Reply To Discussion Board Regarding PTSD

Reply to one peer posting one additional/other evidence based practice pharmacologic and/or a non-pharmacologic main gold standard treatment/s for PTSD. Students may chose to post a complementary alternative method (CAM).  


Two graduate level, cited references in APA format. If accessible, post a link to the guideline or research article with the treatments.


Reply to this students post:

Case study: A 30-year-old male military veteran was taking a college exam. The classroom was located on the main floor university building. This particular classroom had many windows looking outside onto the grass. During the middle of a midterm exam the maintenance men started the lawn mower right outside the window to cut the grass. The large sound startled the man and he immediately jumped up and ran around the classroom twice and out into the hallway yelling secure the area! The man never came back to the exam room. A week later the man returned to class to apologize to the professor and classmates. He stated he mentioned he was an Iraq veteran and the starting of the lawnmower caused a flashback. The lawnmower sounded like a military machine in Iraq and he had a flashback in the middle of the exam where he felt he was back in Iraq during a bombing and he had to help get his squad out alive to secure the area. After this incident the man visited the university health clinic where he reported abrupt loud noises influenced frequent flashbacks. He reported being more irritable, easily startled, and reduced concentration. He reports to have nightmares once a week of the bombing due to the recollection of his friends death. He feels numbness. Today at the clinic he is asking for help in treatments to cope with PTSD.


PTSD Epidemiology/Etiology:

According to the US Center for Military Health Policy Research, published a population-based study that examined the prevalence of PTSD among previously deployed Operation Enduring Freedom and Operation Iraqi Freedom (Afghanistan and Iraq) Service members. PTSD was assessed using the PCL, as in the Gulf War Veterans study. Among the 1,938 participants, the prevalence of current PTSD was 13.8%. This study was relevant to the case study above.  Furthermore, PTSD is nondiscriminatory and can affect all individuals with trauma.

The etiology and pathophysiology of PTSD is unclear. However, studies using magnetic resonance imaging scans have shown that there is decreased volume of the hippocampus with patients who have PTSD compared with matched controls. (Bremner, Randall, Scott, Bronen, Seibyl, Southwick, Delaney, McCarthy, Charney,& Innis, 1995)

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Diagnostic criteria (what rating scale/tool would you want to use to score/rate/diagnose?)

According to the DSM-5 the criteria for PTSD will include the following. The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. The traumatic event is persistently re-experienced, Unwanted upsetting memories, Nightmares, Flashbacks, Emotional distress after exposure to traumatic reminders, Physical reactivity after exposure to traumatic reminders. Inability to recall key features of the trauma. Negative thoughts or feelings that began or worsened after the trauma, overly negative thoughts and assumptions about oneself or the world, Exaggerated blame of self or others for causing the trauma, Negative affect, Decreased interest in activities, Feeling isolated, Difficulty experiencing positive affect. Trauma-related arousal and reactivity that began or worsened after the trauma, Irritability or aggression, Risky or destructive behavior, Hypervigilance, Heightened startle reaction, Difficulty concentrating, Difficulty sleeping. Criteria also includes the Symptoms have to last for more than 1 month with Symptoms creating distress or functional impairment (e.g., social, occupational). Above all these symptoms are not due to medication, substance use, or other illness. (Veterans Affairs PTSD and DSM-5, 2013) Moreover, the rating tools I would use in diagnosis of PTSD is the PSS-SR scale and the CAPS-5 interview. The PSS-SR scale is a self-report scale where it has areas to express themselves and describe the trauma in a written setting. Pros to this scale are the following: clarity, ease of reading, opportunity to describe the traumas in the other section. The con is if the patient would rather speak in an interview the CAPS scale would be more beneficial. The gold standard is the CAPS scale in PTSD assessment. The CAPS-5 is a 30-item structured interview that can be used to: Make current (past month) diagnosis of PTSD, make lifetime diagnosis of PTSD, Assess PTSD symptoms over the past week. The benefit in the interview is the individuals can express their emotions to the clinician.


Course and prognosis (prevalence, incidence, example may include prognosis if treated, if not treated)

The course of Posttraumatic stress disorder is a chronic condition. According to the National Comorbidity Survey, There are only one-third of patients recovering at one-year follow-up and one-third still symptomatic 10 years after the exposure to the trauma.  Most individuals who develop PTSD experience its onset within a few months of the traumatic event. However, epidemiologic studies have found that approximately 25 percent experience a delayed onset after six months or more. The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women commonly associated with rape and sexual molestation. Prevalence is elevated in med who have had combat exposure. (1995) The incidence according to the American Psychological Association, states, PTSD affects approximately 3.5 percent of U.S. adults every year, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime. There is no definitive prognosis in treatment of PTSD however there are combination methods of medications and therapy to help reduce symptoms though management of PTSD disorder. The options for treatment are through pharmacological methods of SNRI, SSRI, monotherapy, antipsychotics. Nonpharmacological methods are therapy including CBT, EMDR and CAM options.


Pharmacologic treatment

Especially for the case scenario the veteran patient I believe would benefit from a combination involving Monotherapy. According to Villarreal, Hamner, Caive, Calais,et al., Clinical trials have found monotherapy with quetiapine (Links to an external site.) and other SGAs to reduce PTSD symptoms in military and non-military patients compared with placebo; some of the trials studied small samples. As an example, a randomized clinical trial compared quetiapine (Links to an external site.) monotherapy with placebo in 80 United States military veterans with chronic PTSD. Quetiapine was started at 25 mg/day and increased to an average of 258 mg/day (range, 50 to 800 mg/day). After 12 weeks, patients treated with quetiapine experienced improvement in overall scores on the CAPS, as well as on the re-experiencing and hyperarousal subscores compared with the placebo group. (2016)

Differential diagnosis and what else should be screened for?

The differential diagnosis could be general anxiety disorder, panic disorder, major depressive disorder, and substance abuse. What we should screen for is substance abuse and suicidal ideation. Posttraumatic stress disorder was associated with increased risk of a subsequent suicide attempt. The PTSDsuicide attempt association was robust, even after adjustment for a prior major depressive episode, alcohol abuse or dependence, and drug abuse or dependence. (Wilcox, Storr, & Breslau, 2009)

 




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