Acute Stess Disorders and Post-traumatic Stress Disorders

Presented by:
Eric F. Pazziuagan, RN, MAN

Disorders

that can develop after
exposure to a clearly
identifiable traumatic event
that threatens the
self, others, resources, and/or
sense of control or hope.
The event overwhelms the
individual’s coping strategies.

 Community

violence, war, terrorist
attack, being a hostage or
POW, torture, disasters, bombings, f
atalities in fires or
accidents, catastrophic illness, gross
injury to self or others, childhood
sexual abuse, chronic abuse as a
child or adult, rape, assault, and
sudden or major personal losses.

7.8

to 8% of American adults
Women are twice likely to have
PTSD

 Individual’s

pre-existing
characteristics and conditions
 Usual coping style and defense
mechanisms
 Personal and social resources
 Previous exposure to trauma
 Meaning of the event to the
individual

Acute Stess Disorders and Post-traumatic Stress Disorders

 ASD:

dissociative symptoms during or
immediately after the distressing event:
amnesia, depersonalization, derealization
, decreased awareness of
surroundings, numbing, detachment, or
lack of emotional response,
 PTSD: not made because of initial
reactions at the time of the trauma but is
based on characteristic symptoms that
occur 1 month after the trauma.

 PTSD

may be unrecognized for years (even 10-20
years).
 Persistent attempt to avoid situations,
activities, and sometimes even people who
might evoke memories of the trauma.
 Denial, repression, and suppression are common
in both disorders.
 Constricted or blunted affect, or a limitation in
the range of feelings might occur.
 Might feel detached or estranged from family
and friends.
 Inability to trust might lead to withdrawal.
 Interest to activities is often lost.
 Perceptions of the future might change.

 Might

be in the form of intrusive, unwanted
memories, upsetting dreams or nightmares,
illusions, or suddenly the feeling as if the
event were recurring (flashbacks).
 PTSD: hallucination related to the event.
 Might have obvious connections to the
trauma or might not resemble the original
situation at all.
 Latter case, patients might try to avoid all
activities and people in an effort to prevent
reexperiencing the flashback.

 Increased

arousal, anxiety, restlessness, irritab
ility, disturbances in sleep, and
impairment in memory or
concentration.
 PTSD: occasional outbursts of anger
or rage and survivor guilt- guilt
about surviving or the actions to
survive.

 Psychological

and physiologic symptoms
that develop during exposure to situations
resembling the original trauma
(e.g., anxiety, panic attacks, GI
disorders, headache)
 Problems with grief, depression, suicidal
ideations and attempts, impulsive selfdestructive behaviors, anxiety-related
disorders, and substance abuse.
 Might appear
avoidant, schizoid, schizophrenic, paranoi
d or even manic (which complicate
treatment).

 Preexisting

psychiatric disorders, including
personality disorders can increase the risk.
 History of previous traumas leads to an
increased risk for PTSD after later traumas.
 Events in later life might trigger previously
unrecognized PTSD.
 Some difficulties:
arrests, unemployment, homelessness, abusi
veness, divorce and paranoia toward
authority figures or others whom the patient
sees as directly or indirectly responsible for
not helping with the original traumatic
situation.

 Common:

mistrust, isolation, abandonment
fears, workaholism, focusing on the need of
others, feelings of inadequacy, anger toward
God, unresolved grief, and fear of losing
control of emotions.
 Family members, friends, and co-workers
might develop problems as well, as
“secondary victims.”

Effective approach: prevent or minimize
symptoms.
 Application of critical incidence stress
management (CISM) principles to disaster
situations:










Precrisis preparation
Large-scale demobilization procedures
Individual acute crisis counseling
Brief small group discussions (defusings)
Longer small group discussions (critical incident stress
debriefings or CISDs)
Family crisis intervention techniques
Follow-up procedures and/or referral for
psychological assessment or treatment

Goals of treatment:
 Progressive, intensive review of the traumatic
experiences (exposure therapy)
 Integration of the feelings and memories, often
from the least to the most painful.
 Moving from a victim status to a survivor
status, from “I can’t go on because of this” to “I
have learned from it and can go on with life.”
 Potential for growth and development of
improved coping skills, appreciation of value of
life, and enhanced relationships.


 First

priority: development of trust; might be
difficult.
 Other priorities: safety and security (risk of
suicide and aggression).
 Patients need to hear that they are not crazy
but are having typical reactions to a serious
trauma (teach about dynamics of ASD and
PTSD).
 Be prepared to hear horror stories about
hideous injuries, unpredicted behaviors, and
gross destruction.

 Gently

clarify connections between original
trauma and current feelings and problems.
 Patients need to evaluate their past behaviors
according to the original context of the
situation, not by current values and
standards.
 Specific techniques: exposure therapy
(imaginal or in vivo), systematic
desensitization, CBT, eye movement
desensitization and reprocessing.
 Safe verbalization of feelings, particularly
anger, that have been ignored or repressed.


Writing a journal, expressive therapt (art,music
or poetry).

 Empathy

and reassurance that they will be
safe and need to be taught relaxation
techniques, so they are not overwhelmed of
the anxiety.
 Take time to focus on emergent problems
and potential solutions.
 Encourage adaptive coping skills and use of
relaxation strategies.
 Discourage dysfunctional activities.
 Develop interpersonal skills and reestablish
relationships that provide and support and
assistance.
 Couple or family education and counselling.

 Benzodiazepines

(e.g., clonazepam) to
reduce levels of conditioned fear and anxiety
symptoms; might help with sleep
disturbances and nightmares; risk of
dependence.
 Clonidine and propranolol: diminish
peripheral autonomic response associated
with fear, anxiety, and nightmares.
 Valproic acid or carbamazepine: mood
swings, explosive outbursts and intense
feelings of being out of control; dcreases
hyperarousal, startle response, and
nightmares.

 SSRI

(paroxetine, escitalopram, and
sentraline): reverse continued
emergency responses and decreased
repetitive behaviors, disturbing
images, and somatic states.
 TCAs: depression, anhedonia, sleep
disturbances.
 Antipsychotics: if with psychotic
thinking; hyperarousal and sleep
disturbances; respiradone or
quetiapine to c=decrease flashbacks
and nightmares.

 Social

activities can help rebuild social
skills that have been damaged by
suspiciousness and withdrawal.
 Recreational and exercise programs can
help reduce tension and promote
relaxation.
 Groups: self-esteem, decision
making, assertiveness, anger
management, stress
management, relaxation techniques.
 Group meetings for victims.

 Be

nonjudgmental and honest; offer
empathy and support; acknowledge any
unfairness or injustices related to the
trauma.
 Assure patients that their feelings and
behaviors are typical reactions to serious
trauma.
 Help patients recognize the connections
between the trauma experience and their
current feelings, behaviors, and problems.
 Help patients evaluate past behaviors in the
context of the trauma, not in the context of
current values and standards.

 Encourage

safe verbalization of feelings,
especially anger.
 Encourage adaptive coping strategies,
exercise, relaxation techniques, and sleeppromoting strategies.
 Facilitate progressive review (imaginal or in
vivo) of the trauma and consequences.
 Encourage patients to establish or reestablish
relationships.

Acute Stess Disorders and Post-traumatic Stress Disorders

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Acute Stess Disorders and Post-traumatic Stress Disorders