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Stress : unjustified reaction for various event .
Component of stress response :- مهم
1- emotional response
To threat ------- fear
To loss ---------- depression .
2- somatic response :-
To threat ------ autonomic arousal : 1- palpitation.
2- respiration.
3- sweating .
To loss ------- reduce physical activity .
3- coping strategies :- استراتيجية المواجهة
Potentially adapted :
المواجهة المكيفة
avoidance .
Working through problem .
coming to term with situation .
Mal adaptive: المواجهة غير المكيفة
excessive use of alcohol .
Histrionic behavior .
Aggression .
DSH .
4- Defense mechanism :
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common :
regression .
repression .
denial .
projection .
displacement .
long term:
react form
rationalize
___________
ت
س
امح
It can be classify under 3 heading :
1 –acute stress reaction :
which are immediate and brief response (lasting for few hours to few days ).
Clinical picture :
Emotional response (anxiety , fear , depression)
Example Of such event is ( road accident , sudden trauma ) .
Coping strategy (avoidance behavior , denial to remember , mal adaptive behavior )
Etiology :
1. Special kind of stress (accident , fire , breakage of intimate relation ship ).
2. no longer reaction more than few days , when last more it will be called PTSD .
3. usually exacerbation of pre-existing personality .
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Treatment :-
1-Reduce emotional symptom by supportive thought .
2-encourging re-call .
3-effective coping .
2 – post traumatic stressful disease ( PTSD ) :-
It is intense , prolong and often delayed reaction to stressful event .
Usually the event is intense so that the person can not complete the normal sequence of
psychological change that follow the exposure.
Examples Of such event :
1-natural disaster.
2-flood.
3-earth quick .
4-rape.
5-car accident.
6-serious transport.
7-war effect.
Most vulnerable group are children and old age group.
Clinical picture :
PTSD has 3 group of features
1- persistant anxiety ( irritability , insomnia , poor concentration ) .
2- avoidance of reminder of event ( difficulty in recall event , flash back , distress dream).
3-detachment
-inability to feel ( emotion numbness ) .
-diminish interest in activity .
- PTSD has 3 symptoms :
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A –
the first is the combination of the symptom of anxiety , irritability , insomnia and poor
concentration .
some times attack of panic or episode aggression .
B –
2
nd
group
Avoidance defense mechanism (difficulty in remind )
flash back and distressing dreams.
C –
3
rd
group is inability to feel emotion (numbness).
less activity .
anxiety increase in reminding the pat. due to mal adaptive coping.
PTSD may be direct continuation of acute response stress .
or follow days or occasionally months ( rarely more than 6 months ).
Assessment :-
1-nature and duration of symptoms.
2-the previous personality.
3-past psychological history.
4-neurological examination of traumatic event .
Treatment :-
1-If the condition is recent >>> the patient need no more treatment like mention for acute
stress reaction .
2 - Opportunity to recall stressful event .
3-Few dose of anxiolytic drugs for few nights to restore sleep.
4-Working through (talking about the event).
5 - Counseling and nursing .-
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6-When disorder long standing , it is more difficult to treat and often require special help .
7 - Crisis intervention :- toward psychological support then to encourage .
3 –adjustment disorder :-
Psychological reaction involved in adapting to new circumstance .
Example :-
1-life change commonly provoke adjustment disorder.
2-divorce and separation.
3-major change in work (transition).
4-from school to university.
Psychological symptom similar to that of acute response , but time course is different
disorder is more gradual.
last longer.
anxiety.
poor concentration.
Autonomic hyper arousal .
Poor coping and denial .
- dx. Of adj. disorder is made only when anxiety and depression are so sever to met dx.
Treatment :-
1-coping. 2-problem solving .
3-anxiolytics. 4-crisis intervention.