Identification and Management of Posttraumatic Stress Disorder - Case Study Example

Running Head: POST-TRAUMATIC STRESS DISORDER Reflective Paper of Post-Traumatic Stress Disorder of the Under the guidance of APA format Reflective Paper of Post-Traumatic Stress Disorder Post traumatic stress disorder or PTSD is a mental health condition that occurs as a result of exposure to trauma (Gore, 2014). The condition not only affects the individual mentally but also leads to several physical illnesses. Ignoring this condition may lead to suicide. Working in the psychology wards, it has come to my understanding that it is very important to identify PTSD as soon as possible and initiate appropriate therapy. The condition occurs because of a powerful stress incident that is overwhelming. The incident makes the individual work through their normal reactions of stress and hence lose their abilities to recover from terrible experience. There is enough evidence to project that early identification and management of PTSD causes prevention of progression of disease, decreases physical ailments and helps the individual reverse to normalcy (Gore, 2014). I chose to dicuss PTSD in my project. Various causes, clinical presentation, diagnosis and management will be discussed through review of literature. Initially, PTSD was considered to be a reaction to severe stress or difficult situation. However, it is now identified as a psychiatric disorder and is classified under Diagnostic and Statistical Manual of Mental Disorders. It may be defined as "a pathological anxiety that usually occurs after an individual experiences or witnesses severe trauma that constitutes a threat to the physical integrity or life of the individual or of another person" (Gore, 2014). Inthe initial phase following stress, the individual develops feelings of horror and helpnessness and intense fear. This is the initial phase. In the next phase, the individual re-experiences the event again and again. This leads to hyperarousal, avoidance, numbness, impairment of functions and distress. these symptoms must be present atleast for month to make a diagnosis of PTSD (Gore, 2014). Common traumatic disorders which contribute to PTSD are road traffic accidents, military warfare, natural calamities, death of beloved individual, rape and diagnosis of life-threatening disease like cancer. In adolescents and children, any form of child abuse can lead to PTSD. PTSD can be acute or chronic. In the former, the symptoms are for less than 3 months. In the latter, the symptoms are for more than 3 months. in some cases the symptoms develop late. If the symptoms develop 6 months after the traumatic event, then the PTSD is considered to be delayed (Grinage, 2003). The exact incidence of PTSD all over the world is unknown. However, it has been estimated that the lifetime prevalence is about 8- 10 percent (Gore, 2014). Females suffer more than males. There are basically 2 types of PTSD. They are dissociative PTSD and non-dissociative PTSD. In the former, there is overmodulation of the affect and dysregulation of various emotions. In the non-dissociative form, both the emotions and affect are intact (Gore, 2014). The exact mechanism of causation of PTSD is unknown. One proposed mechanism is activation of amygdala and other related structures like hypothalamus and parabrachial nucleus. Activation of these areas leads to triggering of neurotransmitter and endocrine activities leading to PTSD symptoms (Yeluda, 2002). Stress causes atrophy of nuclei in hippocampus and orbitoprefrontal cortex. hence these areas are no longer in a position to modulate or inhibit activation of amygdala and surrounding areas, which, in normal conditions are able to. Thus various symptoms of PTSD arise. This is the amygdala theory. Another theory is the neuroendocrinology theory. According to this theory, a severely traumatic event causes overactive adrenaline response leading to certain neurological patterns in brain. These patterns last for a long time and make the individual hyperresponsive in certain situations. The neuroendocrinological changes are different from those in depression and other psychotic disorders. Though PTSD is because of stress, unlike in stress, cortisol levels are low. But catecholamine levels are very high. Hence, norepinephrine: cortisol ratio is very high in patients with PTSD. In stress, both cortisol and catecholamines are very high. This indicates that hypothalamic-pituitary-adrenal axis is abnormal is patients with PTSD (Yeluda et al, 2004). There is vague evidence that PTSD is hereditary (True et al, 1993 and Binder et al, 2008). There can be subclinical PTSD and general physicians may fail to recognise this. To establish a diagnosis of PTSD, there are 6 criteria which need to be met. The patient must confront with a traumatic experience which is overwhelming. This must be followed by a phase of helplessness, severe fear and horror. Children and adolescents may have agitation and behavioural problems. The thrid criteria is that the individual re-experiences the traumatic event in one or more ways like dreams, images of injury, thoughts of injury, flash-back episodes, illusions and hallucinations. Children re-experience through repetitive play. Some patients may not recall the events of trauma and some others may experience detachment. They may show lack of interest in certain important activities. The fourth criteria is that there must be presence of other symptoms like irritable mood, hyperarousal, hypervigilance, decreased concentration outbursts of anger and startle response.The fifth criteria is that the symptoms must last atleast for a month. The sixth criteria is that the patient suffers from distress that is significant enough to cause functional impairment. In children, typical features of PTSD seldom occur. Instead, they may present as excessive crying without anyreason, separation anxiety, severe clinging, severe trembling and extreme fright. Regression behaviours lack of attention, sleep disturbances, withdrawl symptoms, refusal to go to school and anxiety may also be seen (Gore, 2014). It is very important to differentiate PTSD from other conditions like mood disorders, acute stress disorder, malingering, adjustment disorder and substance disorders. It is equally important to identify co-existing disorder, i.e., dual diagnosis (Gore, 2014). This is because, PTSD is more common in those with pre-existing psychotic disorders and unless the original disorder is treated, PTSD is unlikely to resolve completely. Most of the symptoms of PTSD can be reverted by early diagnosis, assessment and management. Progression of distress and disabilities can be prevented. Non-pharmacological treatments include art therapy, behavioural therapies, play therapy, management of anxiety, eye movement desensitization and relaxation techniques. In children and adolescents, the main treatment is psychotherapy. In those with PTSD secondary to physical abuse or sexual abuse, psycho-dynamic oriented psychotherapy is the preferred mode of treatment. Other than pschotherapy, some patients may need pharmacological treatment. There are very few drugs approved for use in PTSD. Sertraline and parxetine are currently approved for used in PTSD. Both are equally effective. Those with associated psychotic symptoms may need antipsychotic medication (Grinage, 2003). In view of political and public interest in PTSD, ethical and legal considerations have to be addressed. There are several gaps in this regard. Many veterans suffer from this problem and repeated deployments may exacerbate this condition (Grifford, 2008). Also, many sufferers are reluctant to seek medical help. According to the Ethical Practices in Research, " Veterans with a diagnosis of PTSD should be afforded special consideration consistent with current regulation and policy if and when an IRB determines that these veterans have impaired decision-making capacity, an increased susceptibility to undue influence or coercion, or an increased susceptibility to the risks associated with a particular research study" (Berkowitz et al, 2009). PTSD is a mental health illness that occurs secondary to exposure to severe traumatic incident. It is frequently unrecognised and underdiagnosed. Those who have undergone a diagnosis may be reluctant in seeking medical help. The condition occurs due to maladaptation to stress due to abnormal neuroanatomical changes or due to inappropriate neuroendoctinological response. Clinical examination is the only way to diagnose PTSD. Treatment is mainly non-pharmacological. References Berkowitz, K., Hans, S., Olsen, D., et al. (2009). Ethical Considerations in the Report of a Work Group on Post Traumatic Stress Disorder (PTSD) and Vulnerable Populations in Research. Ethical Practices in Research. Retrieved on Dec 4th, 2010 from http://webcache.googleusercontent.com/search?q=cache:iiL-BD01C30J:www.ethics.va.gov/docs/net/NET_Topic_20090225_exec_summary.doc+PTSD+ethical+consideration&cd=5&hl=en&ct=clnk&gl=in Binder, E.B., Bradley, R.G., Liu, W., et al. (2008). Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. JAMA, 299 (11), 1291–305. Gore, T.A.(2014). Posttraumatic Stress Disorder. Medscape. Retrieved on 22nd April, 2014 from http://emedicine.medscape.com/article/288154-overview Gifford, R.K. (2008). Key Ethical Considerations in PTSD and TBI Research. Uniformed Services University. Retrieved on 22nd April, 2014 from http://www.dtic.mil/biosys/docs/hu-key_ethical_considerations_ptsd_tbi-2008.pdf Grinage, B.D. (2003). Diagnosis and Management of Post-traumatic Stress Disorder. American Family Physician, 68(12), 2401-2409. Retrieved on 22nd April, 2014 from http://www.aafp.org/afp/2003/1215/p2401.html, True, W.R., Rice, J., Eisen, S.A., et al. (1993). A twin study of genetic and environmental contributions to liability for posttraumatic stress symptoms. Arch. Gen. Psychiatry, 50 (4), 257–64. Yehuda, R. (2002). Clinical relevance of biologic findings in PTSD. Psychiatr Q, 73 (2): 123–33. Yehuda, R., Halligan, S.L., Golier, J.A., Grossman, R., Bierer, L.M. (2004). Effects of trauma exposure on the cortisol response to dexamethasone administration in PTSD and major depressive disorder. Psychoneuroendocrinology, 29 (3), 389–404. Read More