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A model of complex post-traumatic stress disorder with potential general practice interventions 18,19

A model of complex post-traumatic stress disorder with potential general practice interventions 18,19

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Background: Childhood trauma is common and can have profound consequences throughout a person's life. Adult survivors of childhood abuse pose a number of challenges for general practitioners (GPs). The diagnosis of their medical and psychiatric illnesses is complex; the therapeutic relationship can be both delicate and critical to recovery; and th...

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Context 1
... following are typical symptoms for adult survivors of childhood trauma (Table 1). Figure 1 summarises the features of complex post-traumatic stress disorder (PTSD), one diagnostic formulation for the consequences of childhood abuse. 18,19 ...
Context 2
... can seem overwhelming to manage patients with PTSD when multiple issues are present and when management options are uncertain. Focusing therapy on the predominant issues presenting at the time engages the person in their own care plan (Figure 1). Needs can constantly change. ...
Context 3
... needs are more critical than self-actualisation, so addressing core beliefs and values may need to be delayed until the patient has safe shelter and food security. Targeted management options are discussed in Figures 1 and 2. Recovery includes addressing social and environmental circumstances, as well as fostering connectedness, self-compassion and a sense of purpose or meaning. ...

Citations

... e therapeutic alliance between client and therapist can be delicate and is a particularly important dynamic during treatment of complex trauma. 25,26 Safety and trust in the therapeutic relationship provide the foundation for deeper trauma memory reprocessing and intra-psychic change. Stable funding and staffing help to establish and maintain effective therapeutic relationships and are essential to maximizing the benefits of complex trauma treatment. ...
Article
Introduction: Sustained, developmentally adverse experiences in childhood put survivors at risk for posttraumatic stress disorder and impairments in biological, affective, cognitive, and intra/interpersonal domains. Complex trauma symptoms are often treated in isolation without addressing their common root cause. The trauma-focused phased Complex Trauma Care Pathway (CTCP) was developed to address this care gap. Methods: We piloted the CTCP in 2 medical centers for 12 months among 46 therapist-referred adults. Outcome measures collected every 3 months included standardized scales assessing anxiety, depression, suicidal thoughts, and disorders of extreme stress not otherwise specified (DESNOS). Results: Statistically significant improvements occurred in mean scores for anxiety (p = 0.003), total DESNOS scores (p < 0.001), and 5 DESNOS domains: alterations in regulation of affect and impulses, alterations in regulation of attention or consciousness, alterations in self-perception, alterations in relationships with others (p < 0.001 for all), and alterations in systems of meaning (p = 0.006). In contrast, decreases in symptoms of somatization, depression, substance use, and suicidal thoughts were not statistically significant. Participant feedback was very positive. Discussion: Many trials evaluate phased interventions for posttraumatic stress disorder, but much less evidence exists about effective interventions for complex trauma. Our study fills a knowledge gap. Conclusion: The CTCP shows promising clinical efficacy and should be evaluated using a more rigorous design. Further research should also explore the relationship between the CTCP or similar interventions and chronic disease management, overall healthcare utilization, and suicide risk.
... 3. Developmental history: 53 This involves exploring childhood experiences, environment and relationships, and includes trauma histories, interpersonal relationship challenges and physical health issues, such as chronic illness. Remember that the impact of adverse childhood experiences is cumulative, so although GPs do not need to know exactly what occurred in childhood, patients who recount multiple instances of trauma are more at risk than those who have experienced a single incident. ...
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Psychiatric classification systems provide useful constructs for clinical practice and research. Evidence-based treatments are based on the classification of mental illnesses. However, while classification is necessary, it is not sufficient to provide a full understanding of ‘what is going on’. A good psychiatric diagnosis will also include a formulation, which provides an understanding of the psychosocial factors that provide a context for illness. Experiences such as trauma and marginalisation will change the illness experience but also provide other forms of evidence that shape therapy. Diagnoses also carry ethical implications, including stigma and changes in self‑concept. The science, art and ethics of diagnosis need to be integrated to provide a complete assessment. In this article, the authors will examine the principles used to craft a good diagnosis, using science, art and ethics to create an accurate, comprehensive and helpful framework for patient care.
Article
Purpose: The purpose of this study is to explore psychiatric nurses' experiences of developing therapeutic relationships with adult survivors of child sexual abuse (CSA). Design and methods: A qualitative descriptive design was adopted. Semistructured interviews were conducted with six registered psychiatric nurses. Data were analyzed using reflexive thematic analysis. Findings: Although participants were able to develop therapeutic relationships with survivors and cited the importance of interpersonal skills, they felt uncomfortable discussing CSA. Practice implications: Given the importance of developing trusting relationships, more support needs to be provided for nurses so they can build stronger alliances with survivors of CSA.
Article
Objective The study investigated factors associated with frequent (admissions), high (total length of stay) or heavy (frequent and high) hospital use, and with ongoing increased hospital use, for mental health conditions in a regional health district. Methods A retrospective population-based study using longitudinal hospital, emergency department and community service use data for people admitted with a mental health condition between 1 January 2012 and 31 December 2016. Multivariate logistic regression models assessed the association of predisposing, enabling and need factors with increased, and ongoing increased, hospital use. Results A total of 5,631 people had at least one mental health admission. Frequent admission was associated with not being married (odds ratio = 2.3, 95% confidence interval = [1.5, 3.3]), no private hospital insurance (odds ratio = 2.2, 95% confidence interval = [1.2, 3.8]), previous mental health service use (community, emergency department, lengthy admissions) and a history of a substance use disorder, childhood trauma, self-harm or chronic obstructive pulmonary disease. High and heavy hospital use was associated with marital status, hospital insurance, admission for schizophrenia, previous mental health service use and a history of self-harm. Ongoing frequent use was less likely among those aged 65 and older (odds ratio = 0.2, 95% confidence interval = [0.1, 1.0]) but more likely among those with a history of depression (odds ratio = 2.2, 95% confidence interval = [1.1, 4.4]). Ongoing high use was also associated with admissions for schizophrenia and a history of self-harm. Conclusion Interventions targeted at younger people hospitalised with schizophrenia, a history of depression or self-harm, particularly with evidence of social and or health disadvantage, should be considered to improve long-term consumer and health system outcomes. These data can support policymakers to better understand the context and need for improvements in stepped or staged care for people frequently using inpatient mental health care.