NRS 493 Assignment: Posttraumatic Stress Disorder Essay
NRS 493 Assignment Posttraumatic Stress Disorder Essay
PTSD is characterized by persistent, intrusive recollection of a traumatic incident, lasting for more than a month. PTSD symptoms start manifesting within six months of the traumatic incident (Sherin & Nemeroff, 2022). The purpose of this paper is to discuss the neurobiological cause of PTSD, diagnostic criteria, and psychotherapy approaches.
Neurobiological Basis for PTSD Illness
The neurobiological cause of PTSD is associated with endocrine and neurochemical factors. Low cortisol production during the period of trauma causes maladaptive stress responses and predisposes an individual to PTSD. Besides, patients with PTSD exhibit a decreased volume of the hippocampus, which is the major brain region that hinders the HPA axis (Sherin & Nemeroff, 2022). In addition, PTSD occurs due to abnormal regulation of serotonin, catecholamine, peptide, amino acid, and opioid neurotransmitters. These transmitters are found in the brain circuits that regulate stress and fear responses and thus, their dysregulation impairs the stress response (Sherin & Nemeroff, 2022). Furthermore, alteration in the activity of norepinephrine and stress hormone is associated with development of PTSD since norepinephrine regulates encoding of fear memories, while glucococorticoids hinder retrieval of emotional memories.
DSM-5 Diagnostic Criteria for PTSD
The DSM-5 criteria for PTSD require a person to have had a direct or indirect exposure to a traumatic event and have features from each of these categories for at least one month: Intrusion symptoms, Negative impact on cognition and mood, Avoidance symptoms, and impaired arousal and reactivity (Miao et al., 2018). The symptoms should create significant distress or impairment in social or occupational functioning that is not attributed to a medical condition or substance use. The video case has adequate data supporting PTSD since the patient symptoms are connected to exposure to a traumatic incident (car crash). The patient has Intrusion symptoms such as having distressing dreams about the car crash and Avoidant symptoms like avoiding memories. Besides, the boy has impairment in arousal and reactivity evidenced by anger outbursts, irritability, and destructive behavior (Miao et al., 2018). His cognition and mood are affected since he cannot remember key details about the accident.
The patient was given other diagnoses like Separation Anxiety disorder, MDD, ODD, and Conduct disorder. Although, the patient has clinical features that occur in ODD, MDD, and conduct disorder like anger outbursts, irritability, and aggression, these symptoms are due to the negative effects of PTSD on mood and cognition. Furthermore, the boy’s anxiety attributed to parental separation is due to intrusion symptoms and not separation anxiety. Thus, I would disagree with these diagnoses since the symptoms are documented features of PTSD and they are due to exposure to a traumatic event.
Additional Psychotherapy Treatment Option
Cognitive Processing Therapy (CPT) is a psychotherapy approach that I would recommend for this client. Watkins et al. (2018) explain that CPT is highly recommended by the APA and VA/DoD guidelines in managing PTSD. It is a trauma focused therapy that hypothesizes that after a traumatic event, individual try to make sense of what occurred. This often causes distorted cognitions about oneself, others, and the world. CPT is considered gold standard therapy since it cognitively triggers the memory, while enabling the patient to recognize maladaptive cognitions related to the traumatic incident. PMHNPs should use evidence-based interventions since they have been established to be safe and effective in promoting the best possible outcomes for a particular patient population.
NRS 493 Assignment: Posttraumatic Stress Disorder Essay Conclusion
PTSD is associated with endocrine factors like reduced cortisol production and abnormal regulation of neurochemical factors. Clinical features in the DSM-5 criteria for PTSD include Intrusion symptoms, Negative impact on cognition and mood, Avoidance symptoms, and impaired arousal and reactivity. CPT is extensively supported as an effective psychotherapy approach for PTSD.
NRS 493 Assignment: Posttraumatic Stress Disorder Essay References
Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0
Sherin, J. E., & Nemeroff, C. B. (2022). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues In Clinical Neuroscience. https://doi.org/10.31887/DCNS.2011.13.2/jsherin
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258
Explanation of my Observation of William
William, a war veteran previously based in Iraq, is a 38-year-old African American male who became homeless after failure to pay his mortgage. He lives with his wife and works as a lawyer with a specialty in finance law. However, his career is in a jeopardy due to his habit of alcohol consumption, which he uses as a survival mechanism from posttraumatic stress disorder (PTSD).
From my analysis of the client, he is experiencing stressful events based on the evaluation using the Diagnostics and Statistical Manual of Mental Disorders fifth edition (DSM-5) tool (Moskowitz et al., 2019). William exhibits re-occurring symptoms of irritability, concentration problems as well as sleep disturbances, which arise from nightmares, flashbacks, and hallucinations. These
are exacerbated by thoughts about the traumatic experiences he encountered as an American soldier in Iraq. Even though William’s depression and PTSD scores reveal a low level of distress, his current life experiences affect how he functions at work (Sareen, 2014). Mainly, he reports intense fear, horror, and sometimes helplessness, which makes him self-medicate with alcohol. However, William is consistently connected to his wife and closest friends, which is mainly achieved through texting rather than direct communication. This is an indication of avoidant coping indicating that he prefers to manage his affairs in isolation.
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As I use the PTSD explorer to examine William, his mood and energy keep on fluctuating from moderate status to worst condition. He is mainly stressed about his previous encounters in the military environment (Zamorski et al., 2015). The client is mainly concerned about the nature of his work as a lawyer in which in some instances, he handles customers whose reprimanding demands reminds him about the nature of the military encounters in Iraq. His mood scores fluctuate and this calls for the need for medications to manage such dilapidating mood disorder.
Therapeutic Approaches for the Client
Due to anxiety, I will administer Klonopin 0.25mg PO x 2 daily (Moskowitz et al., 2019). The patient will be expected to take the
medication for one month until panic stops. However, I might increase the dosage of 0.125mg to the 0.25mg of Klonopin every three days to ensure that anxiety and panic are under control. I will also prescribe Ziprasidone 40mg PO BID for the client. This medication will be used in a combination with Lorazepam 1mg PO BID to address hallucinations and nightmares that occur to the patient due to a flashback about the experiences of the military environment (Moskowitz et al., 2019). However, in the event the patient does not realize improvement in perceptual disturbances, I will increase Ziprasidone gradually up to 80mg PO BID within three days of medication. I will also administer Duloxetine 60mg PO x 1 daily to restore positive mood in the patient.
Expected Outcomes
I will expect William to adhere to the prescribed medication regimen for him to realize a positive change in his psychotic disorder. Upon completion of the drugs, I anticipate to observe a remarkable improvement in the patient particularly in how he relates with the family and friends (Sareen, 2014). This means that his habit of isolation will reduce. I also expect William’s mood to change and his anxiety to drop following the use of the medication after one month. This will mean that his depression will drop based on the analysis using the depression survey score tool (Zamorski et al., 2015). A positive outcome from the psychotropic medication suggests that patient is responding well to the therapy and this provides a valuable understanding of the character dynamics for these clients which guide the decision on medication adjustment or withdrawal.