Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample

Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample

Introduction

Posttraumatic stress disorder (PTSD) occurs after direct or indirect exposure to an actual or threatened traumatic event. PTSD is associated with significant comorbidity, functional distortions, and high mortality and suicide rates. Biological and psychological factors, childhood trauma, current mental illness, poverty, lack of education and adequate social support are risk factors for PTSD development. About 5% to 10% of the US population develop PTSD at some point in their lifetime (Mann & Marwaha, 2022). The case study involves a patient who develops PTSD after a minor car accident. The paper aims to discuss the neurological basis of PTSD, DMS-5 TR criteria for PTSD and symptoms presented in the case study, and discuss alternative treatment options for PTSD other than the one adopted in the case study.(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

Neurobiological Basis for PTSD Illness

Psychological trauma is associated with witnessing or experiencing a traumatic or life-threatening event. Victims are likely to suffer from heightened fear, horror, and helplessness, leading to transient or permanent psychological distress marked by physical, cognitive, emotional, and behavioral changes. The neurology of PTSD entails neuroendocrine, neurochemical, and neuroanatomical modifications in neural networks (Abdallah et al., 2019). Major neurochemical aspects of PTSD include atypical catecholamine, serotonin, amino acid, peptide, and opioid neurotransmitter dysregulation. These chemicals exist in brain circuits regulating or integrating stress and fear responses. PTSD patients experience glucocorticoid signaling dysregulation, increasing hypothalamic–pituitary–adrenal’s (HPA) negative feedback sensitivity. Low cortisol during trauma exposure can explain PTSD development (Miao et al., 2018). Hyper-vigilance, impulsivity, and increased aggression are linked to decreased serotonin transmission in the dorsal and median raphe. PTSD patients experience increased noradrenaline transmission, leading to increased fear and emotional memory encoding, increasing arousal and vigilance. PTSD patients experience hypodomainergia, impeding fear conditioning and anxiety regulation and increasing the risk of substance use disorders (Abdallah et al., 2019). Additionally, neuro-atomic features that help adapt to stress and fear are altered in PTSD patients. PTSD patients also present with a reduced hippocampal volume.   (Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

DSM-5-TR diagnostic criteria for PTSD and the Case Study

The DSM-5 criteria provide that, for a patient to be diagnosed with PTSD, the patient must have a direct or indirect traumatic event exposure and present with symptomology in four categories, including intrusion, avoidance, negative changes in thought and mood patterns, and arousal and reactivity changes. The DSM-5 criteria also require symptoms to have lasted for at least a month, cause significant distress and/or impact an individual’s life, specifying psychological, social, or functional impairment (Miao et al., 2018)(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample) . The PTSD symptoms should not be due to another medical problem or alcohol or substance use for a diagnosis to be confirmed. The symptomology described in the case study aligns with the DSM-5 criteria for diagnosing PTSD. The patient in the case study was directly exposed to a traumatic event: the minor car accident, where the father was threatened with physical harm and chased by the driver who had hit them. The patient presents with intrusive memories of the accident. He suffered from anxiety when presented with anything that reminded him of the accident, including stories in media about car accidents, seeing the type of vehicle that hit their car, and talking about the incident. The patient had trouble sleeping, taking a few hours, sleeping in his father’s room to fall asleep and experiencing nightmares. He became physically aggressive in school and at home. He once turned over tables and threw trash all over the classroom. The patient fought with his older siblings at the slightest provocation. He experienced hyperarousal, intrusive thoughts, a disorganized understanding of events, and could not discuss the incident.(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

The confirmed diagnosis, in this case, is PTSD. The information and symptomology provided in the case are sufficient to diagnose PTSD as it fits the DMS-5 criteria. Trauma-focused cognitive therapy was adopted as the treatment modality in this case. Properties of memory are critical to PTSD development. PTSD patients struggle to retrieve information, and often their memory is disorganized and fragmented. Patients experience maladaptive appraisals: PTSD patients cannot accurately evaluate the event and the fact that it was time-limited. Patients cannot understand the event in the past and over and display a perception of a current threat. Trauma-focused cognitive therapy focuses on three arms of PTSD: memories, meanings, and management.(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

During the mental evaluation, the patient was diagnosed with opposition defiant disorder, conduct disorder, major depressive disorder, attention-deficit hyperactivity disorder (ADHD), separation anxiety disorder, and phobia of spiders. ADHD and fear of spiders were a concern before the event, and all others were diagnosed after the event. I agree with opposition defiant disorder and separation anxiety disorder diagnoses based on Joe’s symptomology, indicating aggression in school and home, fighting, and sleeping in his father’s room. However, conduct disorder seems a misplaced diagnosis, considering the patient has already been diagnosed with opposition defiant disorder. It is uncommon for the two disorders to co-occur or be diagnosed together. It is usually one or the other. In this case, Joe’s behavior is mostly defiant. Major depressive disorder develops progressively and requires monitoring. It is atypical for MDD to be linked to a specific traumatic event, making the diagnosis unlikely in this case.(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

Psychotherapy Treatment Options

Cognitive behavioral therapy (CBT) is a first-line non-pharmacological treatment option for PTSD. CBT is delivered commonly to individuals but can also be delivered in group settings (Miao et al., 2018). CBT significantly improves an individual’s functioning and quality of life. It helps people learn to identify their distorted thinking patterns that have proven problematic, enhance their understanding of behavior, adopt problem-solving skills and coping mechanisms, and increase confidence in one’s abilities (Mann & Marwaha, 2022). CBT is a gold standard PTSD treatment, with evidence-based support as an effective treatment for PTSD. A few CBT sessions, about 12, are enough to eliminate most PTSD symptoms (Miao et al., 2018). Specific CBT treatments include prolonged exposure, cognitive processing therapy, coping mechanisms training, and eye movement desensitization reprocessing (EMDR). Using gold standards or widely accepted and evidence-based treatments in mental health care ensures reliability, accuracy, and effectiveness. Gold standard treatments increase patient confidence and almost certain success in mental health problems treatments.(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

Scholarly Source Review

The study by Miao et al. (2018) is scholarly because it was written by researchers and experts with knowledge in the psychology field and affiliated to institutions with knowledge and capacity to facilitate research in the psychology field, Xue-Rong Miao, Qian-Bo Chen, Kai Wei, and Zhi-Jie Lu are affiliated to the Department of Anesthesiology and Intensive Care, Third Affiliated Hospital of Second Military Medical University, Shanghai, China. The article by Abdallah et al. (2019) was written by researchers and experts in the psychology and medical fields, making it scholarly. Authors are affiliated with the Clinical Neuroscience Division, Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Mann and Marwaha’s (2022) article is also written by experts in the medical and psychology field, making them scholarly. Sukhmanjeet Kaur Mann and Raman Marwaha are affiliated with Case Western Reserve Un/MetroHealth MC.(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

Conclusion

Patients with posttraumatic stress disorder continuously re-experience the traumatic event, display intrusive thoughts, flashbacks, nightmares, dissociation from reality and oneself, severe negative emotions, increased vigilance, reactivity, irritability, and problems sleeping and concentrating. The patient in the case study presents the above symptomology, which aligns with the DSM-5 criteria, confirming PTSD. Psychotherapy is a first-line treatment for PTSD, but a combination with medication leads to better outcomes. Research shows that CBT effectively treats PTSD by helping improve cognitive functioning, guide behavioral changes, and adopt appropriate coping mechanisms.  (Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

References

Abdallah, C. G., Averill, L. A., Akiki, T. J., Raza, M., Averill, C. L., Gomaa, H., Adikey, A., & Krystal, J. H. (2019). The Neurobiology and Pharmacotherapy of Posttraumatic Stress Disorder. Annual review of pharmacology and toxicology, 59, 171–189. https://doi.org/10.1146/annurev-pharmtox-010818-021701(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

Mann, S.K. & Marwaha, R. (2022). Posttraumatic Stress Disorder. StatPearls [Internet]. StatPearls Publishing.(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

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(Posttraumatic Stress Disorder Case Presentation Comprehensive Nursing Paper Sample)

https://www.ncbi.nlm.nih.gov/