To return to the same level of psychological comfort as he/she had before the crisis

(focuses only on the immediate problem)

from a sudden traumatic event, and not universal or experienced by everyone

(eg. loss of job, failure at school, accidents, illness, death)

social/cultural—

eg. natural disasters, wars, massive violence, presidential assassination

• protect from harm
• remain with person if in panic
• reality intervention, focus on here & now
• encourage verbalization
• discourage long explanations

Slow down—3 deep breaths

Think—about what is happening

Options—look for ideas/alternatives

Plan—time for self, regular activities, rest, future.

the process of mourning and coping with the loss of a loved one—can last months or years

shock (denial)

mourning

resolution

educate normal phenomena

support groups

family and friends' support

spiritual support

therapy referrals

life expectancy of < 6 months

(no age, disease, or financial limits)

Medicare pays for it

Forgiveness

love

gratitude

farewell

4-6 weeks,

longer is chaos

Predisposing- vulnerabilities 

Precipitating-external events trigger insomnia, 

Perpetuating-maintain sleep problem

-Benzodiazepines:(Restoril, Ativan, Xanax)

-Barbituates: (rarely used)

-anti-depressants-(used off label for sleep)

Melatonins

Antihistamines

Down Syndrome—

Microcephaly, Mongolian slant, epicanthal fold, simian crease (single palmar crease), short and broad fingers, syndactyly (fusion of two or more toes or fingers), decreased muscle tone at birth, sutures separated, small mouth with protruding tongue, broad flat face, slanted eyes, short nose, palm crease, delayed mental and social skills, iris lesion (abnormalities in eyes – Brushfield spots), cardiac problems common

•Heart defects – may require surgery

•Treat visual problems, hearing loss

•Prevention – increased infections

•Monitor – ↑ incidence of acute leukemia

•Monitor – ↑ Alzheimer’s at early age

•Often results in death at young age (40’s)

before 30 months:

self-absorption, inability to relate, highly repetitive/stereotyped play and rage reactions if interrupted, rhythmical movements, and many language/communication disturbances

•Establish trust

•Maintain Safety

•Limited number of caregivers; familiar person if possible

•Maintain consistency

•Long-term care at various levels of intensity

•Design academic, interpersonal, and social experiences that support the child’s development

Seizures with autism &

depression with Asperger’s

impulsive

accidents

risk-taking behavior

ODD,

then conduct disorder,

and finally antisocial 

•Early exposure to pesticides, lead, food dyes, sugar

•Maternal factors during pregnancy •lack of bonding, poverty, overcrowded living conditions, and marital, family dysfunction

•concussions, ↓dopamine & ↓NE

acting out behaviors or “externalizing”

vs.mood disorders which are “internalizing” individuals keep symptoms to themselves.

pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, with particular key behaviors

(1) often loses temper 

(2) often argues with adults 

(3) often actively defies or refuses to comply with adults' requests or rules 

(4) often deliberately annoys people 

(5) often blames others for his or her mistakes or misbehavior 

(6) is often touchy or easily annoyed by others 

(7) is often angry and resentful 

(8) is often spiteful or vindictive  

anxiety disorders,

usually expressed as:

Separation anxiety disorder

Obsessive Compulsive Disorder (OCD)

inattention

hyperactivity

impulsiveness

Conduct disorder is more serious in the violations of social norms: agression, destruction of property, and cruelty to animals.

ODD is a persistent pattern of disobedience, argumentativeness, angry outbursts, low frustration tolerance, and blaming others.

easy

difficult

slow to warm up

Men have more manic episodes,

females have more depressive episodes

•Mania = abnormally and persistently elevated, expansive, or irritable mood;

•Manic episode = distinct period for one week or more of mania

•Hypomania = less intense mania, less impairment

•expansive = lack of restraint in expressing feelings, indiscriminate enthusiasm for interactions (sex)

•elevated = euphoria (exaggerated well-being) or elation (feel high, on top of the world)

•ADD: usually starts younger

•personality disorder: determined with psychological testing

•Psychosis: look for underlying history such as substance use, depression

•Bipolar: depression at a younger age

for compulsive behavior:

does not allow behavior, anxiety subsides

•ECT: helpful for OCD with depression if not responsive to other treatments

•psychosurgery, radio therapy, deep brain stimulation

a. Dissociative amnesia- (the most common) inability to recall important yet stressful information

b. Dissociative fugue-unexpected travel away from home and they start a new life

c. Depersonalization disorder-detached or disconnected from oneself

d. Dissociative identity disorder (DID)-formally multiple personality, usually a long history of abuse

e. Dissociative disorder NOS

•A) odd and eccentric behaviors, isolated, detached, some sensorial distortions PARANOID, SCHIZOID,SCHIZOTPAL

•B) dramatic and emotional, impulse ANTISOCIAL, BORDERLINE, NARCISSITIC, HISTRIONIC

•C) anxious, fearful, rigid, shy DEPENDENT, OBSESSIVE-COMPULSIVE, AVOIDANT

schizoid characteristics,

& think:

reclusive, uncooperative, avoidant, “loner’ with no close 

Think: unibomber

-attention

-physical release of emotions, tension, anxiety, grief

-staff manipulation

Seem normal, will not see anxiety, depression. See manipulative behaviors, guilt installation in others is very high. Very charming.  Very destructive to society, unique people.

Think: serial killers and substance abuse

Exploitative, grandiose, disparaging, rage, sensitivity to criticism or perceived rejection. Low empathy, handles aging poorly.

Think: Celebrities and CEOs.