Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PSD) is defined as an experiencing of a traumatic event in either daytime reveries or dreams. Natural and / or mad-mad disaster are usually the stress experiences.

Symptoms:
The symptoms of Posttraumatic Stress Disorder are likely same as anxiety, depression and organic mental disorder. Assess the following symptoms when caring of posttraumatic stress disorder patients:

• Substance abuse
• Headache
• Memory (attention deficit)
• Pain

Beside of symptoms I mentioned above, psychosocial and cultural of the client should be assess too.

• Feeling of detachment and guilt
• Inability to feel emotions
• Impulsive behavior
• Anxiety of depression
• Nightmares
• Emotional lability
• Acting out, reliving traumatic experience

Planning:

• Safe and effective care environment
• Physiological integrity (to reduce or eliminate physiological symptoms of stress)
• Psychosocial integrity

Implementation:
There are four stages of implementation regarding Posttraumatic Stress Disorder patients:

1. Recovery: to assist patient to realize that he/she is safe
2. Avoidance: to provide support while patient attempts to suppress thought of traumatic experiences
3. Adjustment: to assist patient to alter environment if needed.

Obsessive Compulsive Disorder

Obsessive compulsive disorder is a type of anxiety disorder whose essential feature is recurrent obsession, persistent, intrusive ideas, thoughts, impulses or images, or compulsion. Compulsion means repetitive, purposeful and intentional behaviors performed in response to an obsession. The person may have both obsession and compulsions that can disrupt normal activities. An example of this disorder is excessive and repeated hand washing to ward off infection.

A person act compulsive behavior patterns can decrease the anxiety that associated with the obsessive thoughts and during stressful time, the ritualistic behavior will be increased. Most of the patient with obsessive compulsive disorder has variety of defense mechanism include repression, displacement, and undoing.


Cause of obsessive compulsive disorder was rare. Some reports have linked obsessive compulsive disorder to head injury and infections and about 20% of those with this disorder have motor tics related to tourette syndrome.

Intervention:

• Try to identify the situation that precipitates the behavior.
• Do not interrupt the compulsive behavior.
• Allow time for the patient to perform the compulsive rituals.
• Keep the client safety
• Make a schedule for patient that can distracts from the ritual.
• Set limit on the ritual.
• Encourage the patient to verbalize concerns.
• Establish the written contract that can assist to decrease the frequency of compulsive behavior.

Anxiety Disorder Classification (part-2)

Post-Traumatic Stress Disorder (PTSD)
This stress disorder occurs after experiencing a psychologically traumatic event outside the range of usual experience such as rape, combat, bombings, kidnapping. The person with posttraumatic stress disorder re-experiences the event through recurrent dreams and flashbacks.

Person with post-traumatic stress disorder may commonly uses emotional numbness, detachment, and estrangement to defend against anxiety. Sleep disturbance, hypervigilance, guilt about surviving, poor concentration, and avoidance of activities that trigger memory of the event are the most symptom with post-traumatic stress disorder.

Phobias
Phobia is irrational fear of an object or situation that persists, although the person may recognize it as unreasonable. Sever anxiety will be occurred if the object, situation, or activity cannot be avoided



Types of Phobias include:

• Agoraphobia: Fear of being alone in open or public places where escape might be difficult; may not leave home
• Social phobia: Fear of situations in which one might be seen and embarrassed or criticized; fear of eating in public, public speaking, or performing
• Specific phobia: Fear of a single object, activity, or situation (eg, snakes, closed spaces, and flying)

Substance-induced anxiety disorder

A substance-induced anxiety disorder is sub-typed or categorized based on whether the prominent feature is generalized anxiety, panic attacks, obsessive-compulsive symptoms, or phobia symptoms. Drug use is related to this disorder.

Symptoms substance-induced anxiety disorder will develop within 1 month of substance intoxication or withdrawal and significant distress of impairment in social and occupational functional will be occurred.

Anxiety Disorder Classification (part-1)

Acute Stress Disorder

Client with acute stress disorder will develop three or more of these dissociative symptoms:

• Subjective sense of numbing
• No emotional responsiveness
• Feeling dazed
• Depersonalization
• Derealization
• Amnesia

Duration of acute stress disorder would be 2 days to 4 weeks.


Generalized Anxiety Disorder

Client with generalized anxiety disorder will develop three off the four categories:

• Autonomic hyperactivity: palpitations, sweating, cold clammy, urinary frequency, pallor or flushing, lump in throat, rapid respiration, and tachycardia.
• Motor tension: restlessness, trembling, inability to relax, fatigue.
• Apprehensiveness: dread, worry, fear, insomnia, rumination, and inconcentrate.
• Hypervigilance: felling edgy and distractibility.

These symptoms persist for at least 6 months.


Obsessive-Compulsive Disorder

Obsession is preoccupation with persistent intrusive thoughts. Compulsion is repeated perfomance of rituals designed to prevent some anxiety. Client with Obsessive-Compulsive Disorder with have obsession symptoms, compulsion symptoms, or both.

The client will be in anxiety condition if obsessions or compulsions are resisted and from feeling powerless to resist the thoughts or rituals.


Panic Disorder

Panic disorder means the recurrent unexpected anxiety attacks. It happens suddenly with intense apprehension and dread.
Client with panic disorder will develop at least four of the following symptoms:

• Dyspnea
• Dizziness
• Chest discomfort
• Hot or cold flashes
• Tingling of hands or feet
• Feeling of unreality
• Palpitation
• Syncope
• Diaphoresis
• Trembling
• Fear of losing control, going crazy or dying

Anxiety Related Disorder

Anxiety-related disorders are the most common of all psychiatric disorders. Client with these disorder will experience physiologic, cognitive, and behavioral symptoms.

Physiologic manifestations are related to the fight and flight response that result in cardiovascular, respiratory, neuromuscular, and gastrointestinal stimulation. The cognitive symptoms are apprehension, uneasiness, an uncertainty. Behavioral symptoms are irritability, restlesnes, pacing, crying, and sighing, tension and nervousness.

Classification

As defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR), anxiety-related disorders are include those listed here.


Anxiety Disorders:

• Panic disorder without agoraphobia
• Panic disorder with agoraphobia
• Agoraphobia without history of panic disorder
• Specific phobia
• Social phobia
• Obsessive-compulsive disorder (OCD)
• Posttraumatic stress disorder (PTSD)
• Acute stress disorder
• Generalized anxiety disorder
• Anxiety disorder due to a general medical condition
• Substance-induced anxiety disorder
• Anxiety disorder not otherwise specified

Dissociative Disorders

• Dissociative amnesia
• Dissociative fugue
• Dissociative identity disorder
• Depersonalization disorder
• Dissociative disorder not otherwise specified