Post-traumatic stress disorder (PTSD) is characterized in DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) as an anxiety disorder resulting from the experience or observation of a traumatic occasion (McMillan, 2019). Such occasions can be life-threatening, cause severe physical damage, intense stress levels, or be driven by sexual and emotional abuse. Emotionally defensive responses to a traumatic event may include dread, apathy, aggression, helplessness, anxiety. Any physical and mental reactions and outcomes can be individual and depend on a large number of personal and external aspects. The American Psychiatric Association (APA) standards for diagnosing post-traumatic stress disorder contain the following factors:
- Partaking in a severe traumatic occasion; observing a traumatic occasion; learning about a traumatic event for relatives or close friends; experiencing emotionally damaging reflections and fears
- Presence of intrusive mental complications such as uncontrollable disturbing memories and baseless suspicions; severe bodily and mental reactions to any inner and outer reminders of the traumatic occasion
- Persistent, intentional avoidance of alarming triggers (people, locations, objects, conditions)
- Damaging shifts in cognition such as memory loss, mental contortions, overly pessimistic emotional state, reduced social activity
- Boosted and overly excessive reactivity
- PTSD outcomes last more than one month
- Damages can not be defined by other causes such as pharmaceutical or mental disorder conditions (Miao et al., 2018).
Diagnostic benchmarks for children under six years of age are relatively different. The principal objective of this assignment is to concern the neurological origin of PTSD and conduct a case study analysis for subsequent discussion of psychotherapeutic therapy.
Neurological Basis of PTSD
PTSD has a neurological basis: traumatic events negatively impact the amygdala, prefrontal cortex, hippocampus, and brain hypothalamus (Watkins et al., 2018). Severe emotional shock causes boosted activation of the amygdala, leading to significantly increased anxiety reaction and emotional dysregulation. The amygdala is accountable for anxiety and aggression and is closely related to the prefrontal cortex (Watkins et al., 2018). Increased activity in this part leads to an increase in dopamine, norepinephrine, glutamate and a decrease in serotonin and GABA activity.
In the case presented, a boy experienced several traumatic events that led to his diagnosis of PTSD. After a traffic accident, Joe began to have nightmares and uncontrollable fears for his father. In this case, Joe meets the necessary criteria for a diagnosis of PTSD. A diagnosis of ODD is currently unfit as the boy’s symptoms last less than six months. A conduct disorder diagnosis is also improper as Joe does not exhibit excessively aggressive behavior. Joe’s previous diagnosis of ADHD may have further contributed to his poor concentration. Joe’s constant wishes to be with his father and anxiety due to his absence exemplify the separation anxiety diagnosis.
Psychotherapy for PTSD
According to the APA, the first-line treatment for PTSD is psychotherapy, such as cognitive processing therapy (CPT), EMDR, and prolonged exposure (PE). Patients treated with EMDR experienced a functional decrease in the amygdala, thalamus, caudate nucleus, and prefrontal cortex processes (McMillan, 2019). Wan Minnen et al. (2020) assumed that multiple therapies are more effective than one if they combine two different mechanisms. EMDR reduces fear levels, and patients end up more relaxed than when they participate in PE treatment (Van Minnen et al., 2020). Rehman et al. (2019) also performed a meta-analysis that assessed several therapies, including CBT, EMDR, PE. Although no particular treatment is more effective than another, Rehman et al. (2019) defined the significance of understanding the potential side effects and tolerability.
Advance nurse practitioners should use evidence-based clinical policies to reach optimal effects. Investigation evidence of any case contains clinical knowledge, patient intentions, and substantive examinations. The APA has the most delinquent data for psychiatry and is essential for psychiatric nurse practitioners to make diagnoses and treatments. In most treatment cases, mixed therapy may be appropriate for a better pattern and a more rapid effect.
McMillan, K. (2019). Post-traumatic stress disorder in adults. InnovAiT, 12(7), pp. 376–382. Web.
Miao, X. R., Chen, Q. B., & Wei, K. (2018). Posttraumatic stress disorder: From diagnosis to prevention. Military Med Res 5, 32. Web.
Rehman, Y., Sadeghirad, B., Guyatt, G. H., McKinnon, M. C., McCabe, R. E., Lanius, R. A., Richardson, D. J., Couban, R. M., Sousa-Dias, H., Busse, J. W. (2019). Management of post-traumatic stress disorder. Medicine, (98)39.
Van Minnen, A., Voorendonk, E. M., Rozendaal, L., & de Jongh, A. (2020). Sequence matters: combining prolonged exposure and EMDR therapy for PTSD. Psychiatry Research, 290, 113032. Web.
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, 12. Web.