Stress and adjustment disorders

1. Stress and adjustment
disorders,Dissociative and
somatoform disorders

2. Stress
&
adjustment
disorders

3. INTRODUCTION
Adjustment disorder is a group of symptoms, such as
stress, feeling sad or hopeless, and physical symptoms that
can occur after you go through a stressful life event. The
symptoms occur because you are having a hard time
coping. Your reaction is stronger than expected for the
type of event that occurred.

4. STRESS DISORDERS
''Stress is a state of strain , whether it is physical or
psychological.''
-(Atkison , Berne & Woodworth)
DEFINITION OF STRESS

5. TYPES OF STRESS
Acute
stress
Episodic
acute stress
Chronic
stress

6. Acute stress
It's our body's immediate reaction to a new challenge,
event, or demand, and it triggers your fight or-flight
responses.

7. Episodic acute stress
When acute stress happens frequently, it's called
episodic acute stress.

8. Chronic stress
If acute stress isn't resolved and begins to increase or lasts
for long periods of time, it becomes chronic stress.This
stress is constant and doesn't go away.

9. CAUSES OF STRESS
Common external causes of stress:
• Major life changes
• Work or school
• Relationship difficulties
• Financial problems
• Being too busy
• Children & family

10. CONTI....
Common internal causes of stress:
• Chronic worry
• Pessimism
• Negative self-talk
• Worryte
• Unrealistic expectations
• Rigid thinking
• Fear
• All-or-nothing attitude

11. SIGN & SYMPTOMS OF STRESS
• Frequent urination
• Diminished sexual desire
• Constipation , diarrhea ,
nausea or vomiting
• Cold or sweaty hands &
feet
• Social withdrawal or
isolation
• Weight gain or loss
• Frequent headaches
• Body aches
• Chest pain or palpitations
• Difficulty in breathing
• Increase smoking or alcohol
use
• Insomnia
• Gritting , grinding teeth

12. Post-traumatic stress disorder ( )
An emotional condition that can develop after a traumatic
event, particularly an event that involves actual or
threatened death or seriously bodily injury to oneself or
others and that creates intense feelings of fear,
helplessness, or horror.

13. ADJUSTMENT DISORDERS
Adjustment disorder is a group of symptoms, such as
stress, feeling sad or hopeless, and physical symptoms
that can occur after you go through a stressful life
event. The symptoms occur because you are having a
hard time coping. Your reaction is stronger than
expected for the type of event that occurred.

14. Types of adjustment disorder
1. Adjustment disorder with depressed mood
2. Adjustment disorder with anxiety
3. Adjustment disorder with mixed anxiety and depressed mood
4. Adjustment disorder with disturbance of conduct
5. Adjustment disorder with mixed disturbance of emotions and
conduct
6. Adjustment disorder unspecified

15. Causes of adjustment disorders
death of a family member or friend
relationship issues or divorce
major life changes
illness or a health issue (in you or someone you’re close with)
moving to a new house or place
sudden disasters
money troubles or fears

16. CONTI...
Typical causes in children and teenagers include:
1. family fights or problems
2. problems in school
3. anxiety over sexuality

17. Symptoms of adjustment disorder
The mental symptoms of adjustment disorders can include:
• rebellious or impulsive actions
• anxiousness
• feelings of sadness, hopelessness, or being trapped
• crying
• withdrawn attitude

18. CONTI...
• lack of concentration
• loss of self-esteem
• suicidal thoughts
 physical symptoms can include:
• insomnia
• muscle twitches or trembling
• fatigue
• body pain or soreness
• indigestion

19. MANAGEMENT

20. PHARMACOLOGICAL
Medications are used to lessen some of the symptoms of
adjustment disorders, such as insomnia, depression, and
anxiety. These medications include:
• benzodiazepines, such as lorazepam (Ativan) and alprazolam
(Xanax)

21. CONTI...
• nonbenzodiazepine anxiolytics, such as gabapentin
(Neurontin)
• SSRIs or SNRIs, such as sertraline (Zoloft) or venlafaxine
(Effexor XR)

22. NON PHARMACOLOGICAL
• psychotherapy (also called counseling or talk therapy)
• crisis intervention (emergency psychological care)
• family and group therapies
• support groups specific to the cause of the adjustment
disorder

23. CONTI...
• cognitive behavioral therapy, or CBT (which focuses on
solving problems by changing unproductive thinking and
behaviors)
• interpersonal psychotherapy, or IPT (short-term
psychotherapy treatment)

24. Dissociative
&
somatoform
disorderS

25. INTRODUCTION
Dissociative disorders are thought to be quite rare, but when
they do occur they may present a very dramatic clinical picture
of severe disturbance in normal personality functioning. and
The term somatoform derives from the Greek “soma” means
body and mind. The somatoform disorders are a group of
disorder that include physical signs and symptoms (for example
pain, nausea and dizziness) for which an adequate medical
explanation cannot be found.

26. Dissociative Disorder ( )
Dissociative disorders (DD) are conditions that
involve disruptions or breakdowns of memory,
awareness, identity, or perception. People with
dissociative disorders use dissociation as a defense
mechanism, pathologically and involuntarily.

27. Types of Dissociative Disorder
• Generalized amnesia.
• Continuous amnesia.
• Systematized amnesia.
• Dissociative fugue.
• Depersonalization disorder.
• Dissociative identity
disorder.
• Dissociative amnesia.
• Localized amnesia. .
• Selective amnesia.

28. Causes
Predisposing factors to dissociative disorder include:
• Genetics.
• Neurobiological.
• Psychodynamic theory.
• Psychological trauma.

29. Clinical Manifestations
Symptoms of dissociative disorder include:
• Impairment in recall.
• New identity away from home.
• Multiple identities.
• Feeling of unreality.

30. CONTI...
Symptoms of dissociative identity disorder:
• Emotional turmoil
• Behavioral turmoil
• Memory gap
• Incidents of out-of-character behavior

31. CONTI...
Symptoms of dissociative amnesia:
• Memory loss
• Depression
• Anxiety
• Confusion

32. CONTI...
Symptoms of depersonalization/derealization disorder:
• Detachment
• Foggy or dreamlike vision
• Emotional disconnection
• Physical numbness
• Distortions in perception of time
• Distortions of distance and the size and shape of objects

33. Management
Medical Management
PHARMACOLOGICAL
Neuroleptics. The atypical neuroleptics, such as
aripiprazole, olanzapine, quetiapine, and ziprasidone,
are the accepted mode of treatment for dissociative
disorders.

34. CONTI...
NON PHARMACOLOGICAL
• Encourage healthy coping behaviors.
• Logging and monitoring emotions.
• Developing a crisis plan

35. Nursing Management
Nursing Assessment
• Psychiatric interview
{Client’s mental status with a thorough description of behavior,
flow of thought and speech, affect, thought processes and
mental content, sensorium and intellectual resources, cognitive
status, insight, and judgement}

36. CONTI...
Nursing Diagnosis
1.Ineffective coping related to inadequate coping skills.
2. Disturbed thought processes related to childhood trauma or abuse.
3. Disturbed personal identity related to severe level of anxiety.
4. Disturbed sensory perception (kinesthetic) related to threat to self-
concept.

37. CONTI...
Nursing Interventions
1. Promote client safety.
2. Assess for stressors.
3. Explore client’s feelings.
4. Encourage methods for coping.
5. Enhance client’s self-esteem.

38. somatoform disorderS
DEFINITION
psychological problem in which there are symptoms of a
physical disorder without a physical cause.
(Somatic refers to body)

39. Types of Somatic Symptom Disorders
1. Somatization disorder.
2. Pain disorder.
3. Hypochondriasis. .
4. Conversion disorder.
5. Body dysmorphic disorder.

40. Causes of Somatoform Disorders
Psychodynamic Perspective
Behaviorist Perspective
Cognitive perspective

41. Predisposing factors to somatoform
disorders include;
1. Genetic.
2. Biochemical
3. Psychodynamic.
4. Family dynamics.
5. Past experience with physical illness.
6. Cultural and environmental factors.

42. Clinical Manifestations
Pain symptoms. Complaints of headache, pain in the abdomen,
head, joints, back, chest, rectum; pain during urination,
menstruation, or sexual intercourse.
Gastrointestinal symptoms. There is nausea, bloating, vomiting
(other than during pregnancy), diarrhea, or intolerance of
several foods.

43. CONTI...
Sexual symptoms. Sexual indifference, erectile or ejaculatory
dysfunction, irregular menses, excessive menstrual bleeding, and
vomiting through pregnancy.
Pseudoneurologic symptoms. Conversion symptoms such as
impaired coordination or balance, paralysis or localized weakness,
difficulty swallowing or lump in throat, aphonia, urinary retention,
hallucinations, loss of touch or pain sensation, double vision,
blindness, deafness, and seizures

44. Diagnostic Evaluation
• Thyroid function studies. Thyroid stimulating hormone
(TSH) at 0.4-10 mIU/L and thyroxine at 5.0-12.5 ng/dL.
• Pheochromocytoma screen.
• Urine drug screen.
• Psychological testing

45. Management
Medical Management
PHARMACOLOGICAL
Antidepressants. SSRIs are greatly preferred over the other
classes of antidepressants; because the adverse effect profile of
SSRIs is less prominent, improved compliance is promoted

46. CONTI...
NONPHARMACOLOGICAL
Cognitive-behavioral psychotherapy.
Psychosocial therapies.
Psychoeducation.

47. Nursing Management of Somatoform
Disorders
Nursing Assessment
• History Collection
• General appearance and motor behavior.
• Mood and affect.
• Thought process and content.

48. CONTI...
Nursing Diagnosis
1. Chronic pain related to severe level of anxiety, repressed.
2. Ineffective coping related to inadequate coping skills.
3. Disturbed body image related to low self-esteem, severe level of
anxiety.
4. Disturbed sensory perception related to regression to, or fixation
in, an earlier level of development.
5. Self-care deficit related to paralysis of body part, pain, discomfort.

49. CONTI...
Nursing Interventions
• Providing health teaching.
• Assisting the client to express emotions.
• Teaching coping strategies

50. Documentation
• Individual findings, including factors affecting, interactions, nature
of social exchanges, specifics of individual behavior.
• Cultural and religious beliefs, and expectations.
• Plan of care.
• Teaching plan.
• Responses to interventions, teaching, and actions performed.
• Attainment or progress toward the desired outcome.

51. CONCLUSION
• Adjustment disorder is a group of symptoms, such as stress,
feeling sad or hopeless, and physical symptoms that can occur
after you go through a stressful life event. The symptoms occur
because you are having a hard time coping. Your reaction is
stronger than expected for the type of event that occurred
• somatoform disorders more closely resemble physical phobias or
social phobias . Dissociative disorders involve the disruption or
loss of the integrative mechanisms of consciousness, memory,
identity, or perception