Running head: PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 1
Panic Disorder and Post Traumatic Stress Disorder
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PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 2
Panic Disorder and Post Traumatic Stress Disorder
Introduction
Michael is a patient who is 30 years old and has panic disorder and Post-traumatic stress
disorder. Through the tests, I identified that he has a racing heartbeat. From the patient's
examination and inquiring about their experiences, Michael stated that he had severe headaches,
stomachaches, and chest pains. The aches keep recurring, mostly whenever he encounters similar
experiences to those that led to the previous accident. Michael stated that he mostly felt faint,
nausea, and even increased sweating when the weather was cool. The shortness of breath was
also evident, with Michael stating that he felt dizzy and was trembling in most cases. The
patient's mouth was dry, and he admitted that he had fears, especially on incidences that caused
death, such as accidents if he watched them on the television. At times, the patient would
respond to the questions aggressively, and when I inquired on knowing the accident he was
involved in, he was a bit angry and scared. During our time with the patient, I realized that he
was uneasy and felt frightened without even a stimulus that could have triggered the change in
the patient's mood. Michael expressed the feeling of disassociation with others where he said that
he spends most of the time alone and feels that he should not be engaged in any social activities
or be part of the social groups. When Michael is not in the work environment, he ensures that he
locks himself in the house and rarely welcomes anybody. Michael experiences dreams related to
the accident he was involved in, which caused various types of disabilities and even the death of
some of his friends they were traveling with. He stated that he could not travel using a bus to fear
an accident. Michael prefers using his bike for distances that can be accessed through riding. He
does not enjoy having long-distance traveling. In some cases, the patient has numbness, and a
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 3
feeling of ringing in his ears which makes him fear, especially when he has nature walks in the
forest or isolated areas.
Clinical History
Michael's family is part of the immigrant families to the united states of America.
Michael schooled in California, where in high school education, he attended Whitney High
School and later joined San Jose State University and pursued a software engineering course.
The family of Michael was not economically well up and depended on the casual works in the
factories to help them support the education of the two children and provide basic needs for the
family. Michael lost his father when he was about ten years and was raised by his mother.
Michael is an introvert and prefers staying alone with the report I acquired from his family
members and friends who brought him to the hospital. The family members explained that
throughout his life in high school and even in university, he mostly stayed alone and could not
make friends and maintain. He would be aggressive when provoked, but the condition worsened
after he was involved in an accident. Michael was with his workmates during a summer vacation
where they traveled to New York to have a vacation and retreat.
After spending a week in New York, the team decided to travel back to California.
Unfortunately, they were involved in a road accident that killed Michael's five colleagues, and
about ten workers were disabled. Michael and ten other friends escaped with minor injuries
though he lost two of his best friends. One of his friends schooled with him in high school and
joined the San Jose State University, where they pursued software engineering and later secured
a job in California. The two secured jobs at Unified software company, placed in the same office.
Whenever Michael had issues in his job, he would interact with a friend to help him solve the
problem. He finds it hard to make friendships where he did not have any close interaction with
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 4
his colleagues at work after his friend's demise. The patient had therapy sessions for one year
with a therapist who conducted them through online sessions. The change was not noticed from
the sessions with the family members deciding to visit the hospital.
Michael takes alcohol heavily with the family members stating that he started the habit
after the accident. The alcoholic behavior, according to Michael, helps him reduce the fear and in
sleeping. Michael smokes cigarettes and is currently a chain smoker. Currently, Michael lives
alone in an apartment near his workplace and hardly gets back home even during his leaves from
his job. Although he spends time far from home, he financially supports his mother and sister.
Michael pays fees for his sister and other items that are needed in the facilitation of his
education. He does not easily socialize, and any time he visits a social place, he isolates himself
and concentrates more on his phone. Michael was involved in an accident two months ago
though he had minor injuries again. That triggered the fear and made him depressed. After the
accident, his behavior changed in where he experienced frequent mood swings, which led to
aggressive behaviors in the workplace. The company gave him four months of sick leave and
recommended medical attention to the employee's current situation. Michael had set up a
business selling electronics and provided computer services. Due to the reduced time, he spent
monitoring the business, the employees mismanaged, making it collapse. He has plans of
reviving the business; however, due to the responsibilities and the alcoholism, Michael cannot
save enough funds to start a business. The expenses for his family are increasing since his sister
is almost joining the college, which makes Michael worried about how he will be able to pay for
the college fees.
Diagnoses
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 5
The Diagnostic and Statistical Manual of Mental Disorders updated the diagnoses of
Panic disorder since there has been a series of many health professionals confusing panic
disorder with other anxiety disorders such as bipolar disorder. I employed the DSM-V to identify
the disorders that the patient was suffering from correctly. DSM-V defined panic disorder as an
anxiety disorder primarily based on panic attacks occurrence that is unexpected and most
recurrent. The patient may have the symptoms recurring twice or thrice a week if it is a severe
panic disorder, while in some other cases, the attacks occur about two times a month. The attacks
resulting from panic disorder are not caused by a medical condition or direct effects of
physiological effects resulting from substance use, including drug use or any medication (Greene
& Eaton, 2016). Other metals disorders cannot account for the attacks experienced when a
person has panic disorder. Panic attacks are essential in identifying and diagnosing panic
disorder according to the DSM-V guidelines. Panic attacks are classified according to the DSM-
V as unexpected or expected panic attacks (Greene & Eaton, 2016). The expected panic attacks
are associated with certain fears, such as flying. The unexpected attacks do not have any
apparent trigger and appear to be occurring from no triggering situation. For an attack to be
termed a panic attack, it must present at least four or more symptoms that help a clinician
conclude that a person is suffering from the disorder. The symptoms according to DSM-V could
be accelerated heart rate, sweating, shaking and trembling, smothering or the sensation of
shortness of breath to some patients, a feeling of being chocked, chest discomforts and pain,
abdominal distress that may lead to nausea, dizzy feeling, and unsteadiness, depersonalization
and derealization (Greene & Eaton, 2016).
Similarly, the person may fear death, hot flushes, and a feeling of loss of control. The
symptoms affect the person and reoccur within a week or a month without being triggered by
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 6
anything. For the diagnoses of post-traumatic stress disorder (PTSD), I also consulted the DSM-
V, where I keenly identified some of the symptoms that a patient must present for him to be said
to have PTSD. PTSD is experienced when a person is exposed to threatened or actual death,
sexual violence, serious injuries (Pai et al., 2017). The person who suffers the disorder may have
experienced the traumatic event directly, witnessed the events that are traumatic occurring on
other people, knowing that such as traumatic event occurred to a family member or even a friend,
or been exposed to aversive details of a traumatic event repeatedly especially for the people who
are involved in the work of saving the people from traumatic events. The person may also have
intrusion symptoms associated with traumatic events like recurrent distressing dreams with not
traumatic or related to a traumatic event, but the content is not well recognizable (Pai et al.,
2017). Thirdly the person may be in a situation of persistently avoiding stimuli associated with
the trauma even after the experience of the traumatic event. The avoidance is a trial of
disconnecting with the traumatic experience, affecting the person and causing stress.
Fourthly, the person may present behaviors that show negatively altered cognitions and a
negative change in mood, which is mostly associated with the traumatic events. The person with
PTSD, according to the DSM-V, may have significant alteration in the reactivity and arousal
where many are aggressive and easily get angry when provoked slightly and have problems with
the concentration where they concentrate for a short period (Pai et al., 2017). the person with
PTSD may have sleep disturbance caused by the recurrence of the thoughts on the experienced
traumatic event. The disturbance from the PSTD occurs for not less than a month. It causes
significant clinical distress, social, occupational impairments, and impairments in other
functioning in important areas such as academics. More important to note that the disturbance is
not attributed to substance physiological effects such as alcohol consumption or medications. In
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 7
addition to the symptoms, a patient must be presenting persistent or recurrent symptoms of
depersonalization and derealization to justify that the situation is a post-traumatic stress disorder.
Rationale
By evaluating the symptoms presented by Michael and the information acquired directly
from him and even from the friends and family members, such as frequent cases of chest pains,
headaches, insomnia, fear of traveling using the bus after the traumatic experience they had of an
accident that killed his close friend and his aggressiveness then I could diagnose post-traumatic
stress disorder. The shivering and exaggerated anxiety, sweating, shortness of breath, and other
symptoms that Michael explained to have been encountering guided me in concluding that he
had panic disorder, which was having repeated panic attacks about three times a week.
To treat the panic disorder affecting Michael, I will use medication and psychotherapy.
Having gone through repeated therapy and has not recovered from the panic disorder, I find it
important to use the two clinical methods to treat the panic disorder to help him recover from the
disorder. Cognitive-behavioral therapy will be useful to help recover from the disorder and have
some behavioral changes (Milrod et al., 2016). The therapy shall be used in helping him to
identify some of the ways of handling the issues that make him have panic attacks which are the
symptoms of panic disorder. The medication and psychotherapy will take about two months
consecutively. I will engage the patient in activities that will reduce the recurrence of the
thoughts that lead to the fears and encourage him to listen to music whenever he feels like there
are panic attacks, and changes his perception of the occurrence of various events. More so, I will
help him identify the best methods of socialization and the importance of socialization,
especially in helping reduce the stressful thoughts such as fears about raising funds needed to
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 8
take care of his family. Gaming is another activity that I will involve Michael in using the cell
phone to help him reduce the stressors, mostly caused by the isolation behavior.
During the first month of the psychotherapy, I will be administering the selective
serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. The SSRIs and
the SNRIs are very effective for patients with the panic disorder since they reduce the effects of
depression that many of the patient’s experience (Perrotta, 2019). The dosage will be
administered first low, and later the normal dose will be used to help the patient get used to the
drugs. After the first month, I will withdraw the medication and continue with the psychotherapy
for another month as I monitor the progress from the therapy sessions and the effects of the
medication on the patient.
For the treatment of post-traumatic stress disorder, I will use psychotherapy, but in this
case, I will consult a virtual reality center that uses the virtual reality technique in helping
patients with mental disorders (Levi et al., 2016). The exposure therapy will be specifically
employed first to the patient, where he will have an opportunity to re-enter the setting that leads
to the experiencing of trauma. The therapy will be combined with eye movement desensitization
and reprocessing, which will be very well guided by an expert from the Virtual reality center to
ensure that Michael can process the traumatic memories and change the reaction towards the
traumatic events and thoughts and perception. I will have the treatment divided into five sessions
in a week, taking about eight hours to ensure that the patient is fully engaged in the achievement
of desired results. The treatment of post-traumatic disorder will be done after the two months of
panic disorder treatment to ensure that I effectively apply all the identified treatments well.
Anger and depression are symptoms that overlap in Michaels's situation. To ensure that I
treat the symptoms well after withdrawal of the medication I will use for the panic disorder I and
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 9
having one month without employing the medication in treating the disorder, and I will then
embark on the use of the antianxiety medications to help the patient recover from the responding
to situations through anger and having depression. The antianxiety medicines I will use are
benzodiazepines (Shalev et al., 2017). Since I know the exposure to the antianxiety drugs may be
addictive, with the patient demanding to use them severally, I will only use them for medication
within two weeks and then continue with the psychotherapy. The overlapping symptoms will be
treated through the medication in the first months involving antidepressants. Then the use of the
antianxiety drugs which have presented desirable results in previous situations where they were
used for the patients affected the anxiety disorder.
Treatment Protocol
The first session will take two months, where I will target reduction of response to the
stimulus by the patient. The social activities and engagement in gaming in the cell phone gaming
activities will improve the patient's concentration and reduce the series of thoughts that lead him
to stress, which results in depression. The sessions will help him improve socialization and avoid
the isolation which affects his ability to handle the challenges and manage stress. Changing the
negative attitude towards socialization will help ensure that the patient can reduce the cases of
aggressiveness which is mostly caused by depression. I will be engaging the patient in talks that
will help identify the best methods of dealing with anxiety and panic attacks. More so, I will be
working in the last interactions in the panic disorder sessions in helping the patient avoid the use
of alcohol.
The second session, which will also take two months, will help the patient cope with the
situations and respond positively to any stimuli related to the traumatic situations. The first
sessions will involve identifying the traumatic events that the patient has gone through and help
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 10
him understand the need to focus on the future. Then I will use the last four interactions in the
last month to take the patient into the Virtual reality center, where he will be exposed to a similar
experience as the one that caused the trauma. Then, through analysis of the situations, the patient
will be able to tell me the best methods h thinks should be employed to deal with such a situation
when it occurs. The sessions will be helpful for the patient to change how he responds to the
events that are related to the one that led to the trauma that is affecting him. By accepting the
occurrence and existence of such experiences, he will be able to cope with the situation and
positively respond to similar situations. The medication using the antidepressants will help the
patient in the first month of the second session, which will be dealing with post-traumatic stress
disorder.
Discussion
Michael’s case was complicated since it involved panic disorder and post-traumatic stress
disorder, which present overlapping symptoms. That made it hard for me to identify the disorders
at the start until I engaged Michael, who explained and provided a lot of information that helped
me identify the disorders. To be very sure about the diagnoses, I ensured that I counterchecked
what I had with the DSM-V, which was essential in helping me identify the disorders in Michael.
The exposure to the traumatic event when he was involved in the accident was key in
contributing to the post-traumatic stress disorder. The experience kept recurring, which made
him aggressive and even caused depression. I combined the psychotherapy and medication to
treat the panic disorder to ensure that the disorder was fully treated (Greene & Eaton, 2016). I
used cognitive behavioral therapy and selective serotonin reuptake inhibitors, and serotonin-
norepinephrine reuptake inhibitors to ensure that the best results were achieved in the panic
disorder treatment. To treat the post-traumatic disorder, I also used psychotherapy, but in this
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 11
case, I skillfully administered antidepressants and antianxiety drugs for two weeks to ensure that
the patient was not addicted to the use of the drugs in managing the trauma. I also engaged him
in the virtual reality environments to change the responses to stimulus positively. The cases had
overlapping symptoms such as stress, headache, anger, and isolation which I used cognitive
behavioral therapy to treat them and the combination of the antidepressants. The methods
employed are effective for treating panic and post-traumatic stress disorder.
PANIC DISORDER AND POST TRAUMATIC STRESS DISORDER 12
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