Acute and Posttraumatic Stress Disorders Dissociative Disorders and Somatic Symptom Disorders Dissociation The disruption of the normally integrated mental processes involved in memory consciousness identity or perception Traumatic Stress Defined in the DSM 5 as an event that involved actual or threatened death or serious injury or sexual violence to self or witnessing others experience trauma learning that loved ones have been traumatized or repeatedly being exposed to details of trauma Acute Stress Disorder ASD Occurs within one month after exposure to traumatic stress Post Traumatic Stress Disorder PTSD Lasts longer than one month Sometimes has a delayed onset Symptoms of ASD and PTSD 1 Intrusive Reexperiencing o Intrusive Flashbacks o Repeated distressing images or thoughts 2 Avoidance 3 Increased Arousal or Reactivity 4 Negative Mood or Thoughts others 5 Dissociative Symptoms o Depersonalization Feeling like a robot o Persistent fear anger or guilt or feelings of detachment from Diagnosis of ASD and PTSD DSM 5 groups ASD and PTSD in a new diagnostic grouping o Trauma and Stressor related disorders o This new category includes adjustment disorders Brief Historical Perspective o Vietnam War prompted much interest in PTSD due to delayed reactions to combat being very common What Defines Trauma 1 A direct exposure to actual or threatened death serious injury or o Sexual violation is a new part of the definition 2 Being witness to actual or threatened death serious injury or sexual violation sexual violation o being in a car that is hanging off a bridge 3 Learning of violence to a loved one 4 Through repeated exposure to details of trauma 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 o Sense of commitment o Control o Challenge in facing stress Frequency of Trauma PTSD and ASD Prevalence of PTSD o 6 8 of people living in the United States o 90 of people living in Detroit have experienced a trauma with 9 developing PTSD o Unexpected death of loved one is most common cause o 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 People with ASD are likely to develop PTSD Course and Outcome Causes and PTSD and ASD Social Factors Psychological Factors o Victims of trauma are more likely to develop PTSD when the trauma is more intense o With less severe stressors social support after a trauma can play a crucial role in alleviating long term psychological damage o The risk for PTSD depends on cognitive factors Preparedness purpose and absence of blame o Emotional Processing Engage emotionally with trauma Articulation and organization of the chaotic experience Cognitive shift The world is not a terrible place Meaning Making o The role of dissociation is debated may not be adaptive may be related to more PTSD o Posttraumatic Growth Positive changes resulting from trauma linked with depression and more positive well being but also with more intrusive and avoidant thoughts Prevention and Treatment of ASD PTSD Cognitive Behavior Therapy for PTSD o The most effective treatment for PTSD is reexposure to trauma Prolonged exposure Cognitive restructuring Imagery rehearsal therapy Antidepressant Medication o Antidepressants and therapeutic reexposure are first line therapies for PTSD o Effectiveness of SSRIs is likely at least partially due to the high comorbidity between PTSD and depression o Traditional antianxiety medications are not effective in treating PTSD Only 30 treated recover fully Symptoms characterized by persistent maladaptive disruption in the integration of memory consciousness or identity o Psychologically produced amnesia o Confused travel of long distances from home o Existence of two or more personalities in one person Dissociative Disorders Controversial and disbelieved by many Concerns the very nature of human psyche Hypnosis o Debated as being a true state of dissociation o Some assert that hypnosis works mostly on highly susceptible participants or people who are merely complying with a social role Symptoms of Dissociate Disorders o Dissociative Identity Disorder DID Two or more personalities coexist within a single individual o Depersonalization o Derealization People feel detached from themselves Symptom involves feelings of unreality detachment from the environment o Dissociative Amnesia Partial or complete loss of recall for particular events or for a particular period of time emotional distress can be a cause 03 25 2015 Neurocognitive Disorders Overview Neurocognitive Disorders patients Dementia functioning Delirium Amnestic Disorders o Most frequent disorders found among elderly psychiatric o A gradual worsening loss of memory and related cognitive o A confusional state that develops over a short period of time o Memory impairments that are more limited than those seen in dementia or delirium Dementia and delirium are listed as cognitive disorders in DSM 5 Cognitive Processes o Physician who deal with disease of the brain and nervous o Perception and attention o Memory o Reasoning and decision making Neurologists system Neuropsychologists o Assess for cognitive impairments Symptoms Delirium o Primary Symptom A clouding of consciousness in association with a reduced ability to maintain and shift attention o Symptoms of delirium follow a rapid onset from a few hours to several days o Symptoms usually worsen at night o Sleep wake cycle is often disturbed o Coma may occur if symptoms allowed to progress Neurocognitive Symptoms o Memory and Learning Memory loss is diagnostic hallmark Retrograde amnesia Anterograde amnesia Most obvious problem during the beginning stages Inability to learn or remember new information of dementia o Verbal Communication Aphasia Apraxia Loss or impairment in language Difficulty performing purposeful movements in response to verbal commands Personality and Emotion o Changes and disturbances frequently associated with dementia dementia cases o Hallucinations and delusions are seen in at least 20 of More common during the later stages of the disorder o Emotional consequences are varied Apathetic or emotionally flat Exaggerated and unpredictable Stress and Physical Health 03 25 2015 Stress Any challenging event that requires physiological
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