Trauma and Stress-Related Disorders
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A person is involved in a car accident and is diagnosed with PTSD three weeks later. Which DSM-5 criteria would not yet be met for a PTSD diagnosis?

  • Having negative alterations in cognition and mood related to the accident.
  • Exhibiting efforts to avoid thoughts or feelings associated with the accident.
  • Experiencing recurrent, involuntary, distressing memories of the accident.
  • Demonstrating symptoms from each of the four PTSD categories. (correct)

Which of the following best exemplifies the 'avoidance' symptom category in PTSD?

  • Displaying hypervigilance and an exaggerated startle response to stimuli.
  • Feeling detached from others and emotionally numb after a traumatic experience.. (correct)
  • Having persistent negative beliefs about oneself and the world following a trauma.
  • Experiencing flashbacks where the traumatic event feels like it is happening again.

Which of the following scenarios would be categorized as an 'intrusive symptom' of PTSD?

  • A victim of a robbery developing a belief that they are inherently unsafe and cannot trust anyone.
  • A former soldier feeling detached and unable to connect with their family after returning from deployment.
  • A survivor of a house fire experiencing vivid nightmares about being trapped in the burning building. (correct)
  • A veteran consciously avoiding driving on highways after experiencing a roadside bomb explosion.

A person with PTSD reports a loss of interest in hobbies and difficulty experiencing joy, which category of symptoms does this fall under?

<p>Negative alterations in cognition and mood (C)</p> Signup and view all the answers

After experiencing a traumatic event, an individual begins to blame themselves for what happened, despite evidence to the contrary. Which PTSD symptom category does this behavior align with?

<p>Negative Alterations in Cognition and Mood (A)</p> Signup and view all the answers

Which of the following is an example of a maladaptive response to a traumatic event, as it relates to stress-related disorders?

<p>Becoming socially isolated and emotionally numb to avoid reminders of the event (D)</p> Signup and view all the answers

Why might a clinician assess for avoidance behaviors when evaluating a patient for potential PTSD?

<p>To understand the patient's efforts to cope with the trauma by avoiding reminders. (C)</p> Signup and view all the answers

How do flashbacks differ from recurrent distressing memories in individuals with PTSD?

<p>Flashbacks involve a feeling as if the trauma is happening again, while recurrent memories are distressing but recognized as past events. (C)</p> Signup and view all the answers

Which of the following is an example of a hyper-arousal symptom commonly observed in individuals with PTSD?

<p>Exaggerated startle response and hypervigilance. (B)</p> Signup and view all the answers

A patient with PTSD reports frequent nightmares. Which medication would be the MOST appropriate first-line treatment to address this specific symptom before considering other options?

<p>Prazosin (Minipress). (B)</p> Signup and view all the answers

Which of the following pre-trauma factors could increase an individual's susceptibility to developing PTSD after experiencing a traumatic event?

<p>Pre-existing mental health conditions such as anxiety or depression. (D)</p> Signup and view all the answers

What is the primary mechanism of action by which Prazosin (Minipress) alleviates nightmares in individuals with PTSD?

<p>Blocking alpha-1 adrenergic receptors to reduce hyperarousal. (D)</p> Signup and view all the answers

Which of the following factors occurring during a traumatic event would MOST likely contribute to the severity of subsequent PTSD?

<p>The duration and type of trauma experienced. (C)</p> Signup and view all the answers

A patient with PTSD is experiencing significant agitation and anger outbursts. Which class of medication might be considered to manage these symptoms?

<p>Atypical antipsychotics. (C)</p> Signup and view all the answers

What is a potential risk factor for PTSD that falls under the category of 'Post-Trauma Factors'?

<p>Lack of social support. (A)</p> Signup and view all the answers

Why are benzodiazepines recommended for short-term use only in the treatment of panic attacks associated with PTSD?

<p>To allow for the development of coping mechanisms. (B)</p> Signup and view all the answers

A patient with PTSD also has a history of hypertension. What consideration is MOST important when prescribing Prazosin (Minipress) for nightmares?

<p>The potential for excessive lowering of blood pressure. (C)</p> Signup and view all the answers

Which medication used to treat anxiety is most similar in its mechanism of action to minipress?

<p>Propranolol. (D)</p> Signup and view all the answers

Which dosage range presents a typical, effective amount of Prazosin for treating PTSD related symptoms?

<p>1 - 5 mg. (C)</p> Signup and view all the answers

Which of the following is NOT a common side effect from taking Minipress?

<p>Increased energy. (B)</p> Signup and view all the answers

A patient with what condition would require extra assessment of the benefits versus the risks before using minipress?

<p>Renal impairment. (A)</p> Signup and view all the answers

What effect do alpha one adrenergic blockers have on blood vessels that helps to reduce blood pressure?

<p>Relaxation of blood vessels. (C)</p> Signup and view all the answers

What can maladaptive coping strategies lead to?

<p>Impeded recovery from PTSD. (C)</p> Signup and view all the answers

A patient is experiencing nightmares and flashbacks following a traumatic event. According to the information, what is the primary goal of using prazosin in this scenario?

<p>To improve the patient's quality of life by reducing nightmares and flashbacks. (B)</p> Signup and view all the answers

Which of the following therapies involves guided eye movements to help process traumatic memories?

<p>Eye Movement Desensitization and Reprocessing (EMDR). (D)</p> Signup and view all the answers

A patient is diagnosed with Acute Stress Disorder after experiencing a traumatic event. According to DSM-5 criteria, within what timeframe do the symptoms need to occur?

<p>Within three days to one month after the trauma. (A)</p> Signup and view all the answers

A first responder is called to the scene of a school shooting. Following the event, short-term crisis intervention is implemented. What does this intervention typically involve?

<p>Group therapy and counseling to address the immediate impact of the trauma. (A)</p> Signup and view all the answers

What is the critical timeframe for diagnosing Adjustment Disorder, according to the information?

<p>Symptoms must develop within three months of the stressful life event. (A)</p> Signup and view all the answers

A patient is experiencing depression, anxiety and insomnia following a recent job loss. The patient is diagnosed with adjustment disorder. Which of the following treatments would be most appropriate as a first-line intervention?

<p>CBT, supportive therapy, and counseling. (C)</p> Signup and view all the answers

A patient is diagnosed with dissociative amnesia. What is the primary characteristic of this condition?

<p>Inability to recall important personal information, usually related to trauma. (B)</p> Signup and view all the answers

Which factor is most commonly associated with the development of dissociative disorders?

<p>Severe childhood trauma and abuse. (B)</p> Signup and view all the answers

A patient is experiencing emotional numbing and amnesia following a traumatic event. What is the most likely explanation for these symptoms?

<p>These are defense mechanisms the body uses to cope with overwhelming trauma. (B)</p> Signup and view all the answers

A patient is diagnosed with Acute Stress Disorder but their symptoms persist beyond one month. According to the DSM-5, what is the most likely revised diagnosis?

<p>Post-Traumatic Stress Disorder (PTSD). (C)</p> Signup and view all the answers

A patient is diagnosed with Adjustment Disorder. What characteristics differentiate Adjustment Disorder from Post Traumatic Stress Disorder (PTSD)?

<p>PTSD requires exposure to a life threatening event, while adjustment disorder can result from less severe stressors. (C)</p> Signup and view all the answers

Following a traumatic event, an individual exhibits increased irritability, hypervigilance, and difficulty sleeping. Which category of symptoms does this best describe?

<p>Hyperarousal. (B)</p> Signup and view all the answers

A victim of a car accident cannot remember the moments immediately before or after the crash. Which of the following best describes this symptom?

<p>Amnesia (C)</p> Signup and view all the answers

Which statement accurately differentiates acute stress disorder(ASD) from PTSD based on diagnostic criteria?

<p>ASD is diagnosed if symptoms occur within three days to one month of the trauma, while PTSD is diagnosed if symptoms last longer than one month. (D)</p> Signup and view all the answers

Which of the following is a therapy that aims to reframe negative thoughts associated with trauma, grief, or guilt?

<p>Cognitive behavioral therapy (D)</p> Signup and view all the answers

A patient reports being found miles away from their home with no recollection of how they got there and appears confused about their identity. Which condition is MOST likely indicated by these symptoms?

<p>Dissociative fugue (C)</p> Signup and view all the answers

A patient experiencing depersonalization is MOST likely to report which of the following sensations?

<p>Feeling as if they are observing themselves from outside their body. (C)</p> Signup and view all the answers

A therapist is working with a patient diagnosed with Dissociative Identity Disorder (DID). Which therapeutic goal is MOST appropriate for this patient?

<p>Facilitating the integration of all alters into a single, cohesive identity. (B)</p> Signup and view all the answers

A patient reports significant gaps in their memory, with no recollection of several hours at a time. During these periods, witnesses describe the patient's behavior and mood as drastically different. Which condition is MOST consistent with these symptoms?

<p>Dissociative Identity Disorder (DID) (C)</p> Signup and view all the answers

A patient who experienced a traumatic event is having difficulty recalling specific details of the event. They can remember some parts clearly, while others are completely forgotten. Which type of amnesia is the patient MOST likely experiencing?

<p>Selective amnesia (A)</p> Signup and view all the answers

Which therapeutic approach is generally considered MOST appropriate for addressing both depersonalization and derealization?

<p>Cognitive Behavioral Therapy (CBT) (C)</p> Signup and view all the answers

A patient reports feeling detached from their body, as if they are watching themselves from outside. However, they acknowledge that their surroundings are real. Which condition BEST describes the patient's experience?

<p>Depersonalization (C)</p> Signup and view all the answers

A patient suddenly travels to a different state and starts a new life under a new name, with no memory of their past. After several weeks, their memory returns, and they are distressed to find themselves in an unfamiliar place. Which condition is MOST likely?

<p>Dissociative Fugue (D)</p> Signup and view all the answers

What is the primary difference between depersonalization and derealization?

<p>Depersonalization involves detachment from oneself, while derealization involves detachment from the surrounding environment. (D)</p> Signup and view all the answers

Which factor is MOST commonly associated with the development of Dissociative Identity Disorder (DID)?

<p>Severe, repeated childhood trauma (C)</p> Signup and view all the answers

A patient with Dissociative Identity Disorder (DID) presents with multiple alters, each with distinct characteristics. Which of the following is a common manifestation of these alters?

<p>Different speech patterns, including accents not typically used by the individual. (A)</p> Signup and view all the answers

Which of the following statements is TRUE regarding the treatment of Dissociative Identity Disorder (DID)?

<p>Long-term psychotherapy is often necessary to address trauma and facilitate integration. (C)</p> Signup and view all the answers

During a therapy session, a patient describes feeling like they are living in a movie, where everything around them seems unreal and dreamlike. They are MOST likely experiencing:

<p>Derealization (B)</p> Signup and view all the answers

A first responder finds a survivor of a mass casualty event miles away from the site. The survivor is confused, disoriented, and unable to recall any details of the event or their personal information. What condition might this survivor be experiencing?

<p>Dissociative Fugue (D)</p> Signup and view all the answers

What is the intended outcome of therapy, like Cognitive Behavioral Therapy(CBT) or Dialectical Behavior Therapy (DBT), for a patient with Dissociative Identity Disorder (DID)?

<p>To integrate the alters, creating a more cohesive sense of self. (B)</p> Signup and view all the answers

Flashcards

Trauma & Stress-Related Disorders

Mental health conditions triggered by traumatic or highly stressful life events (e.g., combat, assault, disasters).

PTSD (Post-Traumatic Stress Disorder)

A mental health condition where symptoms occur for at least one month after experiencing a traumatic event.

Intrusive Symptoms (PTSD)

Recurrent, involuntary, and distressing memories of the trauma, including flashbacks and nightmares.

Flashbacks

Feeling as if the traumatic event is happening again in real-time.

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Avoidance Symptoms (PTSD)

Efforts to avoid thoughts, memories, places, people, or situations associated with the trauma.

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Emotional Numbing

Becoming emotionally numb or detached from others after a traumatic experience.

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Negative Alterations in Cognition and Mood (PTSD)

Persistent negative beliefs about oneself, others, or the world after trauma.

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Distorted Blame

Distorted assignment of blame to self or others for the traumatic event.

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Mini Press

Medication sometimes use for intense nightmares and flashbacks. It may not be a long-term solution.

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Trauma-Focused CBT

A psychotherapy approach focused on reframing negative thoughts related to trauma and grief.

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EMDR

Therapy using guided eye movements to process traumatic memories. It is a specialized treatment.

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Prolonged Exposure Therapy

Therapy to reduce negative avoidance behaviors.

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Acute Stress Disorder

A stress disorder similar to PTSD but occurs within 3 days to 1 month after trauma exposure.

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Dissociative Symptoms

Feeling detached from reality.

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Hyperarousal

Irritability or being constantly 'on edge'.

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Amnesia (Trauma-Related)

Emotional numbing or blocking out the traumatic event.

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Crisis Interventions

Short-term interventions after a major event.

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Adjustment Disorder

Maladaptive response to a stressful life event within 3 months; stressors are less severe than PTSD.

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Stressors (Adjustment Disorder)

Divorce, job loss, chronic illness or financial problems.

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Dissociative Disorders

Disorders involving disruptions in memory, identity, emotion, perception and/or behavior.

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Dissociative Amnesia

Disruptions or gaps in memory.

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SSRI (Adjustment disorder)

First line treatement for adjustment disorder.

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Feelings associated with Adjustment disorder

Feeling worry or hopelessness

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PTSD: Hyper-Arousal Symptoms

Irritability, hyper-vigilance, exaggerated startle response, difficulty concentrating, and trouble sleeping.

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PTSD: Pre-Trauma Risk Factors

Pre-existing mental health conditions, genetic predisposition to anxiety, and childhood adversity.

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PTSD: Peri-Trauma Factors

Severity and duration of the trauma, type of trauma, and the person's thoughts during the event.

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PTSD: Post-Trauma Factors

Lack of social support, repeated exposure to trauma reminders, and maladaptive coping strategies.

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PTSD: First-Line Medication

SSRIs (like Zoloft, Paxil, Prozac) are often the first choice for PTSD treatment.

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PTSD: Prazosin (Minipress)

Prazosin (Minipress) can be used for nightmares or flashbacks related to PTSD.

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PTSD: Agitation Treatment

Mood stabilizers or atypical antipsychotics can be used if there is significant agitation.

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PTSD: Panic Attack Meds

Benzodiazepines can provide short-term relief for panic attacks.

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Minipress: Mechanism of Action

It blocks alpha-1 adrenergic receptors, relaxing blood vessels and reducing blood pressure.

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Minipress: PTSD Benefit

It reduces the body's hyper-arousal response to adrenaline, which can help with nightmares.

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Propranolol for Anxiety

Propranolol lowers the hyper-arousal symptoms of anxiety, such as a pounding heart.

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Minipress: Common Side Effects

Dizziness, drowsiness, orthostatic hypotension, nausea, vomiting, and headache.

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Minipress: Uncommon Side Effects

Blurred vision, urinary incontinence, and impotence.

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Minipress: Renal Caution

Assess kidney function, especially in patients with renal impairment or on dialysis.

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Minipress: Hypertension Caution

Be cautious when prescribing Minipress to patients already on other anti-hypertensive medications.

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Localized Amnesia

Inability to recall events from a specific period.

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Selective Amnesia

Partial memory loss where some event details are forgotten.

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Generalized Amnesia

Complete loss of memory; very rare.

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Dissociative Fugue

Sudden travel away from home with confusion about identity.

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Trauma-Focused Therapy

Therapy that focuses on processing traumatic memories.

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Cognitive Techniques (for Memory)

Techniques to improve memory recall.

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Dissociative Identity Disorder (DID)

Presence of two or more distinct personality states or alters.

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Alters Characteristics in DID

Distinct patterns of thought, behavior or speech for each personality.

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Depersonalization

Feeling detached from oneself; an out-of-body experience.

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Derealization

Feeling that one's surroundings are unreal.

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Cognitive Behavioral Therapy (CBT)

Therapy to change negative thinking and behavior patterns.

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Dialectical Behavior Therapy (DBT)

Therapy to manage intense emotions and improve relationships.

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Grounding techniques

Techniques to bring you back to the present moment

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Benzodiazepines for Anxiety

Medications used short-term for anxiety or panic attacks.

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Study Notes

  • Trauma and stress-related disorders are mental health conditions triggered by traumatic or highly stressful life events.
  • Such events could include combat, sexual assault, accidents, natural disasters, terrorist attacks, or childhood abuse.
  • Individuals may exhibit emotional and behavioral responses such as anxiety, fear, dissociation, avoidance, and hypervigilance.

Post-Traumatic Stress Disorder (PTSD)

  • According to DSM-5, PTSD requires the exhibition of symptoms for longer than one month, across four categories

Intrusive symptoms

  • Recurrent, involuntary, and distressing memories of the trauma
  • Flashbacks, which are feelings as if the trauma is happening again
  • Nightmares related to the trauma (flashbacks can occur during nightmares)
  • Intense emotional and physical reactions to trauma reminders

Avoidance

  • Efforts to avoid thoughts, memories, or conversations about the event
  • Avoidance of places, people, or situations associated with the trauma
  • Emotional numbing or detachment from others

Negative Alterations in Cognition and Mood

  • Persistent negative beliefs about oneself, others, or the world
  • Distorted blame of self and others for the trauma
  • Inability to experience positive emotions
  • Loss of interest in activities

Hyperarousal Symptoms

  • Irritability or anger outbursts
  • Hypervigilance (constantly on edge)
  • Exaggerated startle response
  • Difficulty concentrating
  • Trouble sleeping

PTSD Risk Factors

  • Pre-trauma factors: pre-existing mental health conditions (anxiety, depression), genetic predisposition, childhood adversity
  • Peritraumatic factors: severity and duration of the trauma, type of trauma, and the person's thoughts during the event
  • Post-trauma factors: lack of social support, repeated exposure to trauma reminders, and maladaptive coping strategies (e.g., drinking, drug use, avoidance)

PTSD Treatment and Medication Management:

  • SSRIs (Zoloft, Paxil, Prozac, etc.) are first-line treatments.
  • Prazosin (Minipress) can be used for nightmares or flashbacks.
  • Mood stabilizers or atypical antipsychotics may be used for agitation (Risperdal, Seroquel, Depakote).
  • Benzodiazepines can be used short-term for panic attacks.

Prazosin (Minipress)

  • It's a blood pressure medication (alpha-1 adrenergic blocker).
  • Off-label use for PTSD-related nightmares.
  • It can help with sleep and stopping nightmares.
  • The mechanism of action is the blockade of alpha-1 receptors, leading to the relaxation of blood vessels and reduced blood pressure.
  • It can reduce the body's hyperarousal response to adrenaline.
  • For social/performance anxiety, propranolol can be used; however, minipress works better for PTSD.
  • Propranolol lowers hyperarousal symptoms of anxiety (heart pounding, etc.).
  • Minipress dosage typically starts at 0.5mg and can be titrated up to 1-15mg (usual dose 3-5mg).

Minipress Side Effects

  • Dizziness
  • Drowsiness
  • Orthostatic hypotension
  • Nausea and vomiting
  • Headache
  • Uncommon side effects include blurred vision, urinary incontinence, and impotence -- discontinue use if these occur.
  • Use with caution in patients with renal impairment or those on other antihypertensive medications
  • The main goal is to improve the quality of life for individuals experiencing nightmares/flashbacks.
  • It may not be a long-term medication.

Psychotherapy for PTSD

  • Trauma-focused Cognitive Behavioral Therapy (CBT) helps reframe negative thoughts.
  • Eye Movement Desensitization and Reprocessing (EMDR) uses guided eye movements to process traumatic memories.
  • Prolonged Exposure Therapy reduces negative thoughts and avoidance behaviors (be cautious of retraumatization).

Acute Stress Disorder

  • Similar to PTSD, but occurs within three days to one month after the trauma.
  • If symptoms persist past one month, it may develop into PTSD.

Common Symptoms of Acute Stress Disorder

  • Dissociative symptoms (feeling detached from reality)
  • Intrusive thoughts, flashbacks, nightmares
  • Avoidance of trauma-related stimuli
  • Hyperarousal (irritability, being on edge)
  • Emotional numbing or amnesia

Treatment for Acute Stress Disorder Includes

  • Short-term crisis interventions
  • Trauma-focused CBT
  • SSRIs or short-term benzodiazepines

Adjustment Disorder

  • A maladaptive emotional or behavioral response to a stressful life event within three months.
  • Stressors may include divorce, job loss, chronic illness, or financial problems.
  • No requirement for a life-threatening event.

Symptoms of Adjustment Disorder

  • Depression
  • Anxiety
  • Anger
  • Conduct problems in children
  • Trouble sleeping
  • Withdrawal from social interactions
  • Increased worrying or feelings of hopelessness
  • Impaired daily function

Treatment for Adjustment Disorder

  • CBT
  • Supportive therapy and counseling
  • Possibly short-term use of antidepressants or anti-anxiety medications

Dissociative Disorders

  • Involve disruptions in memory, identity, emotion, perception of reality, and behavior.
  • Are commonly linked to severe childhood trauma and abuse.

Dissociative Amnesia

  • Inability to recall important personal information, usually following a trauma.
    • Localized Amnesia: Cannot recall events during a specific time period.
    • Selective Amnesia: Partial memory loss.
    • Generalized Amnesia: Complete memory loss (uncommon).
    • Dissociative Fugue: Sudden travel or wandering away from home with identity confusion.
    • Treatment includes trauma-focused therapy and cognitive techniques to improve memory recall.

Dissociative Identity Disorder

  • Presence of two or more distinct personality states or alters.
  • Each identity has different memories, behaviors, and speech patterns.
  • Often related to severe, repeated childhood abuse.

Symptoms of Dissociative Identity Disorder Include

  • Memory or time loss
  • Rapid changes in mood, behavior, or identity
  • Increase in self-injurious behaviors or suicidal tendencies

Treatment for Dissociative Identity Disorder

  • Long-term psychotherapy
    • Aims to integrate all identities into one.
    • CBT and DBT may be used.
    • Hypnotherapy may be used in some cases.

Depersonalization vs. Derealization

  • Depersonalization: Feeling detached from oneself (out-of-body experience).
  • Derealization: Feeling that the surroundings are unreal.
  • Treatments include CBT and grounding techniques.
  • Medication management includes SSRIs or short-term benzodiazepines for anxiety or panic attacks.

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Trauma and stress-related disorders arise after exposure to traumatic events like combat or abuse. PTSD, as defined by DSM-5, involves intrusive symptoms, avoidance, negative alterations in cognition and mood, and marked alterations in arousal and reactivity. Symptoms must persist for more than one month.

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