CLINICAL PSYCHOLOGY IN OLDER PEOPLE: MENTAL HEALTH SERVICES
TRAUMA AND PTSD IN LATER LIFE
AGE TASK BASIC VIRTUE
0-1 Trust v mistrust Hope
1-3 Autonomy v shame/ doubt Willpower
3-5 initiative v guilt Purpose
6-puberty Industry v inferiority Competence
Adolescence Identity v role confusion Fidelity
Early adulthood Intimacy v Isolation Love
Middle adulthood Generativity v stagnation Care
Old age Integrity v dispar Wisdom
Elderly Geronotranscendence
Erik Erikson’s Psychosocial Stages
TRAUMA-INFORMED OR TRAUMA-DENIED
Principles and implementation of trauma-informed services for women
Journal of community psychology 2015
• Underpin psychological working with people in
distress- different language is used
Recent developments: The Power Threat • Working with the person opposed to a psychiatric
Meaning Framework framework
• Understanding whether patient had either
depression or anxiety: Boundaries are fluent
Underpin psychological working with people in
distress- different language is used
• Working with the person opposed to a psychiatric
framework
Trauma
• 15 x more likely to commit suicide
• 4 x to have STDs
• 4 x to develop alcoholism
• 4 x to inject drugs
• 3 x to use antidepressant medication
• 3 x absent from work
• 3 x to have serious job problems
• 3 x to experience depression
• 2.5 x smoke tobacco
PTSD Criterion A
, DSM-5 used in America
• Psychological injury not a mental illness
Posttraumatic stress disorder (PTSD) is an anxiety disorder that can develop after a trau -
matic experience such as domestic violence, natural disasters or combat-related trauma.
The cost of such disorders on society and the individual can be tremendous. In this article,
we review how the neural circuitry implicated in PTSD in humans is related to the neural
circuitry of fear. We then discuss how fear conditioning is a suitable model for studying the
molecular mechanisms of the fear components that underlie PTSD, and the biology of fear
conditioning with a particular focus on the brain-derived neurotrophic factor (BDNF)–tyro-
sine kinase B (TrkB), GABAergic and glutamatergic ligand-receptor systems. We then
summarize how such approaches might help to inform our understanding of PTSD and
other stress-related disorders and provide insight to new pharmacological avenues of
treatment of PTSD.
Exposed to: • death
• threatened death
• actual or threatened sexual violence
One required: 1) Direct exposure
2) Witnessing in person
3) Indirect (learning that close relative was exposed to trauma eg. violent or
accidental)
4) Repeated or extreme indirect exposure to aversive details of the event(s) (eg.
course of professional duties: collecting body parts, being exposed to cold
abuse victims not media exposure to violent content)
The DSM-IV-TR also requires that the person’s subjective response to the event involve
intense fear, helplessness, or horror.
• military combat, violent personal assault, being taken hostage, a terrorist attack, tor-
ture,
natural or manmade disasters, and being diagnosed with a life-threatening illness.
Criterion A Exposure to trauma
Criterion B Re-experiencing event
Criterion C Avoidance and numbing
Criterion D Increased arousal
Criterion E Duration of at least one month
Criterion F Significant distress or impairment of social functioning
Impairment of occupational functioning
Intrusion symptoms - recurrent memories
- Recurrent dreams
- Feeling of recurrence
- distress at re-exposure
- Physiological reactivity
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