Neurobiological Basis of Post Traumatic Stress Disorder and Other Anxiety Disorders, Relationship between Nurses and Chronically Ill Mental Patients - Assignment Example

Case Study: Anxiety Disorder Student’s Name Institutional Affiliation Case Study: Anxiety Disorder Question One Amir is most likely suffering from PTSD or Post Traumatic Stress Disorder. It is a psychiatric condition that presents as a pathological anxiety occurring after an individual witnesses or experiences a severe traumatic event that is a threat to the physical well-being or life of the individual or another person (Gore, 2014). Important events that may result in trauma include violent personal assault, war, being kidnapped or taken hostage, confinement as a war prisoner, terrorist attack, torture, natural disaster, and dangerous car accident (Javidi & Yadollahie, 2012). PTSD types include acute and chronic. The former occurs if symptoms only continue for less than three months. Chronic PTSD, on the other hand, is symptomatic for more than three months. Common obvious symptoms of PTSD include continuous re-experiencing of the source of the trauma; resultant avoidance, numbness and hyper-arousal; and negative thoughts feelings and moods (Gore, 2014). These symptoms should persist for at least a month. PTSD may also affect the patient’s overall appearance. The patient may be poorly groomed and disheveled. Chronic PTSD patients may exhibit somatic complaints and clinical signs and symptoms that may be attributed to comorbidities. The diagnosis of PTSD is based on identification of eight DSM-5 criteria. Criterion A requires a person to have been exposed to a traumatic event through one of the following: direct exposure, personally witnessing the occurrence of a traumatic event, indirectly learning that a close relative experienced the traumatic event and repeated exposure to aversive scenes of the traumatic event (Gore, 2014). Amir satisfies this first criterion as he witnessed numerous episodes of self-harm through fellow detainees. He also faced direct trauma while in Afghanistan with his family. Criterion B entails persistent re-experience of the traumatic event. Amri exhibits intrusive, negative thoughts and often has dreams about the traumatic events he experienced while in detention and Afghanistan. These two signs are typical of criterion B of PTSD diagnosis. Amri also shows signs under criterion C. His reserved nature and reluctance to engage with others is because he is trying to avoid people or activities that may bring back the dreadful memories. Amri shows two symptoms grouped in criterion D. These include his diminished interest or participation in activities and his hopelessness and detachment feeling. He also exhibits two criterion E symptoms, that is, difficulties in concentrating and sleep disturbances. However, it should be ascertained that Amri has experienced these symptoms for more than one month and that the symptoms are not as the result of any medication. Question Two Neurobiology is a term that entails the biology of nerves and the nervous system. The neurobiology of anxiety, therefore, involves the function and activity of nerves in relation to anxiety or fear. “Normal” anxiety is just one way an individual responds to threats in the environment (Charney & Drevetes, 2002). The threat impulse is first transmitted to the fear or emotional center of the brain called amygdala. The latter stimulates the sympathetic nervous system in a 'fear and flight' response. This happens subconsciously. However, some sensory information is sent to the cortex via the hypothalamus. In the cortex, the information is analyzed, and a decision of whether a fear response is required is made. If the threat necessitates fear, the amygdala is signaled by the cortex to maintain the body in an alert mode (Charney & Drevetes, 2002). Visual and auditory stimuli are first processed by the thalamus before filtered cues are shunted to the amygdala or the appropriate cortical regions. Tactile and olfactory stimuli bypass the thalamus moving directly to the amygdala. Therefore, pain and smell usually evoke stronger feelings or memories than do sounds and sights (Martin, Ressler, Binder &Nemeroff, 2009). The amygdala has a primary role of triggering immediate response to fear. Information passing it is labelled emotionally important. On the contrary, the stria terminalis’ bed nucleus (BNST) preserves the response to fear leading to long-term distress and worry typically of anxiety (Charney & Drevetes, 2002). Unlike fear that develops after concrete stimulus, anxiety may develop with or without any stimuli and is generalized, tonic and of lower intensity. Startle reflex or reaction (SR) is used experimentally to study anxiety and fear. SR potentiation with conditioned stimulus serves as a fear model while potentiation with context illustrates anxiety (Martin, Ressler, Binder & Nimeroff, 2009). Anxiety disorders are a result of overactive BNST or amygdala and/or an underactive prefrontal cortex. Therefore, signals in the amygdala and prefrontal cortex of PTSD patients are more active and weaker respectively. Neurotransmitters mediating fear and anxiety include neuropeptide Y, substance P, Cortisol Releasing Hormone, norepinephrine, dopamine, serotonin, Gamma aminobutyrate (GABA) and glutamate (Charney & Drevets, 2002). Brain image studies can show the morphological relations of anxiety disorders. Other brain centers commonly involved include the memory center – hippocampus, raphe nuclei, periaquaeductalgray, basal ganglia and coeruleus (Charney & Drevets, 2002). Question Three Relationship between nurses and chronically ill mental patients can last for a very long time. The fluctuating moods and feelings of mentally ill patients requires nurses to have mastered other concepts and skills such as hope to offer safe, effective mental nursing care (Jackson & O’Brien, 2009). Hope plays an important role in clients and their families’ lives. Hope entails actively overcoming the temptation to despair. Creating and maintaining hope in a mentally ill patient is paramount towards recovery of the patient (Perkins & Repper, 2013). The practitioner’s hopefulness is central in rehabilitation too. There is an association between suicide and hopelessness. Hope is central to a mentally ill patients’ willingness to readily accept and participate in their mental recovery and rebuilding. Such patients face exclusion and prejudice in the society making it very easy for them to despair. Therefore, a nurse should take the responsibility of restoring and perpetuating this hope. Amri has a hopelessness feeling as he reveals to the nurse. This pessimistic feeling should be replaced by some optimism. The nurse should create hope inspiring relationship with Amri. Such therapeutic interpersonal relationships are significant in Amri's healing process (Jackson & O'Brien, 2009). He should be valued as a unique person, and his uncertainty over his future developments should be tolerated. Any failures or decompensations on Amri's recovery should not frustrate but be accepted by the nurse. The nurse should show belief in Amri’s potential and strengths. He should be reassured that he can overcome his condition and find employment. Amri’s reciprocal relationships with friends, peers, partners, family members and other people important in his life should be fostered (Perkins & Repper, 2013). Reciprocal relationships and hope would be fortified in group therapy, education of family and patient, employing appropriate humour, and developing Amri’s spiritual roots. Ultimately, restored hope would rebuilt Amri’s sense of well-being and self-esteem. Herth Hope Index can be used to asses Amri’s hopefulness and monitor his recovery progress. As a nurse, appropriate communication skills are important in assessing and managing mentally ill patients. Listening to Amri explain events make him connect with the nurse. Probing skills also come in handy. Open-ended questions are recommended as they encourage the patient to give a complete descriptive response (Morrissey & Callaghan, 2011). Non-verbal behavior or communication cues such as body language would help reveal more information about the patient. Question Four Ethnicity is an ethnic affiliation that encompasses membership in a social group that an individual chooses to be recognized with basing on shared cultural heritage and ancestry (Fenton, 2013). Amri comes from the Hazara community. When performing a cultural assessment of Amri, consideration would be on (1) his extend of acculturation – how deeply he relates to his culture relative to the new culture, (2) the language he is comfortable speaking and whether or not a translator may be required, (3) how he perceives certain non-verbal communication patterns from his ethnic perspective, that is, how he relates to eye contact, personal space, touch, gestures and facial expressions, (4) social customs and etiquette involving typical greetings and social customs prior to the assessment, and (5) his description of the problem. The assessment of the description should border on the diagnosis, onset, cause, course, prognosis and treatment. Open-ended questions should be used to elicit the best description from him (Jan, 2013). During nutritional assessment emphasize should be on his meals’ pattern, foods he perceives appropriate and inappropriate and food taboos and intolerances (Jan, 2013). Identification of potential drug or food interactions with his traditional foods is significant. Certain foods forbidden in his culture should not be imposed on him. In the course of pain assessment, his cultural patterns of handling pain should be understood. He may be the stoic or expressive type when in pain. Amri should be politely asked to reveal what pain means to him, his perception of severe pain before and after treatment, and his attitude concerning using pain medication (Jan, 2013). If he has ever experienced a severely painful episode, he should describe how he coped with it. The description is important in understanding the absence/presence and level of pain he might be experiencing. Another cultural assessments to be done should be relative to medication. Amri’s perception of western drugs should be documented (Jan, 2013). His attitude towards such drugs may be poor thereby resulting in compliance and adherence problems. Any traditional remedies that he consumes should be revealed to the nurse. Knowledge of the remedies will assist in instituting proper treatment while avoiding any confounding medicines. In addition, knowledge of Amri’s previous healthcare experiences is significant. He may have been uncomfortable with some elements of the healthcare system. Such elements need to be identified as they are paramount to his attitude and response to treatment. Lastly, a psychosocial assessment should be done to understand his family structure and resources. Family members may be needed in discussing his care since they may play a major role in decision making, in his life. Amri should be encouraged to help identify such family members. Any cultural support services in his community that may help in his recovery may be incorporated. References Charney, D.S. & Drevets, W.C. (2002). Neurobiological basis of anxiety disorders. In L.D. Kenneth, C. Dennis, T.C. Joseph & N. Charles (Eds.), Neuropsychopharmacology: The fifth generation of progress (pp. 901-930). Philadelphia, PA: Lippincott Williams & Wilkins. Fenton, S. (2013). Ethnicity (2nd ed.). Malden, MA: Polity Press. Gore, T.A. (2014). Posttraumatic stress disorder. Retrieved from http://emedicine.medscape.com/article/288154-overview Jackson, D & O'Brien, L. (2009). The effective nursing. In R. Elder, K. Evans & D. Nizette (Eds.), Psychiatric and mental health nursing (pp. 2-11). Chatswood, N.S.W: Elsevier. Jan, B. (2013). Assessment and diagnosis. In R. Elder, K. Evans & D. Nizette (Ed.), Psychiatric and mental health nursing (pp. 182-210). Chatswood, N.S.W: Mosby/Elsevier. Javidi, H. & Yadollahie, M. (2012). Post-traumatic stress disorder. International Journal of Occupational & Environmental Medicine, 3(1), 2-9. Martin, E.I., Ressler, K.J., Blinder, E. & Nemeroff, C.B. (2009). The neurobiology of anxiety disorders: Brain imaging, genetics, and psychoneuroendocrinolgy. Psychiatric Clinics of North America, 32(3), 549-575. Morrissey, J. & Callaghan, P. (2011). Communication skills for mental health nurses. Berkshire: Open University Press. Perkins, R. & Repper, J. (2013). Recovery and social inclusion. In I. Norman & I. Ryrie (Eds.), The art and science of mental health nursing: Principles and practice (3rd ed.), pp. 60-77). Berkshire: Open Univerity Press. Read More