NURS 663 COMPREHENSIVE UPDATED EXAM
QUESTIONS AND ANSWERS GRADED A+
✔✔SPARCS - ✔✔Structured Psychotherapy for Adolescents Responding to Chronic
Stress
✔✔SPARCS description - ✔✔-Consists of a group intervention,
-16 sessions
-focus on the needs of adolescents (12-19 years old) chronic trauma and PTSD.
-Utilizes cognitive behavioral techniques, and -incorporates many of the components of
TF-CBT
-Includes mindfulness techniques and relaxation.
✔✔TARGET - ✔✔Trauma Affect Regulation:Guide for Education and Therapy
✔✔TARGET description - ✔✔-affect regulation therapy,
-combines CBT components, such as cognitive procession, with affect modulation.
-adolescents (13-19) exposed to maltreatment and/or chronic traumatic exposure to
such things as community violence or domestic violence.
-12 sessions, which focuses on past or current situations.
✔✔TARGET efficacy - ✔✔--Like SPARCS treatment, gradual exposure may occur in
the context of recounting past trauma but is not a core component of treatment.
--Reduces anxiety, depression, and PTSD
--Promising treatment for girls with h/o delinquency, especially to reduce anger and to
enhance optimism and self efficacy.
✔✔Crisis intervention/Psychological Debriefing - ✔✔1. several sessions immediately
after an exposure to a traumatic event; encouraged to describe the traumatic event in
the context of a supportive environment.
2. Psychoeducation is provided and guidance about the management of initial emotional
reactions may be provided.
3. No controlled studies have yet provided evidence that this intervention leads to a
more positive outcome
✔✔PTSD criteria add'l info - ✔✔1. Over 6 years old
2. Sx over 1 month duration, or dx criteria may not have occurred until at least 6 months
after the trauma
3. Constricted emotions can show up suddenly after major life event, stressor, or
accumulated stressors that challenge defenses.
4. Can hide in somatic complaints or co-occur with depression, substance abuse,
anxiety or after head injury
✔✔PTSD differential diagnosis: Medical - ✔✔hyperthyroidism, caffeinism, migraine,
asthma, seizure disorder, and catecholamine or serotonin-secreting tumors. Some
,prescription medications and even some OTC medications may have similar effects,
such as antiasthmatics, sympathomimetics, steroids, SSRIs, and antipsychotics, diet
pills, antihistamines, and cold medicines
✔✔PTSD differential diagnosis - ✔✔anxiety disorders, such as separation anxiety
disorder, obsessive-compulsive disorder (OCD) or social phobia, depressive disorders,
bereavement trauma, disruptive behavior d/o
✔✔PTSD-associated psychosis - ✔✔does not respond well to neuroleptic
(antipsychotic) medication; may respond better to psychosocial interventions. The
hallucinations and delusions connect to the traumatic situation and perpetrators. Older
kids show symptoms like adults.
✔✔PTSD criteria - ✔✔Trauma: occured, witnessed, learned about
Harm or threat of harm to self, loved one
1. Re-experiencing traumatic event
2. Sustained high level of anxiety, hyperarousal / hypervigilance / exaggerated startle
3. Avoid activities, people, places, situations, objects that arouse memories
4. A numbing of responsiveness, concentration
5. Re-exp. flashbacks, nightmares, intrusive memories
6. Inability to remember aspects of the trauma
7. Chronic negative emotional state, decreased interest / participation in significant
activities
8. Depression, survivor's guilt, relationship problems, panic attacks
9. Substance abuse
10. Anger, aggressive, reckless, thrill-seeking, or self-destructive behavior
✔✔PTSD stats - ✔✔20 to 76% _________ children in inpt psych units endorse
hallucinations.
Psychosis is present in up to 75 to 95% of those diagnosed with dissociative disorders.
✔✔Traumatized C/A - ✔✔1. Hear perpetrators frightening them, making derogatory
remarks, or announcing / threatening new victimization.
2. See the perpetrator, smell them, fear victimizer will follow them, or feel they will come
hurt them again.
3. Hear command hallucinations (by the perpetrator) telling them to harm themselves or
others.
4. Hallucinations (PTSD type) are frequently nocturnal. Occur in 9% of abused children.
5. Nightmares are frightening, recurrent
✔✔PTSD under 6 yo - ✔✔alterations in arousal and reactivity associated with the
traumatic event(s) including:
irritable behavior and anger outbursts, hypervigilance, exaggerated startle response,
problems with concentration, and sleep disturbance.
, ✔✔PTSD under 6 yo add'l - ✔✔1. May have enuresis after they were toilet trained
2. Developmental regression-Stop speaking or forget how to talk -
3. Become very clingy
4. Act out trauma through play or re-enactment
5. Egocentric theory of causality: blame self
✔✔ODD - ✔✔oppositional defiant disorder
✔✔ODD criteria - ✔✔A pattern of angry/irritable mood, argumentative/defiant behavior,
or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from
the categories, and exhibited during interaction with at least one non-sibling
✔✔ODD categories - ✔✔Angry/Irritable Mood
1. Often loses temper.
2. Is often touchy or easily annoyed.
3. Is often angry and resentful. Argumentative/Defiant Behavior
4. Often argues with authority figures or, for children and adolescents, with adults.
5. Often actively defies or refuses to comply with requests from authority figures or with
rules.
6. Often deliberately annoys others.
7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months.
✔✔ODD add'l criteria - ✔✔children younger than 5 years, the behavior should occur on
most days for a period of at least 6 months
5 years or older, the behavior should occur at least once per week for at least 6 months
✔✔ODD severity - ✔✔Specify number of settings for severity:
Mild: one setting (e.g., at home, at school, at work, with peers).
Moderate: at least two settings.
Severe: three or more settings
✔✔Conduct Disorder (CD) - ✔✔A. Repetitive/persistent pattern of behavior in which
basic rights of others or major societal norms/rules are violated
B. at least 3 of following 15 criteria in past 12 mo, with at least 1 criterion present in the
last 6 mo
✔✔CD aggression - ✔✔1. Bullies, threatens, or intimidates others
2. Initiates physical fights
3. Used a weapon that can cause serious physical harm to others (bat, brick, knife, gun
etc.)
4. Physically cruel to people
5. physically cruel to animals
QUESTIONS AND ANSWERS GRADED A+
✔✔SPARCS - ✔✔Structured Psychotherapy for Adolescents Responding to Chronic
Stress
✔✔SPARCS description - ✔✔-Consists of a group intervention,
-16 sessions
-focus on the needs of adolescents (12-19 years old) chronic trauma and PTSD.
-Utilizes cognitive behavioral techniques, and -incorporates many of the components of
TF-CBT
-Includes mindfulness techniques and relaxation.
✔✔TARGET - ✔✔Trauma Affect Regulation:Guide for Education and Therapy
✔✔TARGET description - ✔✔-affect regulation therapy,
-combines CBT components, such as cognitive procession, with affect modulation.
-adolescents (13-19) exposed to maltreatment and/or chronic traumatic exposure to
such things as community violence or domestic violence.
-12 sessions, which focuses on past or current situations.
✔✔TARGET efficacy - ✔✔--Like SPARCS treatment, gradual exposure may occur in
the context of recounting past trauma but is not a core component of treatment.
--Reduces anxiety, depression, and PTSD
--Promising treatment for girls with h/o delinquency, especially to reduce anger and to
enhance optimism and self efficacy.
✔✔Crisis intervention/Psychological Debriefing - ✔✔1. several sessions immediately
after an exposure to a traumatic event; encouraged to describe the traumatic event in
the context of a supportive environment.
2. Psychoeducation is provided and guidance about the management of initial emotional
reactions may be provided.
3. No controlled studies have yet provided evidence that this intervention leads to a
more positive outcome
✔✔PTSD criteria add'l info - ✔✔1. Over 6 years old
2. Sx over 1 month duration, or dx criteria may not have occurred until at least 6 months
after the trauma
3. Constricted emotions can show up suddenly after major life event, stressor, or
accumulated stressors that challenge defenses.
4. Can hide in somatic complaints or co-occur with depression, substance abuse,
anxiety or after head injury
✔✔PTSD differential diagnosis: Medical - ✔✔hyperthyroidism, caffeinism, migraine,
asthma, seizure disorder, and catecholamine or serotonin-secreting tumors. Some
,prescription medications and even some OTC medications may have similar effects,
such as antiasthmatics, sympathomimetics, steroids, SSRIs, and antipsychotics, diet
pills, antihistamines, and cold medicines
✔✔PTSD differential diagnosis - ✔✔anxiety disorders, such as separation anxiety
disorder, obsessive-compulsive disorder (OCD) or social phobia, depressive disorders,
bereavement trauma, disruptive behavior d/o
✔✔PTSD-associated psychosis - ✔✔does not respond well to neuroleptic
(antipsychotic) medication; may respond better to psychosocial interventions. The
hallucinations and delusions connect to the traumatic situation and perpetrators. Older
kids show symptoms like adults.
✔✔PTSD criteria - ✔✔Trauma: occured, witnessed, learned about
Harm or threat of harm to self, loved one
1. Re-experiencing traumatic event
2. Sustained high level of anxiety, hyperarousal / hypervigilance / exaggerated startle
3. Avoid activities, people, places, situations, objects that arouse memories
4. A numbing of responsiveness, concentration
5. Re-exp. flashbacks, nightmares, intrusive memories
6. Inability to remember aspects of the trauma
7. Chronic negative emotional state, decreased interest / participation in significant
activities
8. Depression, survivor's guilt, relationship problems, panic attacks
9. Substance abuse
10. Anger, aggressive, reckless, thrill-seeking, or self-destructive behavior
✔✔PTSD stats - ✔✔20 to 76% _________ children in inpt psych units endorse
hallucinations.
Psychosis is present in up to 75 to 95% of those diagnosed with dissociative disorders.
✔✔Traumatized C/A - ✔✔1. Hear perpetrators frightening them, making derogatory
remarks, or announcing / threatening new victimization.
2. See the perpetrator, smell them, fear victimizer will follow them, or feel they will come
hurt them again.
3. Hear command hallucinations (by the perpetrator) telling them to harm themselves or
others.
4. Hallucinations (PTSD type) are frequently nocturnal. Occur in 9% of abused children.
5. Nightmares are frightening, recurrent
✔✔PTSD under 6 yo - ✔✔alterations in arousal and reactivity associated with the
traumatic event(s) including:
irritable behavior and anger outbursts, hypervigilance, exaggerated startle response,
problems with concentration, and sleep disturbance.
, ✔✔PTSD under 6 yo add'l - ✔✔1. May have enuresis after they were toilet trained
2. Developmental regression-Stop speaking or forget how to talk -
3. Become very clingy
4. Act out trauma through play or re-enactment
5. Egocentric theory of causality: blame self
✔✔ODD - ✔✔oppositional defiant disorder
✔✔ODD criteria - ✔✔A pattern of angry/irritable mood, argumentative/defiant behavior,
or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from
the categories, and exhibited during interaction with at least one non-sibling
✔✔ODD categories - ✔✔Angry/Irritable Mood
1. Often loses temper.
2. Is often touchy or easily annoyed.
3. Is often angry and resentful. Argumentative/Defiant Behavior
4. Often argues with authority figures or, for children and adolescents, with adults.
5. Often actively defies or refuses to comply with requests from authority figures or with
rules.
6. Often deliberately annoys others.
7. Often blames others for his or her mistakes or misbehavior.
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months.
✔✔ODD add'l criteria - ✔✔children younger than 5 years, the behavior should occur on
most days for a period of at least 6 months
5 years or older, the behavior should occur at least once per week for at least 6 months
✔✔ODD severity - ✔✔Specify number of settings for severity:
Mild: one setting (e.g., at home, at school, at work, with peers).
Moderate: at least two settings.
Severe: three or more settings
✔✔Conduct Disorder (CD) - ✔✔A. Repetitive/persistent pattern of behavior in which
basic rights of others or major societal norms/rules are violated
B. at least 3 of following 15 criteria in past 12 mo, with at least 1 criterion present in the
last 6 mo
✔✔CD aggression - ✔✔1. Bullies, threatens, or intimidates others
2. Initiates physical fights
3. Used a weapon that can cause serious physical harm to others (bat, brick, knife, gun
etc.)
4. Physically cruel to people
5. physically cruel to animals
