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.

Question

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.

Dan Palmer · Accepted Answer

The occurrence of Post-traumatic stress disorder is enabled by both biological and psychological factors. To understand the neurobiological basis of the illness, it is crucial to understand how traumatic experiences can impact the brain’s structure ad and chemical balance. One of the aspects to consider when analyzing the brain is the hippocampus. This region's primary responsibility is memory formation and consolidation (Al Jowf et al., 2023). For patients with PTSD, the hippocampus might show altered activity which affects the way the traumatic memories have been formed. Another focus area is the amygdala.  This part is crucial in regulating emotions which include anxiety and fear. When a person is suffering from PTSD the amygdala usually becomes hyperactive and leads to extreme fear responses and invasive memories. The prefrontal cortex can also affect individuals with PTSD because it is responsible for decision-making and emotional regulation (Al Jowf et al., 2023). When it is underactive, one cannot effectively manage their emotions or rationalize fear. It is also crucial to understand how social factors and genes can contribute to PTSD.  DSM-5-TR diagnostic criteria for PTSD  The DSM diagnostic criteria make it possible for two different doctors to come up with the same diagnosis. This is considered the industry standard and it helps in making more accurate diagnoses. One aspect of consideration in the diagnosis should be the exposure to a traumatic event. The event can cause serious injury or threaten serious injury, cause actual death, or threaten death among other traumatic experiences (Martin et al., 2021). The second aspect is intrusion symptoms as explained by Al Jowf et al. (2023). This can include recurrent distressing memories of the event, and emotional distress upon exposure to cues that can be associated with the traumatic event.  The third measure is avoidance symptoms such as inability to recall crucial details of the events, avoidance of external events that remind them of the traumatic events, and avoiding thoughts or feelings that can be linked to the event. The fourth determinant of diagnosis is the negative alternations in cognition and moods. This can include negative emotional states, different perceptions of the world such as perceiving it as dangerous, and having intrusive thoughts about what caused the traumatic events and their consequences.  When considering the case study, there was sufficient information to diagnose PTSD (Morganstein et al., 2021). On the first cluster, it is clear that Joe had been exposed to a traumatic accident where he was involved in a minor traffic accident and they were pursued home by the assailant. In cluster B, Joe had intrusive nightmares about the traumatic event and also had emotional distress from remembering the event.  On cluster C, Joe had tried to block out memories of the event and this explains why he was only remembering fragments of the event as he filled it up with the worst scenarios to expect. In cluster D, it is clear that Joe was in constant fear that something bad would happen to his father as he was still living in the experience. Additionally, he experienced separation anxiety as he did not want to be separated from his father. I therefore agree with the diagnosis given.  Gold Standard for Addressing the Case  The gold standard when treating children with PTSD is trauma-focused cognitive behavioral therapy. According to Thielemann et al. (2022), this involves teaching a child and their parents about trauma and explaining that the symptoms are common experiences of people experiencing trauma. This therapy method then focuses on ensuring that they help children learn how to deal with the symptoms by helping them understand their thoughts and how the thoughts affect what they do and their lives in general.  After making children understand their thought systems and how they work, the treatment focuses on helping children talk about the trauma.  It is possible that they might not be willing to talk about it, but the therapist should slowly help them open up as that is a part of the experience and is necessary for healing (Chipalo, 2021). After this, there can be a trauma narrative which is usually stories written by the therapist for the children that allows them to think more about the trauma in a calm and safe space. Through the narrative, the child understands that they are now safe and quits reliving the trauma.  References  Al Jowf, G. I., Ahmed, Z. T., Reijnders, R. A., de Nijs, L., & Eijssen, L. M. T. (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), 5238. https://doi.org/10.3390/ijms24065238  Chipalo, E. (2021). Is Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) Effective in Reducing Trauma Symptoms among Traumatized Refugee Children? A Systematic Review. Journal of Child & Adolescent Trauma, 14(4). https://doi.org/10.1007/s40653-021-00370-0  Martin, A., Naunton, M., Kosari, S., Peterson, G., Thomas, J., & Christenson, J. K. (2021). Treatment Guidelines for PTSD: A Systematic Review. Journal of Clinical Medicine, 10(18), 4175. https://doi.org/10.3390/jcm10184175  Morganstein, J. C., Wynn, G. H., & West, J. C. (2021). Post-traumatic stress disorder: update on diagnosis and treatment. BJPsych Advances, 1–3. https://doi.org/10.1192/bja.2021.13  Thielemann, J. F. B., Kasparik, B., König, J., Unterhitzenberger, J., & Rosner, R. (2022). A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents. Child Abuse & Neglect, 134, 105899. https://doi.org/10.1016/j.chiabu.2022.105899

Briefly explain the neurobiological basis for PTSD illness.

Written By: Dan Palmer, RN

Edited By: Ethan Green, MSN-FNP