Traumatic stress disorders dissociative disorders and somatoform disorders look different but share an important similarity Dissociation The disruption of the normally integrated mental processes involved in memory consciousness identity or perception Traumatic Stress De ned in the DSM 5 as an event that involves actual or threatened death or serious injury or sexual violence to self or witnessing others experience trauma learning that loved ones may have been traumatized or repeatedly being exposed to details of trauma Post traumatic Stress Disorder PTSD Lasts longer than one month sometimes has a delayed onset Symptoms of ASD and PTSD Intrusive Re experiencing Repeated distressing images or thoughts Intrusive ashbacks Negative Mood or Thoughts Persistent fear anger or guilt or feelings of detachment from others Dissociative Symptoms Depersonalization feeling like a robot DSM 5 groups ASD and PTSD in a new diagnostic grouping Trauma and stressor related disorders This new category includes adjustment disorders Dissociation is involved in many PTSD symptoms not just the explicit dissociative symptoms Vietnam War prompted much interest in PTSD due to delayed reactions to combat being very common Being witness to actual threatened death serious injury or sexual violation being in a car that is hanging off a bridge 1 Disaster and Emergency Workers Not immune to trauma s aftereffects Emergency workers are less than half as likely to develop PTSD as victims Training preparation and sense of purpose appear to be protective Hardiness Sense of commitment Control Challenge in facing stress Prevalence of PTSD Unexpected death of a loved one is most common cause 20 40 of children develop PTSD Many traumas do not occur at random due to risky behaviors People who are anxious or who have a family history of mental illness also experience more traumas Course and Outcome People with ASD are likely to develop PTSD Post traumatic growth positive changes resulting from trauma linked with depression and more positive well being but also with more intrusive and avoidant thought Antidepressant Medication Antidepressants and therapeutic reexposure are rst line therapies for PTSD Dissociative Identity Disorder DID Two or more personalities coexist within a single individual Depersonalization People feel detached from themselves 2 Derealization Dissociative amnesia Symptom involves feelings of unreality detachment from the environment Partial or complete loss of recall for particular events or for a particular period of time emotional distress can be a cause Neurocognitive disorders Most frequent disorders found among elderly psychiatric patients Dementia Delirium A gradual worsening loss of memory and related cognitive functioning A confusional state that develops over a short period of time Primary symptom A clouding of consciousness in association with a reduced ability to maintain and shift attention Neurologist Physicians who deal with disease of the brain and nervous system Neuropsychologists Asses for cognitive impairments Neurocognitive Symptoms Memory and Learning Memory loss is diagnostic hallmark Aphasia Loss or impairment in language Apraxia Symptoms Most obvious problem during the beginning stages of dementia Dif culty performing purposeful movements in response to verbal commands 3 Personality Emotion Motor Behaviors Hallucinations and delusions are seen in at least 20 of dementia cases May become agitated pacing restlessly or wandering away from familiar places Muscular rigidity Dyskinesia Tic tremors and jerky movements of the face and limbs called chorea Approximately 25 of dementia patients also exhibit symptoms of major depressive disorder Prevalence of Dementia Samples in North America and Europe Increases dramatically in older age groups Almost 40 of people over 90 years of age exhibit symptoms of moderate or severe dementia Delirium Can be caused by many different kinds of medication including Psychiatric drugs antidepressants antipsychotics and benzodizepines Drugs used to treat heart conditions Pain killers Stimulants including caffeine When a person clearly suffers from a primary type of dementia such as the Alzheimer s type a return to previous levels of functioning is extremely unlikely Medication Acetylcholine Donepezil Neurotransmitter involved in memory Unfortunately it usually works for only six to nine months but not able to reverse the relentless progression of the disease Patients with dementia 4 Experience fewer emotional problems Are less likely to become agitated if they follow a structured and predictable daily schedule Help the person remain active and interested in everyday events Preserve familiar routines and surroundings Stress adaptation Any challenging event that requires physiological cognitive or behavioral Stress is a challenging major or minor event requiring physiological cognitive or behavior adaptation Richard Lazarus de nes stress as the individual s appraisal of a challenging life event Primary appraisal Secondary appraisal physicians endocrine functioning Evaluation of the challenge threat or harm posed by an event Assessment of our abilities and resources for coping with that event Increased stress is correlated with illness behaviors and more frequent visits to Social Support in humans predicts improved immune cardiovascular and Medical scientists now view every physical illness from colds to cancer to AIDS as a product of the interaction between the mind and body Holistic View not included in DSM V Behavioral Medicine A multidisciplinary eld that includes both medical and mental health professionals who investigate psychological factors in the symptoms cause and treatment of physical illness Walter Cannon Viewed stress as the activation of the ght or ight response activates sympathetic nervous system Fight or ight is a maladaptive reaction to much stress in the modern world Psychophysiological Response to Stress 5 Adrenal hormones Immune System Responses When a perceived threat registers in the cortex it signals the amygdala Release of cortisol stress hormone and CRF also causes immunosuppression the decreased production of immune agents Psychoneuroimmunology PNI investigates the relation between stress and immune function Psychophysiological Response to Stress Illness and Chronic Stress Cannon stated chronic stress overwhelms the body s homeostasis General adaptation syndrome GAS consists of 3 stages Alarm occurs rst and involves the
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