Understanding PTSD and Dissociative Disorders

Posttraumatic Stress Disorder (PTSD)

• PTSD is marked by a delayed emotional response to a traumatic event
• PTSD can be diagnosed in individuals of all age groups
• Elevated blood glucose is not a common symptom of PTSD

Dissociation

• Dissociation is a subconscious defense mechanism that distances the mind from trauma

Diagnosis of PTSD

• Diagnosis requires symptoms to persist for at least 1 month after the trauma

Dissociative Disorder

• Dissociative identity disorder is characterized by two or more distinct personalities

PTSD in Elderly

• Even common accidents can cause PTSD in elders

Nursing Diagnosis for PTSD

• Post trauma syndrome is a suitable nursing diagnosis for a client experiencing flashbacks and nightmares

Nursing Care for PTSD

• The goal of immediate outcomes in nursing care is identifying the traumatic event and beginning anxiety reduction
• The first nursing action when a client with PTSD reports suicidal ideation is to ensure the client's safety
• Electroconvulsive therapy is not a commonly used therapy for PTSD treatment

Trauma Survivors

• Platitudes should be avoided when talking with trauma survivors, as they may invalidate the client's feelings

Depersonalization Disorder

• Depersonalization disorder includes the feeling of detachment from one's body

Dissociative Amnesia

• Dissociative amnesia involves forgetting important personal information

Nursing Interventions

• Encouraging the expression of feelings best promotes a client's self-esteem

Long-term Goal for PTSD

• A long-term goal in the nursing care of PTSD is the integration of trauma into life post-discharge

Historical Term for PTSD

• PTSD among war veterans was historically called combat fatigue or shell shock

Survivor's Guilt

• A client stating, "I should have died instead of them" indicates survivor's guilt

Grounding Techniques

• "Grounding techniques" in PTSD care involves orienting the client to reality during dissociation

PTSD Management

• PTSD may take years to manage and affect daily function

Anxiety and Anxiety Disorders

• Anxiety is a vague feeling of dread without a clear cause
• Mild anxiety is considered motivating and helpful for problem-solving and requires no direct nursing intervention
• Someone displaying muscle tension, dry mouth, and selective attention is likely experiencing moderate anxiety
• A person pacing, crying, and having ritualistic behavior with nausea and a headache is likely experiencing panic

Panic Attacks

• Panic attacks last 5 to 30 minutes and involve intense physical symptoms
• The first nursing priority during a client's panic attack is ensuring client safety

Phobias

• Systematic desensitization is a non-pharmacologic treatment approach for phobias

Mental Illness

• Anxiety disorders are the most common category of mental illness according to the World Health Organization

Generalized Anxiety Disorder (GAD)

• In GAD, symptoms are experienced for more than 6 months

Biological Factors

• GABA imbalance is a biological factor contributing to anxiety

Anxiolytics

• Benzodiazepine is classified as an anxiolytic with high abuse potential

Neurotransmitters and Anxiety

• GABA and serotonin are the neurotransmitters most associated with anxiety

Nursing Interventions (Anxiety)

• A nursing intervention for moderate anxiety includes speaking in short, simple sentences

Primary Gain and Anxiety

• Primary gain is relief from anxiety through performance of anxiety-driven behavior

Phobias and Avoidance

• A patient with a phobia of elevators avoids visiting certain buildings which is an example of avoidance behavior

Panic Disorder

• Panic disorder involves a sudden onset of intense fear with at least 4 physical symptoms

Cognitive Behavioral Therapy (CBT)

• Decatastrophizing is part of Cognitive Behavioral Therapy (CBT)

Social Anxiety Disorder

• Social anxiety disorder is a type of phobia rooted in low self-esteem and fear of judgment

Benzodiazepines

• The use of benzodiazepines in anxiety treatment has a high risk for dependency and is only used short-term

Obsessive-Compulsive and Related Disorders

• An obsession is best defined as repetitive thoughts that are intrusive and persistent

Compulsions

• Repetitive intrusive thoughts are a compulsion

Trichotillomania

• Trichotillomania is a disorder that involves compulsive hair-pulling

Dermatillomania

• According to DSM-V, dermatillomania is categorized under Obsessive-Compulsive and Related Disorders

Fluoxetine

• Fluoxetine is a medication approved for children as young as 6 years old with OCD

OCD Therapy

• The main goal of response prevention in OCD therapy is delaying or avoiding rituals
• Inflated personal responsibility is a cognitive factor commonly associated with OCD
• Hoarding is a common reward-seeking behavior associated with OCD
• A client reports they count to 20 before entering a room to prevent bad luck which is an example of a compulsion

Body Dysmorphic Disorder

• Body dysmorphic disorder is best described as a preoccupation with an imagined physical defect

OCD Management

• A nurse should avoid telling a client with OCD that "Your rituals are interfering with your life."
• In OCD management, exposure refers to confronting the avoided stimuli
• Obsessions are thoughts, compulsions are actions
• OCD is classified as an anxiety disorder
• Kleptomania is characterized by compulsive stealing
• A nursing outcome for a client with OCD includes a decrease in obsessive thoughts and improved functioning
• Chronic nail-biting is a self-soothing behavior under the OCD spectrum
• In the nursing implementation for OCD, allowing time for ADLs and giving PRN guidance is most appropriate
• Paxil is an SSRI approved only for adults in OCD treatment
• Participation in achievable enjoyable activities should be encouraged in OCD clients during nursing care

Schizophrenia and Related Disorders

• Schizophrenia is primarily characterized by disturbances in thought, perception, and behavior
• Hallucinations are a DSM-5 diagnostic criterion for schizophrenia
• The 4 A's of Schizophrenia include all EXCEPT Anhedonia
• Dopamine is the neurotransmitter increased in schizophrenia
• A client displays delusions and hallucinations but no catatonia or disorganized behavior is likely to have paranoid schizophrenia
• Blunted affect and alogia are negative symptoms of schizophrenia
• A person with persecutory delusions for over a year but is otherwise functioning likely has a delusional disorder
• Olfactory is the hallucination that involves the sense of smell
• A client repeating phrases said to them is called Echolalia
• Derealization is what a client with a lack of ego boundaries may experience
• A client is stiff, with a blank face and slow movement it may be catatonia
• In schizoaffective disorder, symptoms include: mood symptoms and psychosis
• Involuntary muscle contractions are a side effect of antipsychotics

Acute Dystonia

• Diphenhydramine treats acute dystonia
• Pseudoparkinsonism is a side effect that mimics Parkinson's disease
• Akathisia is the side effect that involves restlessness and inability to stay still
• High fever and muscle rigidity are symptoms of Neuroleptic Malignant Syndrome (NMS)
• Tongue protrusion and lip smacking are symptoms of Tardive dyskinesia
• There is no known cure for tardive dyskinesia, but prevention includes avoiding all medications
• Blurred vision is a common anticholinergic side effect of antipsychotics
• The main difference between typical and atypical antipsychotics is that atypical antipsychotics treat both positive and negative symptoms
• A patient shows clang associations in speech, indicating the use of rhyming words without meaning
• A nurse notices a client laughing alone, whispering, and not responding so they should ask what they are hearing
• When managing hallucinations, the nurse should encourage reality-based activities
• A priority nursing intervention for delusions include: present and maintain reality
• Shared psychotic disorder (folie à deux) involves a delusion shared between two closely related individuals
• Disorganized is the schizophrenia subtype involves disorganized behavior and flat affect
• A client with schizophreniform disorder displays symptoms lasting under 6 months
• When a client exhibits word salad, the nurse should reflect feelings
• Distraction and redirection is the intervention that helps clients with socially inappropriate behaviors

Mood Disorders and Suicide

• Loss of interest or pleasure is a core symptom of major depressive disorder
• Norepinephrine and serotonin are the neurotransmitters decreased in depressive disorders
• Anergia is the term for lack of energy commonly experienced in depression
• Recurrent depressive disorder is described as recurrent depression with no history of mania
• Seasonal Affective Disorder (SAD) is commonly treated with phototherapy (light therapy)
• Freud's introjection theory links depression to anger turned inward
• Postpartum psychosis is considered a medical emergency
• Pressured speech and grandiosity characterize mania
• Kindling theory proposes mood disorders are triggered by repeated exposure to stress
• Serum lithium levels should be monitored regularly in clients taking lithium
• A patient on lithium reports nausea, tremors, and confusion these are signs of lithium toxicity
• Group therapy is not recommended during acute manic stages
• A nurse observes that a bipolar patient begins multiple tasks but finishes none and this is an example of flight of ideas
• Suicide is a primary safety risk for clients with depression
• A woman experiences mild mood changes and crying spells in the first few days after giving birth which is likely maternity blues
• Premenstrual dysphoric disorder usually resolves with menstruation
• A client who is making inquiries about poisons and shows sudden calmness may be at risk for suicide
• MAOIs are an antidepressant class that are least prescribed due to tyramine interaction risk
• In bipolar disorder, psychotherapy is most effective during mild depressive or euthymic states
• Rearranging chairs or walking is a suitable activity for a client in a manic phase
• A client exhibiting anhedonia, psychomotor retardation, and hopelessness are signs of major depression
• A nurse should use clear, simple sentences when talking with a manic patient
• Maintain consistent salt and fluid intake is essential for a patient on lithium therapy
• Electroconvulsive Therapy (ECT) is indicated when antidepressants are ineffective or intolerable
• A Zung Self-Rating Depression Scale is used to assess depression severity
• To a depressed client who says, "I'm worthless, and no one cares”, the nurse should say, "You are not worthless. Let's talk about what's going on."
• A bipolar client invades others' personal space and acts provocatively the nurse should gently remind them about personal boundaries
• A nurse recognizes a depressed client is at highest risk for suicide when they appear calm after deep depression
• Anticonvulsants are a useful medication class when lithium is not tolerated for bipolar disorder
• Keep them under direct observation is the best intervention for a suicidal client in an inpatient setting