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Ptsd (post traumatic stress disorder)


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Post Traumatic stress disorder

Post Traumatic stress disorder

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  • 1. PTSD (post traumatic stress disorder)By: Rasida K. Amilasan, RN, BSN
  • 2. P T S D ost raumati c tres s isorde r
  • 3. POST TRAUMATIC STRESS DISORDER (PTSD) Grieving-like behaviors that result from a major and severe trauma like rape, assault, accidents, fire, wartime combat, acts of violence, or natural disaster; Usually occurs AFTER a major traumatic events (usually after ONE month) Acute Stress Disorder – anxiety during or immediate after a traumatic event (within 4 weeks or 1 month); may resolve after 4 weeks. 3
  • 4.  May show physical manifestations: a. Flashbacks b. Insomnia and nightmares c. Eating problems d. Depression and isolation e. Hypervigilance and guilt about surviving the event; 4
  • 5.  Types of PTSD: a. Acute – less than 3 months after the event; b. Chronic – 3 months or more after the event; c. Delayed – at least 6 months after the event; 5
  • 6. Signs and Symptoms:  Anger  Poor impulse control  Chronic anxiety and tension  Avoidance of people, places, and things associated with the traumatic events  Emotional detachment or numbness  Social withdrawal  Decreased self - esteem
  • 7. Diagnosing PTSD ( key assessment)  inability to recall specific aspects of the traumatizing event  Recurring dreams, flashbacks, or thoughts of the traumatic event  Feeling or acting as one did when event originally occurred  Intense distress when faced with cues reminiscent event
  • 8.  Treatments: a. Psychotherapy b. Pharmacotherapy 1. Antidepressants – SSRI (1st line drugs to treat depression). 2. Benzodiazepines 3. Beta – adrenergic blockers 4. TCA’s 5. MAOI 8
  • 9.  Nursing Interventions: P – provide safe environment for the client. T – try to recall the traumatic event. S – suicide precaution. D – don’t leave client alone. 9
  • 10. Nursing interventions (cont.):  Deal constructively with patient’s displays of anger  Encourage patient to assess angry outbursts by identifying how anger escalates  Assist in regaining control over angry impulses, help to identify situations in which patient lost control, to talk about past and precipitating events
  • 11.  Use displacement as means of dealing with urges( from self or others), provide safe, staff – monitored room  Encourage move from physical to verbal expressions of anger
  • 12. Dissociative disorders By: Rasida K. Amilasan, R
  • 13. DISSOCIATIVE DISORDERS Rare; Disturbances in the normal waking state; Is characterized by splitting off or removal from conscious awareness of some information, feeling, or mental function; Affect fundamental aspects of consciousness, memory, identity, self – perception, and perception of the environment; Also associated with traumatic events and severe anxiety; 13
  • 14. Types:  Depersonalization  Dissociative amnesia  Dissociative fugue  Dissociative identity disorder
  • 15. Diagnosing dissociative disorder:  Dissociative disorders interview schedule  SCID – D  Diagnostic drawing series
  • 16. Depersonalization disorder
  • 17. • An altered self-perception in which one’s own reality is temporarily lost or changed; • Feeling of self- detachment; Persistent or recurrent feeling of being detached from the person’s own mental processes or body; • Patient may perceive change in consciousness as barrier between herself and outside world; Depersonalization disorder
  • 18. • The client may experience feelings of detachment but intact reality testing; • Patient may feel that external world is unreal or distorted; • Sudden onset, usually occurring in adolescent or in early adulthood; • Symptom of depersonalization is brief and has no lasting effects • Typically progresses; in many patients becomes chronic with exacerbations and remissions • Resolution usually occurs gradually
  • 19. Causes: • Exact cause is unknown • Severe stress • History of physical, mental, or substance abuse • History of OCD sensory deprivation • Neurophysiologic factors
  • 20. Signs and symptoms: • Feeling detached from entire being and body or loss of touch with reality • Loss of self – control • Difficulty speaking • Obsessive rumination • Disturbed sense of time
  • 21. Diagnostics: • Rule out physical disorders • Psychological tests and special interviews • Confirmed if DSM – IV – TR criteria met
  • 22. Treatment: • Many recover without treatment • Treated when condition is persistent, recurrent, or distressing • Psychotherapy • Cognitive – behavior therapy • Hypnosis • Drugs: • SSRIs, TCAs • Identifying and addressing all stressors linked to onset
  • 23. Nursing interventions: • Establish therapeutic, nonjudgmental relationship with patient • Encourage patient to recognize that depersonalization is a defense mechanism • Recognize and deal with anxiety – producing experiences • Assist patient in establishing relationships
  • 24. Dissociative Amnesia
  • 25.  inability to recall important personal information that can’t be explained by ordinary forgetfulness and because it is anxiety provoking;  memory impairment may be partial or complete;  amnesia may be anterograde (recent information) or retrograde (past information);  Forgetting basic autobiographical information  Most patients aware that they have “lost” some time 25 Dissociative Amnesia
  • 26. Types:  Localized  Selective  Generalized  Continuous  Systematized
  • 27. Causes:  Stress caused by traumatic experience  Predisposition  History of physical, emotional, or sexual abuse
  • 28. Signs and symptoms:  Patient may seem perplexed and disoriented or wander aimlessly  Can’t remember event that precipitated episode  Doesn’t recognize inability to recall information  When episode ends, unaware of memory disturbances
  • 29. Diagnostics:  Physical examination to rule out organic cause of symptoms  Psychiatric examination, including psychological tests  Must meet DSM – IV – TR criteria
  • 30. Treatment:  Helping patient recognize traumatic event trigger  Teaching of reality – based coping strategies by psychotherapist  When recovery is urgent, questioning patient under hypnosis or in drug – induced, semi hypnotic state  Drugs:  Benzodiazepines  SSRIs
  • 31. Nursing interventions:  Establish therapeutic, nonjudgmental relationship  Encourage patient to verbalize feelings of distress  Help patient recognize that memory loss is a defense mechanism  Help patient deal with anxiety – producing experiences  Teach and assist patient in using reality based coping strategies  Teach family members techniques for dealing with patient’s memory loss
  • 32. Dissociative Fugue
  • 33.  Sudden travel away from home and assumes a new personality with inability to recall the past;  This may occur suddenly for several hours or days;  Follows severe psychosocial stress (marital quarrels, personal rejections, or natural disaster)  It allows escape or flight from an intolerable situations.  “When the fugue state stops or lost ….. the client returns home …… UNABLE to recall the fugue state.” 33 Dissociative (Psychogenic) Fugue
  • 34. Upon return to pre – fugue state, patient may have no memory of events that occurred during fugue Inability to recall past Confusion about personal identity Occasional formation of new identity during episode Degree of impairment varies with duration of fugue and nature of personality state evoked usually resolves rapidly 34
  • 35. Causes:  Precise cause unknown  Follows extremely stressful event  Heavy alcohol use (possible predisposing factor)
  • 36. Signs and symptoms:  Often asymptomatic during fugue  Confusion about identity or puzzled about past  Confrontational when new identity (or absence of identity) is challenged  Depression  Discomfort  Shame  Intense internal conflict  Suicidal or aggressive impulses  Confusion, distress, even terror due to failure to remember events during the fugue
  • 37. Diagnostics:  Psychiatric examination (during suspected fugue)  Psychological history to check for episodes of violent behavior  May not be able to diagnose until fugue ends  Physical examination to rule out medical conditions  Confirmed if DSM – IV – TR criteria met
  • 38. Treatment:  Psychotherapy  Anxiolytics  SSRI  Establish trusting relationship  Hypnosis  Cognitive therapy  Group therapy  Family therapy  Creative therapies such as music or art therapy
  • 39. Nursing interventions:  Encourage patient to identify emotions that occur under stress  Monitor patient for signs and symptoms of overt aggression toward self or others  Teach patient effective coping skills  Encourage patient to use available social support systems
  • 40. Dissociative Identity Disorder (DID)
  • 41. 41 • or multiple personality; • existence of two or more fully developed distinct and unique personalities within the person; • the personalities may take full control of the person one at a time; • the personalities may or may not be aware of each other; • the person is unable to recall important information; Dissociative Identity Disorder
  • 42. 42 • char by sudden transition from one personality to the other RELATED TO STRESS; • “dissociation is used as a method of distancing and defending self from anxiety and traumatic events;” • Clients with depersonalization disorder (like DID) are not admitted unless they are suicidal; CAUSE: • Strong connection between DID and history of severe childhood abuse
  • 43. Signs and symptoms:  Lack of recall beyond ordinary forgetfulness  Pronounced changes in facial presentation, voice behavior  Hallucinations particularly auditory and visual  Suicidal tendencies or other self – harming behaviors
  • 44. Diagnostics:  Correct diagnosis only after months or even years in mental health system  Medical history revealing unsuccessful psychiatric treatment, periods of amnesia, and disturbances in time perception  DSM – IV – TR criteria
  • 45. Treatment:  GOAL: “Integrate the personalities or memories so that they can coexist with the original personality and prevent personality from splitting again.”  Long term process  After stabilization, decreasing degree of dissociation, enhancing cooperation and consciousness among subpersonalitie, and ultimately merging them into one personality
  • 46. 46 • Family and couples therapy • Psychotherapy • Hypnosis • Drugs : Benzodiazepines SSRIs TCAs Treatment cont.:
  • 47. The don’ts of DID therapy  Don’t encourage patient to create new personalities  Don’t suggest that patient adopt names for subpersonlities  Don’t encourage subpersonalities to function more autonomously  Don’t encourage patient to ignore certain subpersonalities  Don’t exclude unlikable subpersonalities from therpy