PTSD forms an incapacitating mental disorder that develops due to exposure to actual or threatened harm, demise, and sexual assault, termed as traumatic events. It can lead to individual and family performance disturbance, causing significant clinical, social, and financial issues. PTSD diagnosis occurs depending on various clusters of symptoms happening after exposure to extreme stressors (Miao et al., 2018). The prompt will discuss PTSD’s neurological basis and its DSM-5-TR diagnostic criteria relating to the case study symptomatology. The prompt will also focus on the video’s case presentation and related questions.
Neurological Basis of PTSD
Studies indicate that PTSD links with changes in the brain’s stress response coordination and pathways. Notably, it relates to amygdala hyperactivation, which involves fear conditioning and expressive memory. Moreover, PTSD is interconnected with condensed hippocampal volume, which is consolidated and contextualized (Dossi et al., 2020). Consequently, these neurobiological alterations can cause symptoms like hypervigilance, avoidance of trauma-associated stimuli, and re-occurrences of traumatic circumstances.
PTSD Diagnostic Criteria According to DSM-5-TR and Relation to Case Study Presentation
According toMiao et al. (2018), the most accepted PTSD diagnostic guideline include DSM-5 editions and ICD-11. DSM-5-TR diagnostic criteria for this disorder include various symptoms; avoidance, negative mood, cognition shifts, reactivity and arousal changes, and intrusion. From the video, Joe met the DSM-5-TR criteria for diagnosing PTSD, as shown by the intrusive re-emergence of trauma via memories and nightmares and avoiding trauma-associated stimuli by declining to talk about the car crash. Joe also had negative mood and cognition alterations since he had disorganized event comprehension.
Moreover, aggressive and dissociative manifestations show that reactions to trauma usually go beyond fear and anxiety domain (Tye et al., 2015). Joe’s frustrations could cause outbursts in class, for instance, table overturning and classroom trashing. Lastly, Joe exhibited elevated arousal and reactivity via petulance, hypervigilance, and annoyance eruptions (Dr. Todd Grande, 2019).
Video Case Presentation and PTSD Diagnosis
The case information presented in the video by Dr. Grande is sufficient to develop a PTSD diagnosis. It is because Joe’s symptomology is consistent with DSM-5-TR criteria for PTSD, and his account of the traumatic situation and its outcome offers proof of trauma experience.
Other Diagnoses
Attention deficit hyperactivity disorder (ADHD) and specific phobia mark the other diagnosis presented in the case, as they appear to be comorbid with PTSD. However, these diagnoses were present before the accident. The PTSD manifestations may have worsened the specific phobia and ADHD. According to Eaton et al. (2018), phobias include avoidance and fear. Major depressive disorder, conduct disorder, and oppositional defiant disorder are among the additional disorders discussed. The client is hostile, argumentative, adamant, and physically aggressive. It implies that Joe meets the criteria for an oppositional defiant disorder diagnosis. Furthermore, he feels gloomy, sad, and uninterested in his activities. These symptoms meet the major depressive disorder diagnostic criteria. Finally, his displeasure with the circumstances regularly resulted in outbursts in class, including tumbling tables and destroying a classroom, which met the criteria for conduct disorder diagnosis (Dr. Todd Grande, 2019).
Other Psychotherapy Treatment
Joe’s other psychotherapy treatment is cognitive behavioral therapy (CBT). It is an evidence-based approach that shifts cognitive patterns to change negative beliefs and actions. From the presentation, Joe has PTSD, Major depressive disorder, conduct disorder, oppositional defiant disorder, and a spider phobia. CBT is effective in managing all these conditions. In this case, the therapist may work with him to identify his unpleasant thoughts and sensations when he is reminded of the car accident and confrontation. The therapist can then teach Joe tools for modifying his ideas and actions, relaxation methods, cognitive restructuring, and exposure therapy. CBT may be a good psychotherapy therapy for Joe to tackle his concerns since it effectively manages conditions like PTSD.
Gold Standard Treatment
Clinical practice guidelines regard CBT as the gold standard treatment for PTSD. CBT is a widely accepted, evidence-based treatment for various psychological health disorders, including PTSD. Psychoeducation, exposure therapy, relaxation techniques, and cognitive restructuring are among the CBT components. CBT has been demonstrated to reduce PTSD symptoms like intrusive thoughts, avoidant behaviors, hyperarousal, and mood swings. Three specific CBT forms, cognitive processing therapy, cognitive therapy, self-instructional training, and prolonged exposure, offer significant evidence for their efficacy in treating PTSD. CBT aims to assist patients in processing and reshaping traumatic memories and related ideas and beliefs (David et al., 2018).
Psychiatric-mental health nurse practitioners (PMHNPs) should use gold-standard, evidence-based interventions from clinical practice guidelines because evidence-based treatments have been proven in rigorous scientific studies to be beneficial. They also provide a standardized approach for addressing specific disorders. PMHNPs may guarantee that their patients receive the greatest possible care and outcomes by employing evidence-based treatments (David et al., 2018). Furthermore, adhering to clinical practice guidelines helps PMHNPs offer care that aligns with the most recent research and clinical standards.
Resources
The articles by David et al. (2018) provide an evidence-based analysis of CBT, making it a gold-standard psychotherapy. The authors of the journal are specialists, as indicated by the article’s bibliography. The article also provides deep insights into the CBT modality. Additionally, the article by Watkins et al., 2018 provides more information on CBT. Its publication is done by a peer-reviewed journal, making it scholarly. The article by Eaton et al. (2018) is scholarly as its publication is in a peer-reviewed clinical journal; it provides a complex overview of phobias, and the authors are specialists and argumentative. The article also has an exhaustive reference list. The resource by Tye et al. (2015) is also scholarly as a renowned journal publishes it, has reference lists, provides authors’ information, and comprehensively discusses PTSD diagnostic criteria. Moreover, the work of Miao et al. (2018) is also scholarly as its publication is by a peer-reviewed journal; it provides comprehensive information on PTSD, an authors’ bibliography, and a comprehensive reference list. Lastly, an article by Dossi et al. (2020) provides in-depth information about the neurological bases of PTSD. Its publication is by Frontiers in Psychiatry, a peer-reviewed academic journal. The authors’ bibliography shows their expertise, and it is written in a legible and accessible manner.
Conclusively, PTSD is a disorder with a neurological basis, as evidenced by its association with various brain organs like the amygdala and hippocampus. The information in the case presentation is adequate to make a PTSD diagnosis. From the presentation, Joe has ADHD and specific phobias for spiders before the accident. After the accident, the patient may have developed other conditions like Major depressive disorder, conduct disorder, and oppositional defiant disorder. CBT forms a gold standard therapy for treating PTSD patients. Using gold standard, evidence-based treatments from clinical practice guidelines is essential for PMHNP because it ensures clients obtain the most effective and suitable care. Evidence-based practices have been rigorously studied and tested, and their effectiveness has been demonstrated through clinical trials and meta-analyses.
References
David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9(4), 1–3. https://doi.org/10.3389/fpsyt.2018.00004
Dossi, G., Delvecchio, G., Prunas, C., Soares, J. C., & Brambilla, P. (2020). Neural Bases of Cognitive Impairments in Post-Traumatic Stress Disorders: A Mini-Review of Functional Magnetic Resonance Imaging Findings. Frontiers in Psychiatry, 11, 176. https://doi.org/10.3389/fpsyt.2020.00176
Dr. Todd Grande. (2019). Presentation Example: Post-traumatic Stress Disorder (PTSD). In YouTube. https://www.youtube.com/watch?v=RkSv_zPH-M4
Eaton, W. W., Bienvenu, O. J., & Miloyan, B. (2018). Specific phobias. The Lancet Psychiatry, 5(8), 678–686. https://doi.org/10.1016/s2215-0366(18)30169-x
Miao, X.-R., Chen, Q.-B., Wei, K., Tao, K.-M., & Lu, Z.-J. (2018). Post-traumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1). https://doi.org/10.1186/s40779-018-0179-0
Tye, S., Van Voorhees, E., Hu, C., & Lineberry, T. (2015). Preclinical Perspectives on Post-traumatic Stress Disorder Criteria in DSM-5. Harvard Review of Psychiatry, 23(1), 51–58. https://doi.org/10.1097/hrp.0000000000000035
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: a Review of Evidence-Based Psychotherapy Interventions. Frontiers in Behavioral Neuroscience, 12(258), 1–9. https://doi.org/10.3389/fnbeh.2018.00258
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