Posttraumatic Stress Disorder

1

Week 9 Assignment: Post-Traumatic Stress Disorder

NRNP - 6645: Psychthrpy Mult Modalities Winter 2023

Date: January 24, 2024

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) occurs after a traumatic event (e.g., war, attack, disaster) that leads to severe physical and/or psychological stress (Forkus et al., 2022). PTSD may never be resolved due to a lack of help for effective diagnosis and treatment. This paper aims to explain the neurobiological basis for PTSD, discuss the DSM-5 diagnostic criteria, and review the case study of 7-year-old child Joe, how he was diagnosed with PTSD, and what treatment options were given to him.

The neurobiological basis for PTSD

The neurobiology of PTSD involves the neuroendocrine system, centered around the hypothalamic-pituitary-adrenal (HPA) axis, which controls the body's response to stress (Cross et al., 2017). The HPA axis is the body's primary response system to stress. The hypothalamus releases corticotropin-releasing hormone (CRH), which binds to receptors on pituitary cells that release the adrenocorticotropin hormone (ACTH). The ACTH is transported to the adrenal glands which produce and release adrenal hormones such as cortisol. The release of cortisol activates sympathetic pathways, causing negative feedback to both the anterior pituitary gland and the hypothalamus. This negative feedback system appears to be impaired in patients with PTSD (Sherin & Nemeroff, 2011). HPA is controlled by cortisol and reduces the response of noradrenergic to stress. Both processes are subject to negative feedback.

Dysregulation of opioid neurotransmitters, amino acids, catecholamines, and peptides are involved in brain circuits. Therefore, controlling the response to fear and stress has a neurochemical basis. Norepinephrine and dopamine are two examples of interesting brain catecholamines. People with PTSD have a higher-than-average rate of catecholamine release. Changes that occur in both the hippocampus and amygdala are among the brain structural changes in PTSD development (Cross et al., 2017). Overall, different parts of the brain carry out different functions. Changes in the way circuits connect can lead to the development of PTSD.

DSM-5 Diagnostic Criteria for PTSD

The DSM-5 criteria for diagnosing PTSD in people over 6 years of age require the presence of the following symptoms; exposure to actual death or risk of death, serious bodily injury, or sexual violence; the presence of one (or more) of the following intrusive symptoms; persistent avoidance of stimuli associated with the traumatic event; negative changes in cognition and mood associated with traumatic events; significant changes in arousal and reactivity associated with traumatic events; the suspension period is more than 1 month; the disability causes significant suffering or disability; the disorder is not due to the physiological effects of the substance (Center for Substance Abuse Treatment, 2014).

In this case, Joe continues to dream, think and is unable to enjoy daily life and continues to relive the horrific incident, as evidenced by a series of flashbacks related to the event (Forkus et al., 2022). Joe has a habit of being overly excited, prone to sudden outbursts of irritation, has trouble sleeping well, has difficulty concentrating, and frequently gets into arguments with his co-workers and siblings. In Joe's case, he was with his father when he was involved in the accident. Therefore, there must be a reason why he went through such a traumatic event. There were also negative changes in Joe's emotions, such as altered perception, pessimism, and a persistent lack of ability to perceive pleasant emotions, which led him to get into fights. This video provided the information needed to make a diagnosis of PTSD. The video contained extensive details of the traumatic incident. as well as details of Joe's later life are then provided, including how he experienced a change in thinking and how upset he became, especially when events comparable to the accident were discussed. Therefore, the information provided is sufficient and I agree with the diagnosis given.

The Video Case Study and One Other Psychotherapy Treatment

Cognitive behavioral therapy (CBT) is the first-line treatment for his PTSD and includes trauma-focused cognitive behavioral therapy, cognitive processing therapy, and prolonged exposure therapy (PE). The strategy I recommend for Joe is PE therapy. It is widely accepted as the gold standard treatment guideline for the treatment of PTSD in both adults and children. This intervention is supported by extensive treatment standards and conducted research. Significantly reduces signs and symptoms of feeling unwell and feeling sad (Booysen & Kagee, 2021). Emotional processing is one of the many forms of intervention included in the procedure.

Conclusion

A psychiatric mental health nurse practitioner must utilize evidence-based research to improve patient outcomes, diagnosis, and treatment. PTSD is a common mental disorder seen in several patients by her PMHNP in our clinical practice. The papers used in this article are considered scholarly because they are written by scholars and professionals in the field and are published in popular academic journals.

References

Booysen, D. D., & Kagee, A. (2021). Preliminary effectiveness of brief prolonged exposure therapy for PTSD: Expanding access to effective therapies. Clinical Case Studies, 20(6), 482–497. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=psyh&AN=2022-01994-004&site=eds-live&scope=site

Center for Substance Abuse Treatment (US). (2014). DSM-5 Diagnostic Criteria for PTSD. Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. https://www.ncbi.nlm.nih.gov/books/NBK207201/pdf/Bookshelf_NBK207201.pdf

Cross, D., Fani, N., Powers, A., & Bradley, B. (2017). Neurobiological development in the context of childhood trauma. Clinical Psychology- science and Practice, 24(2), 111–124. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=e19c26e9-7fd5-4afb-820c-7dfc9ffa11d9%40redis

Forkus, S. R., Raudales, A. M., Rafiuddin, H. S., Weiss, N. H., Messman, B. A., & Contractor, A. A. (2022). The Posttraumatic Stress Disorder (PTSD) Checklist for DSM–5: A systematic review of existing psychometric evidence. Clinical Psychology: Science and Practice. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=69b9a9be-70d3-4650-8cec-39d47f860c86%40redis

Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/pdf/DialoguesClinNeurosci-13-263.pdf

To prepare:

· Review this week’s Learning Resources and reflect on the insights they provide about diagnosing and treating PTSD.

· View the media  Presentation Example: Posttraumatic Stress Disorder (PTSD) and assess the client in the case study. 

· For guidance on assessing the client, refer to Chapter 3 of the Wheeler text.

Note:  To complete this Assignment, you must assess the client, but you are not required to submit a formal comprehensive client assessment.

The Assignment

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.

1

Week 9 Assignment: Post-Traumatic Stress Disorder

NRNP - 6645: Psychthrpy Mult Modalities Winter 2023

Date: January 24, 2024

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) occurs after a traumatic event (e.g., war, attack, disaster) that leads to severe physical and/or psychological stress (Forkus et al., 2022). PTSD may never be resolved due to a lack of help for effective diagnosis and treatment. This paper aims to explain the neurobiological basis for PTSD, discuss the DSM-5 diagnostic criteria, and review the case study of 7-year-old child Joe, how he was diagnosed with PTSD, and what treatment options were given to him.

The neurobiological basis for PTSD

The neurobiology of PTSD involves the neuroendocrine system, centered around the hypothalamic-pituitary-adrenal (HPA) axis, which controls the body's response to stress (Cross et al., 2017). The HPA axis is the body's primary response system to stress. The hypothalamus releases corticotropin-releasing hormone (CRH), which binds to receptors on pituitary cells that release the adrenocorticotropin hormone (ACTH). The ACTH is transported to the adrenal glands which produce and release adrenal hormones such as cortisol. The release of cortisol activates sympathetic pathways, causing negative feedback to both the anterior pituitary gland and the hypothalamus. This negative feedback system appears to be impaired in patients with PTSD (Sherin & Nemeroff, 2011). HPA is controlled by cortisol and reduces the response of noradrenergic to stress. Both processes are subject to negative feedback.

Dysregulation of opioid neurotransmitters, amino acids, catecholamines, and peptides are involved in brain circuits. Therefore, controlling the response to fear and stress has a neurochemical basis. Norepinephrine and dopamine are two examples of interesting brain catecholamines. People with PTSD have a higher-than-average rate of catecholamine release. Changes that occur in both the hippocampus and amygdala are among the brain structural changes in PTSD development (Cross et al., 2017). Overall, different parts of the brain carry out different functions. Changes in the way circuits connect can lead to the development of PTSD.

DSM-5 Diagnostic Criteria for PTSD

The DSM-5 criteria for diagnosing PTSD in people over 6 years of age require the presence of the following symptoms; exposure to actual death or risk of death, serious bodily injury, or sexual violence; the presence of one (or more) of the following intrusive symptoms; persistent avoidance of stimuli associated with the traumatic event; negative changes in cognition and mood associated with traumatic events; significant changes in arousal and reactivity associated with traumatic events; the suspension period is more than 1 month; the disability causes significant suffering or disability; the disorder is not due to the physiological effects of the substance (Center for Substance Abuse Treatment, 2014).

In this case, Joe continues to dream, think and is unable to enjoy daily life and continues to relive the horrific incident, as evidenced by a series of flashbacks related to the event (Forkus et al., 2022). Joe has a habit of being overly excited, prone to sudden outbursts of irritation, has trouble sleeping well, has difficulty concentrating, and frequently gets into arguments with his co-workers and siblings. In Joe's case, he was with his father when he was involved in the accident. Therefore, there must be a reason why he went through such a traumatic event. There were also negative changes in Joe's emotions, such as altered perception, pessimism, and a persistent lack of ability to perceive pleasant emotions, which led him to get into fights. This video provided the information needed to make a diagnosis of PTSD. The video contained extensive details of the traumatic incident. as well as details of Joe's later life are then provided, including how he experienced a change in thinking and how upset he became, especially when events comparable to the accident were discussed. Therefore, the information provided is sufficient and I agree with the diagnosis given.

The Video Case Study and One Other Psychotherapy Treatment

Cognitive behavioral therapy (CBT) is the first-line treatment for his PTSD and includes trauma-focused cognitive behavioral therapy, cognitive processing therapy, and prolonged exposure therapy (PE). The strategy I recommend for Joe is PE therapy. It is widely accepted as the gold standard treatment guideline for the treatment of PTSD in both adults and children. This intervention is supported by extensive treatment standards and conducted research. Significantly reduces signs and symptoms of feeling unwell and feeling sad (Booysen & Kagee, 2021). Emotional processing is one of the many forms of intervention included in the procedure.

Conclusion

A psychiatric mental health nurse practitioner must utilize evidence-based research to improve patient outcomes, diagnosis, and treatment. PTSD is a common mental disorder seen in several patients by her PMHNP in our clinical practice. The papers used in this article are considered scholarly because they are written by scholars and professionals in the field and are published in popular academic journals.

References

Booysen, D. D., & Kagee, A. (2021). Preliminary effectiveness of brief prolonged exposure therapy for PTSD: Expanding access to effective therapies. Clinical Case Studies, 20(6), 482–497. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=psyh&AN=2022-01994-004&site=eds-live&scope=site

Center for Substance Abuse Treatment (US). (2014). DSM-5 Diagnostic Criteria for PTSD. Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. https://www.ncbi.nlm.nih.gov/books/NBK207201/pdf/Bookshelf_NBK207201.pdf

Cross, D., Fani, N., Powers, A., & Bradley, B. (2017). Neurobiological development in the context of childhood trauma. Clinical Psychology- science and Practice, 24(2), 111–124. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=e19c26e9-7fd5-4afb-820c-7dfc9ffa11d9%40redis

Forkus, S. R., Raudales, A. M., Rafiuddin, H. S., Weiss, N. H., Messman, B. A., & Contractor, A. A. (2022). The Posttraumatic Stress Disorder (PTSD) Checklist for DSM–5: A systematic review of existing psychometric evidence. Clinical Psychology: Science and Practice. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=69b9a9be-70d3-4650-8cec-39d47f860c86%40redis

Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in Clinical Neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182008/pdf/DialoguesClinNeurosci-13-263.pdf