Post-Traumatic Stress Disorder - Assignment Example

Mental Health Case Study Name Institution Date Mental Health Case Study Question 1 Brief Overview Ben is a classic illustration of the impacts that follow after experiencing a traumatic experience. Ben was sexually abused by his step father and four other men when he was 13 years old and this is when he suffered the anxiety disorder that developed into post traumatic stress disorder. According to Njenga (2006), the symptoms Ben presents illustrate post traumatic stress symptoms which can be classified into 3 key classifications (DSM IV classification) (4) persistent re-experiencing of the incident; the intrusive symptoms. These consist of the nightmares, vivid flashbacks, a feeling of re-living the event, persistent avoidance of any stimuli reminding the person of the trauma in addition to numbing of general responsiveness (Njenga, 2006. Additionally, post traumatic stress disorder patients experience a hyper-arousal state that result to hyper-vigilance, startle reflexes, and sleep disturbance (Njenga, 2006). All these symptoms result to some level of psychological impairment where the affected person is not able to go on with daily activities because of the symptoms. Other symptoms consist of emotional liability, irritability, restlessness, and at times sudden occurrences of violent behavior and drug and alcohol abuse can follow (Njenga, 2006). In this case study, the above symptoms are depicted where Ben after being sexually abused (traumatic experience) changed to being angry and despondent. He started smoking marijuana heavily and had depression and paranoia. Additionally, he rarely socialized and become irritable, in addition to being violent at times. His violent episodes include where he attacks his mother with a knife among others. Marijuana abuse is an attempt to forget the traumatic event (Njenga, 2006). Managing Ben Bryan (2006) helping the patient relax is a vital initial intervention of engaging a patient like Ben and mitigating the effect of the traumatic incident. During these interventions, precaution should be taken for Ben’s safety and other hospital personnel as well. Ben suffers symptoms of hyper-arousal depression and outbursts of violent behavior as depicted by his violent and irritant behavior towards his mother and other people, it is important to assist the patient in relaxing (Cohen, 2010). Relaxation is the most effective way of managing Ben’s irritant moments and episodes of anger and this can be achieved through taking Ben through relaxation techniques like breathing exercises, muscular relaxation exercises, meditations, and such. Through engaging Ben in relaxing activities, it will relax him and he will learn to quiet his distress. As a result, relaxing the patient ensure that he is calm and hence not a threat to himself or people around him (Bryan, 2006). However, security measures need to be taken such like ensuring that a security guard is around him to protect the nurses and people around the hospital in case Ben experiences outbursts of violent behavior and attacks people around him. Nonetheless, the most important thing is to ensure that Ben relaxes, is less aggressive and is calm as well. Supportive counseling will be necessary to provide Ben with emotional and psychological support and relaxation techniques will be very useful mostly during the hyper-arousal state (Widom, 2010). Question 2 Ben’s Mental State Examination Appearance Grinage (2010) asserts that patients with post traumatic stress disorder have problems in daily activities and are hypersensitive and show reactions such as being delirious, being anxious and difficulty in concentration. This is depicted in Ben where he is poorly groomed as shown by his unkempt outfits and strong body odour. He is tense and seems to be delirious as he seems to be mumbling incoherently to himself. Behaviour Ben seems to be anxious as he keeps walking up and down the ED corridor. He is also tense and mumbles to himself incoherently. He seems to isolate himself, apprehensive and does not want to talk to anyone. For instance, he tells the nurse he is like them and while in the cubicle he is hallucinating where he sees things that are not real. He has also shown violent behaviour and marijuana abuse after he was sexually abused. Avoiding people and conversations, nightmares, restlessness, and outbursts of violent behavior and substance abuse are some of behaviors shown in people with post traumatic stress disorder as illustrated in Ben’s case (Njenga, 2000). Speech Difficulty in concentration is a sign of increased anxiety and emotional arousal and this consequently can impact the speech (Stapleton, 2006). Ben is not clear in his articulation, for instance he does not answer questions clearly and takes long before responding to questions. Additionally, his speech is not audible and is incoherent as well. Mood Ben is irritable, depressed, and hyper-aroused. According to Grinage (2010), patients with post traumatic stress disorder are normally irritable, have depression and experience a hyper-arousal. Affect Ben exhibits agitation and confusion where he smiles often but becomes sad all over again. He is not aware that he is in a hospital and keeps asking the nurse why he is there. This indicates that Ben has somehow lost a touch with the reality (Stapleton, 2006). Form of Thought Mental difficulties like scattered thought is common in patients who have had prolonged traumatic circumstances (Cohen, 2010). Ben’s thought is scattered, for example he cannot recollect his thoughts and say something meaningful and is also confused. Content of Thought Cohen (2010) explains that the content of thought in patients with post traumatic stress disorder is normally scattered. Ben depicts this in where he is delusional, for example his thought is preoccupied with imaginary things like imaginary people always being after him and watching him. Perceptual Ben’s perception is abnormal. For example, his actions indicate delusions and passivity phenomena in him. He is in his own world and understands things different from the reality. This is an indication that Ben is emotionally numb and is having mental difficulties (Widom, 2010). Cognition Ben’s cognition skills are not efficient. For example, he cannot remember things that happened to him in the past (temporary amnesia), he is not in touch with reality, is not coherent and cannot answer questions correctly. This indicates that the patient has difficulties in concentrating and is not able to remember important aspects which are typical symptoms of post traumatic stress disorder (Widom, 2010). Insight It is not possible to get information from Ben regarding his condition because he is extremely confused and is not aware of his condition. Additionally, he is uncooperative with the nurses and others in the hospital. This can be attributed to Ben not wanting any intrusive and upsetting memories of the event and thus he does not even want to accept his condition. Confusion can be attributed to mental difficulties resulting from his condition (Grinage, 2010). Question 3 Potential Risks Suicide Risk Ben may experience suicidal thoughts as a result of despair, dejection and depression because of his condition. According to Tull (2008), rates of suicide attempts among individuals who have had sexual assault are 42.9%. Similarly, Tull (2008) found out that a history of sexual molestation, and neglect as a child were allied to high rates of suicide attempts. As per the case study, Ben was sexually assaulted by his stepfather and other four men and since his family members are always involved in marijuana and alcohol abuse, he may have felt neglected as a child. Individuals with a diagnosis of post traumatic stress disorder are at a higher risk of attempting suicide and since the patient is exhibiting signs of despair, dejection from his family members and depression (Tull, 2008). Additionally, since Ben is in hospital and he is not even aware of where he is this can make him feel continuously afraid and isolated. Generally, post traumatic stress disorder can have tremendous effect on an individual’s life. Still, Ben has depression which is common among individuals with post traumatic stress disorder and thus Ben may feel as if he is hopeless and there is no escape from his symptoms leading him to contemplate suicide (Tull, 2008). Violence towards the Hospital Staff Ben is reported to have been involved in several violent incidents in the past. In one instant he threatened his own mother with a knife and other similar violent incidents. He has also been quoted in several occasions to have threatened his neighbours. There is a high probability that he can exhibit the same behaviour at the hospital. He can use any available weapon to attack the nurses around him. Generally, patients with post traumatic stress disorder sometimes have outbursts of violent behaviour, impulsivity, aggression and episodes of intense anger which results from brain and hormonal changes resulting from the condition (Widom, 2010). Forexample, he believes there are imaginary people watching him and following him and he may attack people within vicinity while fighting the imagery individuals. Therefore, Ben’s episodes of anger, aggression, impulsivity and outbursts of violent behaviour pose a risk to the hospital staff because he can become violent any time (Widom, 2010). Self Injuries Porter (2008) explains that patients with post traumatic stress disorder often engage in self-destructing activities. This is exhibited by the erratic events of Ben hurting himself with objects by cutting his own body after moments of despair which has resulted to him having scars, cuts and scratches around his arms. According to the case study, Ben uses marijuana to relax and normally gets restless and intolerable when the influence of marijuana subsides. Since while in hospital he cannot access marijuana that he uses to relax, he can engage in self-destructing activities that can result to self-injuries. Furthermore, delusions, emotional liability, irritability, restlessness and a hyper-arousal state that results to hyper-vigilance, startle reflexes can also contribute to Ben involving to self-destruction activities to counter imaginary battles against him (Porter, 2008) Question 4 Formulation According to Acierno (2010) post traumatic stress disorder is found among people who have had an exposure to prolonged traumatic conditions, in particular during childhood, for instance childhood sexual abuse. Studies indicate that numerous brain and hormonal changes might take place due to early, prolonged trauma and contribute to memory problems and difficulties in emotion regulation. Prolonged traumatic circumstances combined with upsetting, abusive home environment may result to the brain and hormonal changes contributing to severe behavioral difficulties like eating disorders, impulsivity, aggression, alcohol or substance abuse, and other self-destructive actions, as well as emotional regulation (like extreme anger, depression, or panic) and mental difficulties (like scattered thoughts, dissociation, and amnesia) (Widom, 2010). The case study indicates that Ben had a prolonged exposure to traumatic conditions. First, he was sexually assaulted by his stepfather and four men when he was only 13 years which must have been a very traumatic experience for him. From this traumatic event, Ben began getting angry for no reason and started taking marijuana to (Acierno, 2010). This was worsened by the fact that Ben was living in an abusive and dejected home environment where he underwent a lot of hardships during his childhood. His needs, both physical and emotional, were never attended to by his parents. His mother and grandmother are drug addicts and could not adequately take care of him. The mother even spent most part of the family earnings to buy alcohol, marijuana and other drugs. They spent very little on basic needs, such as food. It is reported that Ben would be scolded by his mother for eating too much. The mother repeatedly told him that she was not in a position to meet his eating demands. It is possible that Ben, in most cases, concealed his unmet needs and chose to internalize the resulting feelings of depression and anxiety (Widom, 2010). Hypothesis One of the hypotheses that can be formulated from Ben’s present issues is the traumatic experience which he went through when he was only 13 years old. The sexual assault was such a terrifying incident to Ben that he developed an anxiety disorder after that. Consequently, the sexual assault event triggered post traumatic stress disorder for Ben. Ben after being sexually abused (traumatic experience) changed to being angry and despondent. He started smoking marijuana heavily and had depression and paranoia. Additionally, he rarely socialized and become irritable in addition to being violent at times and these were effects of hormonal and brain changes that occurred after the sexual assault (traumatic event). Marijuana abuse is an attempt to suppress the distressing effects of the traumatic event (Njenga, 2006). Secondly, Ben lived in a home an obnoxious home environment. His grandmother, mother and father were always abusing alcohol and marijuana which in itself is a traumatic environment and thus greatly contributing to his post traumatic stress disorder. For instance, he is not fed enough and his allowance is used by the family to buy alcohol and marijuana which can make him feel dejected, isolated, and desperate and thus making him unable to regulate his emotions leading to feelings of depression and anxiety (Widom, 2010). Question 5 Nursing Care Plan Problem Plan (interventions) Expected Outcome (O) and Criteria for Evaluation (E) Rationale Hyper-arousal symptoms evidenced by irritability, troubled sleep, exaggerated startle response, difficulty in concentrating, and always being alert Begin administration and monitoring of anti-anxiety medication such as Klonipin or Xanax Start Breathing-Relaxation Exercises (Slowik, 2012). (O) Slowing down of the central nervous system as a result of reduction in brain activity Reduction of stress by blocking the effects of adrenaline on various organs Lowered tension and hence lead to inadvertent muscle relaxation resulting to reduced distress Ben has refrained from suicidal (E) Is the patient exhibiting hyper-arousal symptoms like restless, sleep, muscle tension, irritability, and concentration difficulties? If then, are the symptoms reducing or escalating? Is the Ben re-experiencing the traumatic event in flashbacks, delusions, intrusive thoughts, and dissociation? If so, are the experiences increasing or reducing? (Slowik, 2012). Evidence shows that commencement of anti-anxiety medicines improve the symptoms of hyper-arousal and breathing-relaxation exercises reduce tension in patients and thus resulting to inadvertent muscle relaxation and eventually reducing distress (Widom, 2010). Depressive symptoms as evidenced by depression, paranoia, being anti-social, scattered thought pattern Debriefing which will be done in groups and Ben along with other patient will recount his key elements of trauma and their feelings towards the traumatic event and circumstances Start administration and monitoring of prescribed anti-depressant medicines (Slowik, 2012). (O) Significant improvement in concentration Ben is able to talk about his traumatic experiences in the therapy group Improved cognitive processing of the information It will help Ben in getting the traumatic experience off the chest and thus it will provide him with emotional release (E) Increased level of social interactions Increased level of concentration Reduction in levels of restlessness Reassurance of Ben’s normality Ben’s improved level of calmness (Slowik, 2012). Evidence indicates that debriefing is effective and helps patients with post traumatic stress disorder to feel better and relieves anxiety as well. The procedure of the patient being listened to unconditionally and non-judgmentally by an empathic listener greatly contributes to relives patients the depressive symptoms (Njenga, 2006). In addition, evidence indicates that administration of anti-depressant medicines greatly improves symptoms of depression References Acierno, R. (2010). Specifity of posttraumatic stress disorder symptoms: an investigation of comorbidity between posttraumatic stress disorder symptoms and depression in treatment-seeking veterans. J Nerv Ment Dis. Vol. 198(12):885-90. Cohen, J. (2010). Practice Parameter for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder. J of the Amer Acad of Child and Adoles Psychiatry. Vol. 49(4). Grinage, B. (2010). Diagnosis and Management of Post-traumatic Stress Disorder. Am Fam Physician. Vol. 15; 68(12):2401-2409. Njenga, G. (2000). Post-Traumatic Stress Disorder: Case Report. East African Medical Journal. Vol. 77(4). Porter, R. (2008). The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories. Stapleton, J. (2006). Effects of three PTSD treatments on anger and guilt: exposure therapy, eye movement desensitization and reprocessing, and relaxation training. J Trauma Stress. Vol. 19(1):19-28. Slowik, A. (2012). Emergence of delayed posttraumatic stress disorder symptoms related to sexual trauma: patient centered and trauma-cognizant management by physical therapists. Phys Ther. Vol. 92(2):339-51 Tull, M. (2008). Suicide risk in civilian PTSD patients: Predictors of suicidal ideation, planning, and attempts. Social Psychiatry and Psychiatric Epidemiology. Vol. 39, 655-661. Widom, C. (2010). Post-traumatic stress disorder moderates the relation between documented childhood victimization and pain 30 years later. Pain. Vol. 152(1):163-9. Read More