive paranoid – develops acutely with fear, anxiety, paranoid ideas of relation and persecution. The components Kandinski-Clerambault’s syndrome may be (syndrome of psychic automatism). </li></ul>
Pseudodementia <ul><li>patients are giving wrong answers especially, not right fulfilling simple action, usually all actions they are making inside out (white colour they name black colour etc.), exaggeratedly mood and foolish. </li></ul>
Hysteric stupor <ul><li>Dissociative stupor is diagnosed on the basis of a profound diminution or absence of voluntary movement and normal responsiveness to external stimuli such as light, noise, and touch, but examination and investigation reveal no evidence of a physical cause. In addition, there is positive evidence of psychogenic causation in the form of recent stressful events or problems. </li></ul>
Prolonged reactive psychosis <ul><li>1. Reactive depression </li></ul><ul><ul><li>paranoid - depressive form </li></ul></ul><ul><ul><li>asthenic - depressive form </li></ul></ul><ul><ul><li>hysteric - depressive form </li></ul></ul><ul><li>2. Reactive paranoid </li></ul>
Reactive depression <ul><li>D epression is a clinical syndrome consisting of lowering of mood-tone (feelings of painful dejection), difficulty in thinking (slowing down of thinking), and psychomotor retardation (the so called depressive triad). Depressive patients experience conscious psychic suffering, anguish, and sometimes feelings of boredom, despair, guilt or other negative emotions. </li></ul>
Reactive paranoid <ul><li>Paranoid syndrome includes both delusions and hallucinations. Delusions are not systematized among them delusions of persecution prevail, but other themes also occur. This syndrome is the most common of all the delusional syndromes. </li></ul>
Drug Treatment <ul><li>Psychotropic medications have a place in controlling agitation and insomnia. If brief reactive psychosis is suspected initially, neuroleptic medications should be limited to short-term use only and then only when absolutely necessary. If the diagnosis is suspected after neuroleptic treatment has already started, medications should be discontinued as soon as possible. Symptomatic treatment with benzodiazepines will often make the patient more comfortable, although these agents may not relieve all symptoms in some patients. </li></ul>
Psychological Treatment <ul><li>Psychological treatment may take several forms. Simply being removed from the crisis and having the care and attention of the hospital staff may allay the patient's anxiety enough to permit constructive discussion and problem solving. Once the resources of the staff become available, the stress may no longer seem overwhelming. Enlisting the aid of family members may also be important for the same reason. In individual psychotherapy, encouraging the patient to recount the events that led to the breakdown and to discuss their impact and meaning will facilitate recovery. Longer-term psychotherapy directed at more fundamental psychological conflicts may be indicated for some patients. </li></ul>
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