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NRNP 6645 WEEK 9 Posttraumatic Stress Disorder

NRNP 6645 WEEK 9 Posttraumatic Stress Disorder

NRNP 6645 WEEK 9 Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an example of a trauma and stressor-related disorder characterized by anxiety and restlessness. The condition is also associated with behavioral issues, adolescent substance abuse issues, and physical ailments. The purpose of this paper is to describe the neurobiological basis of PTSD, review a case study and diagnostic criteria, and a psychotherapeutic treatment.

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Neurobiological Basis of PTSD

Psychological stressors are the main trigger for PTSD pathogenesis. Psychologic stress causes an increase in cortisol that activates a pro-inflammatory state in the body by increasing interleukin (IL) levels. ILs induce neuroplasticity in several brain regions, such as the amygdala, prefrontal cortex, and hippocampus, responsible for mood and emotional regulation (Al Jowf et al., 2023). For example, elevated IL-6 levels have been associated with amygdala hypertrophy, hippocampal synaptic loss, and downregulation in brain-derived neurotrophic factor (BDNF), resulting in anxiety and behavioral disturbance. Furthermore, prolonged stress exposure disrupts glutamate, serotonin, and noradrenaline neurotransmission, increasing extracellular neurotransmitters and excitotoxicity. The excitotoxicity precipitates neuronal atrophy and reduces the dendritic length, synaptic density, and neurotransmission strength, causing behavioral abnormalities or mood and anxiety dysregulation.

DSM-V Criteria

The DSM-V criteria for diagnosis of PTSD include direct or indirect exposure to the traumatic event, intrusive, arousal, or avoidance symptoms, and alterations in cognition or mood due to trauma. Intrusive symptoms include distressing memories or dreams and flashbacks, while avoidance symptoms include efforts to avoid distressing memories, thoughts, and external reminders of the event. (Schrader et al., 2021). Cognition or mood symptoms include selective

amnesia, persistent negative emotional state, and anhedonia. Furthermore, patients can experience alterations in arousal and reactivity, such as irritability, anger outbursts, recklessness,

hypervigilance, problems with concentration, and sleep disturbance. According to the case, Joe meets the DSM-V criteria for PTSD diagnosis. Joe was directly exposed to the event and has been having intrusive memories, arousal symptoms such as trouble sleeping and nightmares, and avoidance symptoms whenever the street or car is mentioned.

Other diagnoses given after the event include conduct, oppositional defiant, major

depression, and separation anxiety disorders. I would also agree with the diagnosis of separation anxiety disorder, as Joe has been experiencing nightmares about the event and feels the need to sleep with his father event (Danese et al., 2020). The reaction would be due to fear of losing his only remaining parent. However, the diagnosis of oppositional defiant disorder and conduct disorder may be inaccurate as the irritability and mood symptoms may have been a result of the recent. Joe does not meet the diagnostic criterion of major depression as he has not had a depressed mood, weight changes, or fatigue, among other depression symptoms.

Psychotherapy in PTSD

Cognitive Processing Therapy (CPT) is one of the forms of psychotherapy used in PTSD treatment. CPT focuses on how the traumatic event happened and the patient’s coping mechanisms. The cognitive therapy techniques focus on faulty thoughts related to traumatic events and allow the patient to identify and analyze their emotions (Thomas et al., 2023). In addition, CPT enables the patient to identify and address thoughts that may prevent recovery. The therapist also equips the patient with several cognitive skills he can use to aim for recovery. However, despite the use of CPT, the American Psychiatrist Association (APA) recommends trauma-focused cognitive behavioral therapy (CBT) as the goal standard treatment option for PTSD (Schrader et al., 2021). It is crucial to use goal-standard treatment as it reflects evidence-based practices from research to ensure patients receive the most effective interventions that have positive outcomes.

Conclusion

PTSD is a psychiatric disorder that follows exposure to a traumatic event. Its pathogenesis is associated with elevated cortisol levels due to chronic stress. APA has advocated for the use of trauma-focused CBT as the mainstay psychotherapy method as it has shown better results with PTSD patients.

References

Al Jowf, G. I., Ahmed, Z. T., Reijnders, R. A., & T. Eijssen, L. M. (2023). To Predict, Prevent, and Manage Post-Traumatic Stress Disorder (PTSD): A Review of Pathophysiology, Treatment, and Biomarkers. International Journal of Molecular Sciences, 24(6). https://doi.org/10.3390/ijms24065238

Danese, A., McLaughlin, K. A., Samara, M., & Stover, C. S. (2020). Toxic Stress and PTSD in Children: Psychopathology in children exposed to trauma: Detection and intervention needed to reduce downstream burden. The BMJ, 371. https://doi.org/10.1136/bmj.m3073

Schrader, C., & Ross, A. (2021). A Review of PTSD and Current Treatment Strategies. Missouri Medicine, 118(6), 546-551. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8672952/

Thomas, F. C., Loskot, T., Mutschler, C., Burdo, J., Lagdamen, J., Sijercic, I., M. Lane, J. E., Liebman, R. E., Finley, E. P., Monson, C. M., & Wiltsey-Stirman, S. (2023). Initiating Cognitive Processing Therapy (CPT) in Community Settings: A Qualitative Investigation of Therapist Decision-Making. Administration and Policy in Mental Health, 50(1), 137-150. https://doi.org/10.1007/s10488-022-01229-8

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Posttraumatic Stress Disorder

It is estimated that more almost 7% of the U.S. population will experience posttraumatic stress disorder (PTSD) in their lifetime (National Institute of Mental Health, 2017). This debilitating disorder often interferes with an individual’s ability to function in daily life. Common symptoms of anxiousness and depression frequently lead to behavioral issues, adolescent substance abuse issues, and even physical ailments. For this Assignment, you examine a PTSD video case study and consider how you might assess and treat clients presenting with PTSD.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

  • Download Preclinical perspectives on posttraumatic stress disorder criteria in DSM-5. Harvard Review of Psychiatry, 23(1), 51–58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542003/
    Credit: Preclinical Perspectives on Posttraumatic Stress Disorder Criteria in DSM-5 by Susannah Tye, PhD, Elizabeth Van Voorhees, PhD, Chunling Hu, MD, PhD, and Timothy Lineberry, MD, in HARVARD REVIEW OF PSYCHIATRY, Vol. 23/Issue 1. Copyright 2015 by ROUTLEDGE. Reprinted by permission of ROUTLEDGE via the Copyright Clearance Center.
  • Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
    • Chapter 3, “Assessment and Diagnosis” (Previously read in Week 2)
    • Chapter 7, “Eye Movement Desensitization and Reprocessing Therapy”
    • Chapter 11, “Trauma Resiliency Model Therapy”
    • Chapter 15, “Trauma-Informed Medication Management”
    • Chapter 17, “Stabilization for Trauma and Dissociation”
    • Chapter 18, “Dialectical Behavior Therapy for Complex Trauma”

Required Media

 

To prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide about diagnosing and treating PTSD.
  • View the media Presentation Example: Posttraumatic Stress Disorder (PTSD) and assess the client in the case study.
  • For guidance on assessing the client, refer to Chapter 3 of the Wheeler text.

Note: To complete this Assignment, you must assess the client, but you are not required to submit a formal comprehensive client assessment.

 

The Assignment

Succinctly, in 1–2 pages, address the following:

  • Briefly explain the neurobiological basis for PTSD illness.
  • Discuss the DSM-5-TR diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?
  • Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment” from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.

Support your Assignment with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

By Day 7

Submit your Assignment. Also attach and submit PDFs of the sources you used.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK9Assgn_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

Rubric

NRNP_6645_Week9_Assignment_Rubric

NRNP_6645_Week9_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome Succinctly, in 1–2 pages, address the following:• Briefly explain the neurobiological basis for PTSD illness.
15 to >13.0 ptsExcellent 90%–100%

The response includes an accurate and concise explanation of the neurobiological basis for PTSD illness.

 13 to >11.0 ptsGood 80%–89%

The response includes an accurate explanation of the neurobiological basis for PTSD illness.

 11 to >10.0 ptsFair 70%–79%

The response includes a somewhat vague or inaccurate explanation of the neurobiological basis for PTSD illness.

 10 to >0 ptsPoor 0%–69%

The response includes a vague or inaccurate explanation of the neurobiological basis for PTSD illness. Or, response is missing.
15 pts
This criterion is linked to a Learning Outcome • Discuss the DSM-5-TR diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?
25 to >22.0 ptsExcellent 90%–100%

The response includes an accurate and concise description of the DSM-5-TR diagnostic criteria for PTSD and an accurate explanation of how they relate to the symptomology presented in the case study…. The response includes a concise explanation of whether the case provides sufficient information to derive the PTSD and other diagnoses. Justification demonstrates strong diagnostic reasoning and critical thinking skills.

 22 to >19.0 ptsGood 80%–89%

The response includes an accurate description of the DSM-5-TR diagnostic criteria for PTSD and an adequate explanation of how they relate to the symptomology presented in the case study…. The response includes an explanation of whether the case provides sufficient information to derive the PTSD and other diagnoses. Justification demonstrates adequate diagnostic reasoning and critical thinking skills.

 19 to >17.0 ptsFair 70%–79%

The response includes a somewhat vague or inaccurate description of the DSM-5-TR diagnostic criteria for PTSD and a somewhat vague or inaccurate explanation of how they relate to the symptomology presented in the case study…. The response includes a vague or inaccurate explanation of whether the case provides sufficient information to derive the PTSD and other diagnoses. Justification demonstrates somewhat inadequate diagnostic reasoning and critical thinking skills.

 17 to >0 ptsPoor 0%–69%

The response includes a vague or inaccurate description of the DSM-5-TR diagnostic criteria for PTSD and a vague or inaccurate explanation of how they relate to the symptomology presented in the case study. Or, response is missing…. The response includes a vague or inaccurate explanation of whether the case provides sufficient information to derive the PTSD and other diagnoses. Justification demonstrates poor diagnostic reasoning and critical thinking skills. Or, response is missing.
25 pts
This criterion is linked to a Learning Outcome • Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard” treatment from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.
30 to >26.0 ptsExcellent 90%–100%

The response includes an accurate and concise explanation of one other psychotherapy treatment option for the client in this case study…. The response clearly and concisely explains whether the recommended treatment option is a “gold standard” treatment and why using gold standard, evidence-based treatments from clinical practice guidelines is important for PMHNPs.

 26 to >23.0 ptsGood 80%–89%

The response includes an accurate explanation of one other psychotherapy treatment option for the client in this case study…. The response adequately explains whether the recommended treatment option is a “gold standard” treatment and why using gold standard, evidence-based treatments from clinical practice guidelines is important for PMHNPs.

 23 to >20.0 ptsFair 70%–79%

The response includes a somewhat vague or incomplete explanation of one other psychotherapy treatment option for the client in this case study…. The response provides a somewhat vague or incomplete explanation of whether the recommended treatment option is a “gold standard” treatment and why using gold standard, evidence-based treatments from clinical practice guidelines is important for PMHNPs.

 20 to >0 ptsPoor 0%–69%

The response includes a vague and inaccurate explanation of one other psychotherapy treatment option for the client in this case study, or the treatment option is innappropriate. Or, response is missing…. The response provides a vague or incomplete explanation of whether the recommended treatment option is a “gold standard” treatment and why using gold standard, evidence-based treatments from clinical practice guidelines is important for PMHNPs. Or, response is missing.
30 pts
This criterion is linked to a Learning Outcome ·   Support your approach with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. PDFs are attached.
15 to >13.0 ptsExcellent 90%–100%

The response is supported by specific examples from this week’s media and at least three peer-reviewed, evidence-based sources from the literature that provide strong support for the rationale provided. PDFs are attached.

 13 to >11.0 ptsGood 80%–89%

The response is supported by examples from this week’s media and three peer-reviewed, evidence-based sources from the literature that provide appropriate support for the rationale provided. PDFs are attached.

 11 to >10.0 ptsFair 70%–79%

The response is supported by examples from this week’s media and two or three peer-reviewed, evidence-based sources from the literature. Examples and resources selected may provide only weak support for the rationale provided. PDFs may not be attached.

 10 to >0 ptsPoor 0%–69%

The response is supported by vague or inaccurate examples from the week’s media and/or evidence from the literature, or is missing.
15 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.
5 to >4.0 ptsExcellent 90%–100%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineates all required criteria.

 4 to >3.5 ptsGood 80%–89%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

 3.5 to >3.0 ptsFair 70%–79%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.

 3 to >0 ptsPoor 0%–69%

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.
5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 ptsExcellent 90%–100%

Uses correct grammar, spelling, and punctuation with no errors.

 4 to >3.5 ptsGood 80%–89%

Contains 1 or 2 grammar, spelling, and punctuation errors.

 3.5 to >3.0 ptsFair 70%–79%

Contains 3 or 4 grammar, spelling, and punctuation errors.

 3 to >0 ptsPoor 0%–69%

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 to >4.0 ptsExcellent 90%–100%

Uses correct APA format with no errors.

 4 to >3.5 ptsGood 80%–89%

Contains 1 or 2 APA format errors.

 3.5 to >3.0 ptsFair 70%–79%

Contains 3 or 4 APA format errors.

 3 to >0 ptsPoor 0%–69%

Contains many (≥ 5) APA format errors.
5 pts
Total Points: 100

 












            
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