Sample Answer for NRNP 6645 Posttraumatic Stress Disorder Included After Question
Succinctly, in 1–2 pages, address the following:
- Briefly explain the neurobiological basis for PTSD illness.
- Discuss the DSM-5-TR diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?
- Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment” from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.
Support your Assignment with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
A Sample Answer For the Assignment: NRNP 6645 Posttraumatic Stress Disorder
Title: NRNP 6645 Posttraumatic Stress Disorder
One prevalent and debilitating mental ailment is posttraumatic stress disorder (PTSD). There is a neurological basis for many of the symptoms of the disorder, which provides a framework for understanding the complexities of PTSD. The prevalence of PTSD in women is double that in men. The sickness can last a lifetime and show symptoms years after a traumatic event. Due to their signs and symptoms, patients with PTSD usually deal with a variety of psychosocial problems, and their warped perspectives can be detrimental to relationships with family and friends.
The case study is in regards to Joe an 8-year-old boy who underwent a traumatic experience. This paper will look into PTSD’s neurologic basis as a condition, criteria of diagnosis, involved clinical manifestations, utilized treatments and their relation to the gold standard (Martin et al., 2021).
Neurobiological Basis for PTSD Illness
The main neurochemical components of PTSD include peptide neurotransmitters, opioids, amino acids, catecholamines, and aberrant serotonin modulation. The brain circuits that integrate or regulate stress and fear reactions contain these neurochemicals. Stressful life events have an impact on the prefrontal cortex (PFC). It also results in hypoactivity in certain brain areas and hyperactivation in others. Traumatic exposure results in excessive activity. on the anterior cortex and amygdala but hypoactivity on the ventromedial PFC, as well as the dorsolateral PFC, orbitofrontal cortex, and right frontal gyrus.
A portion of the brain’s later regions atrophy due to hypoactivity. An amygdala is triggers the body’s instinctive fight-or-flight reaction in response to stress and conveys the threat to the hippocampal region, which secretes cortisol, a stress hormone. After that, the PFC evaluates the stressor and controls the other brain regions (Harnett et al., 2020).
PTSD Diagnosis and other comorbidities of the Patient
The DSM-5 provides some criteria to diagnose PTSD that involves having direct or indirect contact, exposure or experience of a traumatic event. Indirect contact to the event has been found to also involve personal observation of the event as it occurred to others, learning that the event happened to a relative or a close friend and even indirect exposure during occupational duties. These traumatic events involve instances such as actual or threatened death, a form of sexual violence or a serious injury (DePierro et al., 2022).
Additionally, in order to diagnose this condition, the patient is to present with intrusive symptoms such as nightmares, involuntary distressing memories and flashbacks related to the traumatic event or even intense psychological as well as physiological responses when exposed to remainders of the event that could include avoidance. The patient could also display negative emotions such as fear, anger, guilt or shame and have distorted thoughts on the cause as well as the consequences of the traumatic event (DePierro et al., 2022).
Aside from the negative mood changes patient’s may also be hyper vigilant, irritable aggressive and also have insomnia. Having such clinical manifestations may affect their ability to function in various aspects of their life such as school, work or relationships. The symptoms have been found to persist for more than a month and cannot be explained by substance abuse, medications or other medical conditions in order to identify the patient is suffering from this disorder (DePierro et al., 2022).
The case presentation did provide sufficient information to diagnose PTSD in the patient whereby the 8-year-old boy, Joe in this occurrence was directly involved in the traumatic event despite it being considered a minor event. The child was not injured due to the car accident; however, he was chased together with his father by the other driver who threatened to be physically aggressive. This fits in the DSM-5 criteria for diagnosing this condition. Furthermore, the boy was reported to having intrusive memories of the accident accompanied with anxiety together with irregular sleeping patterns. The boy also is experiencing nightmares and insists on sleeping in his father’s room. He is also reported to be aggressive both at school and at home while being triggered by minor grievances. These signs and symptoms do fit the diagnosis of PTSD (DePierro et al., 2022).
In relation to the other listed diagnoses that include oppositional defiant disorder (ODD), conduct disorder, major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD) and separation anxiety disorder. These diagnoses may not be accurate as they occurred after the traumatic event and the presenting clinical manifestations associated with these conditions may still be manifestations of PTSD. Additionally, there were no any other distinguishing symptoms of these conditions. However, the spider phobia could be relevant as it was detected earlier (DePierro et al., 2022).
An Alternative Psychotherapy treatment for the Patient in the Case Study and its relation to Gold standard treatment
An alternative psychotherapy treatment that can be used in the management of this condition is eye movement desensitization and reprocessing (EMDR) that aims mostly at neural network integration in the treatment of PTSD. This form of treatment is efficient as it can not only be used by itself but also in conjunction to the psychotherapy model used in the case study of cognitive behavioral therapy CBT. It aids in managing the condition through integrating the involved brain networks to process adverse experiences and traumatic events (Laliotis et al., 2021).
Present triggers, previous stresses, and planned future thoughts and behaviors are the three primary components of eight-phase integrative psychotherapy of EMDR treatment. During a session, the therapist may employ protocols and techniques like bilateral stimulation (BLS) to assist the patient in processing somatic, cognitive, and dynamic material. The BLS can appear as alternate tapping of the hands and knees, alternating noises in each ear, or a horizontal back-and-forth movement of the eyes. The goal being to deal with trauma in an appropriate manner (Laliotis et al., 2021).
CBT is considered the gold standard in treatment of PTSD, however EMDR is also an evidence based treatment which as mentioned when used together with CBT can bring forth positive results in a patient. This can be seen through various structured approaches that involve exposure therapy and BLS thus help the patient reduce distressing symptoms. Furthermore, EMDR has displayed positive results in various studies conducted thus making it a reliable form of therapy (Laliotis et al., 2021).
The utilization of gold standard evidence based treatments from clinical practice guidelines is essential for psychiatric-mental health nurse practitioners in ensuring quality of care, professional development and patient safety. Nurse practitioners should ensure as they carry out their duties the best available care which is achieved through being up to date with the latest treatments thus improving their skills and since these treatments have undergone extensive research they result in reduced potential harm to patients. Additionally, through utilization these treatments the efficacy and effectiveness improves thus increasing the likelihood of positive outcomes (Laliotis et al., 2021).
Based on the signs and symptoms of the illness, Joe’s PTSD diagnosis as presented in the video is a legitimate diagnosis. However, the other diagnoses do not have more distinguishing symptoms in order to state the patient is suffering from those conditions. The signs and symptoms the patient presented with were in line with the DSM-5 criteria used to provide a PTSD diagnosis. In addition to trauma-focused cognitive therapy, which the therapist in the presentation in the video employed, I will recommend EMDR. Guidelines for evidence-based practice exist to bolster the benefits of EMDR in the treatment of PTSD (Martin et al., 2021).
The papers used for this project are considered scholarly because their authors have experience with a range of therapeutic modalities. The papers were published during the last five years and were also retrieved from scholarly journals. They evaluate their hypothesis through reviewing material from past research and comparing it to current understanding as well as to their scientific investigations. Finally, publications are peer-reviewed by writers and psychotherapy experts who have received sufficient training and skill in the relevant subjects
DePierro, J., D’Andrea, W., Spinazzola, J., Stafford, E., van Der Kolk, B., Saxe, G., … & Ford, J. D. (2022). Beyond PTSD: Client presentations of developmental trauma disorder from a national survey of clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 14(7), 1167.
Harnett, N. G., Goodman, A. M., & Knight, D. C. (2020). PTSD-related neuroimaging abnormalities in brain function, structure, and biochemistry. Experimental neurology, 330, 113331.
Laliotis, D., Luber, M., Oren, U., Shapiro, E., Ichii, M., Hase, M., … & Tortes St Jammes, J. (2021). What Is EMDR Therapy? Past, Present, and Future Directions. Journal of EMDR Practice & Research, 15(4).
Martin, A., Naunton, M., Kosari, S., Peterson, G., Thomas, J., & Christenson, J. K. (2021). Treatment guidelines for PTSD: a systematic review. Journal of Clinical Medicine, 10(18), 4175.