Causes and Description of Post-Traumatic Stress Disorder - Essay Example

?Running Head: ANXIETY DISORDER Post traumatic stress disorder (PTSD) Outline I Introduction II. Body A. PTSD Definition 2. Overview of Causes 3. Neurological Overview B. Case Study 1. The Case 2. Mental Status Exam 3. DSM-IV Multiaxial Evaluation C. Treatment 1. Pharmacological Treatment 2. Generics and Trade Names 3. Side Effects II Summary A. Stress B. Relationship to Practice C. Summary Post traumatic stress disorder (PTSD) Introduction One of the most problematic anxiety disorders is post traumatic stress disorder. This disorder presents after an event that creates a sense of continuing threat, which in turn creates a sense of continuing terror and stress within the patient. Through an examination of a case study that provides an example of the condition, the effect on both the mind and the body can be appreciated. Treatment is available for the condition and can help the individual to work through the problems associated to this form of anxiety. The anxiety disorder known as post traumatic stress disorder can be a devastating problem, but with effective therapies the individual can work through their issues towards a better future. PTSD Post traumatic stress disorder (PTSD) is defined by Nutt (2003) as “an anxiety disorder precipitated by exposure to an event which involves actual or threatened death or serious injury or threat to the personal integrity of self or others that causes intense fear, helplessness, or horror” (p. 5). The prevalence of the condition is at 3.5% of the general population with 12% of the population within hospitals having various intensities of the condition ( The symptoms of the condition can be experienced acutely, between 1-3 months, chronically for 3 or more months or they can be delayed and experienced more than 6 months after the instigating event. The condition will present through reliving certain events, by active avoidance of certain parts of the event, numbing and increased arousal. The diagnosis of the condition occurs as the patient experiences the symptoms when exposed to different aspects of the event (Nutt, 2003). In exploring PTSD it is clear that the condition can be brought on by events that many will weather through normal forms of processing, while others who experience similar events will be entrenched in those events and unable to appropriately process those events and move past them. The individual will have trouble being ‘in’ the world as they try to concentrate and have trouble sleeping. The events are present even if not thought about while the individual struggles to become unstuck from the events that placed them in a state of PTSD. There are three regions of the brain that are of interest where PTSD is concerned. These regions are the amygdala, the medial prefrontal cortex, and the hippocampus. The amygdala is of interest because it appears to be central to the threat stimuli, the work of this region providing the overstimulation to the concept of a threat. According to Vasterling (2005), “individuals with PTSD have shown heightened acquisition of conditioned fear in Pavlovian fear-conditioning paradigms” (p. 60). The prefrontal cortex is involved as it seems to be the site where instinctual fear responses are formed. Those who acquire PTSD are not able to condition themselves down from a fear response, repeated exposures to threats not decreasing with any significance and remaining at the same level. The patient is hyper responsive to fear stimuli and remains in a vigilant state. The hippocampus can become damaged, having difficulty in retaining memories when the heightened state of fear is prolonged (Vasterling, 2005). Because of the frontal lobe impairment where planning and organization takes place is affected and the temporal lobes are affected as memory and emotion are shut down, the individual with PTSD no longer has joy accessible nor can they plan or execute their future with any effectiveness (Lawlis, 2010). Case Study Rosen and Freuh (2010) present a case study of a patient with PTSD who is male, Caucasian, 45 years old, from Bloomington, Indiana, married to his high school sweetheart and has a mother and sister who are treated for depression. For purposes of the case study he is called Mr. Gavin. He was previously treated by a college counselor for having some difficulties adjusting to college life. As an employee at a bank, Mr Gavin had been a part of a bank robbery and during the course of the events; Mr Gavin had inadvertently caused the robber to discharge his gun which killed a customer. He spent four weeks off work before returning, but was still experiencing depression, difficulty sleeping and concentrating, and drinking an average of between 10 and 12 beers per day in order to cope. The following is an assessment of Mr. Gavin in relationship to the Mental Status Exam. While the case study does not address the specifics on how Mr Gavin looks in relationship with his mental status, he isn’t sleeping and he is drinking quite a bit so it is likely that he would appear ashen and fatigued with dark circles and a glassy look in his eyes. Because he has trouble focusing and concentrating, it is likely that he is a bit disheveled and without polish in his dress. His speech patterns were not discussed in the case study, but because a thorough history was taken because of the potential workman’s compensation case, the precise nature of his history suggests he was coherent and could speak effectively. Mr. Gavin’s mood was depressed and overwhelmed, his feelings of anxiety heightened where he was reminded of the event. He appeared to be within normal intellectual levels and he was aware of his surroundings. According to the DSM-IV Multiaxial Evaluation, the following can be assessed for Mr. Gavin. The first criteria is fulfilled as for Axis A the individual must have experienced a trauma where death was threatened and the response was fear and horror. Mr Gavin fulfills the following for level B: the experience is relived for the individual and recurrent and intrusive memories are inhibiting concentration, intense distress when the events are symbolized in some respect, and his fear and memory is reactivated when reminded of the events. For Axis C Mr. Gavin fulfills the avoidance through drinking and numbing his feelings about the event. For Axis D, Mr Gavin fulfills two of the criteria by having trouble sleeping and concentrating. He concludes fulfilling the DSM-IV Multiaxial Evaluation by having experienced the symptoms for more than one month and he has become impaired by the trauma of the events in his social interactions which are specifically addressed by his inability to effectively work (Nutt, 2003). Treatment The Department of Veterans Affairs sponsored a study to assess the available pharmacological treatments for PTSD and concluded that there is no efficacy of intervention from a pharmacological perspective currently available. The only truly effective treatment known is exposure therapy. The most often drug therapies are often atypical antipsychotics, mood stabilizers, and corticotrophin modulator (Moore & Penk, 2011). The best choice for treating symptoms of PTSD are antidepressants that help with some of the symptoms while psychological therapies are being used to help alleviate the rest of the issues. Fluoxetine is one of the antidepressants that can be used to help put the symptoms under control, which is the generic name for Prozac and is one of the selective serotonin reuptake inhibitor class pharmaceuticals (Gorman & Nathan, 2007). The side effects for Prozac are numerous and often create a fear of the drug from its reputation, especially in someone who is suffering from PTSD through medical issues. Mild side effects include “Abnormal dreams; anxiety; decreased sexual desire or ability; diarrhea; dizziness; drowsiness; dry mouth; flu-like symptoms (eg, fever, chills, muscle aches); flushing; increased sweating; loss of appetite; nausea; nervousness; runny nose; sore throat; stomach upset; trouble sleeping; weakness; yawning” (Drugs.com, 2011). More severe side effects can include: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); bizarre behavior; black or bloody stools; chest pain; confusion; decreased concentration; decreased coordination; exaggerated reflexes; excessive sweating; fainting; fast or irregular heartbeat; fever, chills, or sore throat; hallucinations; increased hunger, thirst, or urination; joint or wrist aches or pain; memory loss; new or worsening agitation, panic attacks, aggressiveness, impulsiveness, irritability, hostility, exaggerated feeling of well-being, restlessness, or inability to sit still; persistent or severe ringing in the ears; persistent, painful erection; red, swollen, blistered, or peeling skin; seizures; severe or persistent anxiety, trouble sleeping, or weakness; severe or persistent nausea, vomiting, diarrhea, or headache; significant weight loss; stomach pain; suicidal thoughts or attempts; tremor; trouble urinating; unusual bruising or bleeding; unusual or severe mental or mood changes; unusual swelling; unusual weakness; vision changes; worsening of depression (Drugs.com, 2011). As shown by the severity of the potential side effects a patient who has PTSD must be carefully watched when under the influence of the drug so that the side effects that could exacerbate the condition are caught before they create a deeper set of issues. Summary The amount of stress involved in PTSD is severe, the initial event putting such pressure on the individual that long lasting effects become overwhelming and can have a transformative effect on the patient’s life. In treating a patient with PTSD it becomes an essential factor to understand how the trauma was experienced and what triggers were set during the event in order to disarm them. In relationship to future practice, understanding that PTSD can occur at events that might not seem quite as traumatic, but affect one’s integrity will be beneficial when helping those who have difficult illnesses such as cancer or heart disease. Different aspects of the care can come under the category of trauma and can be the cause of the condition. Often, it is not the direct event that causes the most distress, but a related event that may not be consciously understood by the patient (Nutt, 2003). In treating someone with PTSD medication is a secondary treatment with addressing the issues of the trauma taking precedence and using effective therapies that confront those issues can help to decrease the effects, hopefully moving towards a return to productive and satisfactory living. References Drugs.com. (2011). Prozac side effects. Drugs.com. Retrieved from http://www.drugs.co m/sfx/prozac-side-effects.html Gorman, J. M., & Nathan, P. E. (2007). A guide to treatments that work. New York: Oxford University Press. Lawlis, G. F. (2010). The PTSD breakthrough: The revolutionary, science-based compass reset program. Naperville, Ill: Sourcebooks. Levenson, J. L. (2011). The American Psychiatric Publishing textbook of psychosomatic medicine: Psychiatric care of the medically ill. Washington, DC: American Psychiatric Pub. Moore, B. A., & Penk, W. (2011). Treating PTSD in military personnel: A clinical handbook. New York: The Guilford Press. Nutt, D. J. (2003). Anxiety disorders. Malden: Blackwell. Rosen, G. M., & Frueh, C. (2010). Clinician's Guide to Posttraumatic Stress Disorder. Hoboken: John Wiley & Sons. Vasterling, J. J. (2005). Neuropsychology of PTSD: Biological, cognitive, and clinical perspectives. New York: Guilford Press. Read More