Respond to student 1 Response
Traumatic accidents are deeply troubling and leave a lasting impact on a person. A number of psycho-emotional and psychological effects are precipitated by the stress that effects from traumatic events. Traumatic incidents such as family and social abuse, rape and attack, earthquakes, conflicts, accidents and abusive aggression present people with such horror and danger that they can temporarily or permanently alter their ability to cope, their understanding of biological danger, and their conceptions of themselves (Van der Kolk, 2000). DMS-5 defines PTSD as a result of being subjected to witnessing: enduring prolonged or serious exposure to aversive incidents: incidents involving a close friend or relative: or one or more of the following events: death or potential injury, or real or attempted sexual assault (Wheeler, 2014). Wheeler also claimed that repetitive thinking, avoidance attitude, destructive thinking and feelings, and hyperarousal must be present for at least 1 month after the trauma incident (Wheeler, 2014). In this discussion, I will analyze MR William Thompson family case study, and include behaviors that comply with the DSM-5 PTSD guidelines. Then, illustrate therapeutic approaches, including psychotropic drugs if applicable, and clarify the client’s expected results on the basis of these therapeutic methods.
Case Study Observation
MR William is a veteran who served in Iraq war. It is reported in one major survey of 60,000 veterans in Iraq and Afghanistan, on which 13.5 percent of deployed and non-deployed veterans tested positive for PTSD, although other reports indicate that the prevalence is as high as 20 percent to 30 percent (Reisman, 2016). When veterans return home after serving their country, they experience an increased incidence of mental health conditions, such as Post traumatic stress disorder, and they also face specific challenges in accessing adequate treatment. The most prominent co-morbidity of PTSD in veterans is depression. William seems distracted and has trouble concentrating. There is also an indication that he is going to lose his job due to alcohol and PTSD. Mr. William’s disorder may seem serious, and last long to adversely affect his personal life. For instance, he says, “they say I have PTSD,” instead of saying I have PTSD, suggesting a kind of dissociation.
There are few therapeutic approach I will use to intervene during treatment. Cognitive behavior therapy and Once highly controversial, eye-movement desensitization and reprocessing (EMDR) has gained acceptance and is now prescribed as appropriate treatment for PTSD in both civilian and combat-related cases in a wide variety of practice guidelines. (Reisman, 2016). All other PTSD drugs are used off-label and have only scientific support and advice: These include SSRI fluoxetine and Serotonin Norepinephrine Reuptake Inhibitor (SNRI) venlafaxine, which are prescribed as first-line therapies in the VA / DoD Clinical Practice Guideline for PTSD (Reisman, 2016). In the case of Mr. William, there is no evidence at this time that he needs psychotropic medicine, though further testing is needed to establish if he needs medication to improve his symptoms.
The expected outcome of any intervention is to stop the subsequent occurrence of adverse psychological effects. Cognitive behavioral psychotherapy includes a variety of techniques (i.e. systematic desensitization, relaxation training, biofeedback, cognitive processing therapy, stress inoculation training, assertiveness training, exposure therapy, mixed stress inoculation and exposure therapy, mixed stimulation and relaxation therapy, and cognitive therapy) (Iribarren et al., 2005). EMDR is for the client to learn how to manage negative feelings to the degree that painful memories can be brought up without negative emotions being generated (Shapiro, 2014).
Iribarren, J., Prolo, P., Neagos, N., & Chiappelli, F. (2005). Post-traumatic stress disorder: evidence-based research for the third millennium. Evidence-based complementary and alternative medicine : eCAM, 2(4), 503512. https://doi.org/10.1093/ecam/neh127
Reisman, M. (2016). PTSD Treatment for Veterans: What’s Working, What’s New, and What’s Next. P & T : a peer-reviewed journal for formulary management, 41(10), 623634.
Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente journal, 18(1), 7177. https://doi.org/10.7812/TPP/13-098
van der Kolk, B. (2000). Posttraumatic stress disorder and the nature of trauma. Dialogues in clinical neuroscience, 2(1), 722.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
Respond to student 2 Response
Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. Symptoms usually begin early, within three months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. (National Institute of Mental Health, 2019). The type of events that can cause PTSD include serious road accidents, violent personal assaults, sexual assault, mugging or robbery, prolonged sexual abuse, violence or severe neglect, witnessing violent deaths, military combat being held hostage, terrorist attacks, etc. People who have PTSD may feel stressed or frightened even when they’re no longer in danger. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers. The Diagnostic and Statistical Manual of Mental Problems (DSM-5) standards of the awful mishap must incorporate a genuine presentation or undermined passing, actual injury, sexual infringement as the necessary trigger for the issue with an individual legitimately encountering or as an observer (Lancaster et al., 2016). The effects of traumatic events place a heavy burden on individuals, families, and communities and create challenges for public institutions and service systems.
This discussion is fixated on Thompson’s family contextual analysis. The contextual analysis is William, a military Captain and an Iraq war veteran, Lawyer, spouse who will lose his employment, has lost his home because he failed to pay the home loan because of liquor use and PTSD. Thus, he lives with his senior sibling and his family (Laureate Education, 2012a). During the presentation of every relative, William has all the earmarks of having issues with fixation and core interest. He didn’t distinguish himself at first by his name; however, as the uncle and is just toward the end when he got out his name. He additionally recognizes that he moved his family to his sibling’s home as a result of the inability to pay his home loan. He further states, “they state I have PTSD,” showing a sort of depersonalization (Laureate Education, 2012a). As shown, he is going to lose his employment because of liquor use and PTSD. Since he is a commander and a war veteran, he more likely than not seen horrible accidents, for example, passing and other fierce acts. His liquor use might be because of the injury he encountered during his administration in the military. According to Dworkin et al. (2018), PTSD and liquor use are co-happening or comorbid in the military. Since William didn’t recognize that he has PTSD, however just said his family accepts that he has PTSD uncovers the measures of the issue. The abnormal response or conduct of the subject fits the utilitarian essentialness rules for PTSD.
The need to address trauma is increasingly viewed as an essential component of effective behavioral health service delivery. Additionally, it has become evident that addressing trauma requires a multi-pronged, multi-agency public health approach inclusive of public education and awareness, prevention and early identification, and practical trauma-specific assessment and treatment (Substance Abuse and mental Health Services Administration, 2016). Various examinations have been advanced elective restorative methodologies in overseeing PTSD on account of William. As a PMHNP treating this customer, I will utilize both pharmacological and non-pharmacological methods remedial since PTSD is an unpredictable, multifaceted tension problem regular among military veterans (Kobayashi et al. 2015), and William will enormously profit them. According to Kobayashi et al. (2015), the board of PTSD with SSRIs and SNRIs are the main line of treatment in dealing with the problem by viably lessening the three center side effects of reexperiencing, evasion, and hyperarousal. The purpose behind pharmacological mediation is because noteworthy affiliations have additionally been accounted for among PTSD and wretchedness and PTSD and self-detailed medical issues (Paintain and Cassidy, 2018). The reason for non-pharmacological therapy is because nonadherence continues to be a frequent phenomenon, often associated with potentially severe clinical consequences and increased health-care costs for patients with mental illness (Ramesh et al., 2015). There are numerous factors associated with medication nonadherence in patients with mental illness. William’s side effects might be more terrible than it appears and couple with how he may not know about his PTSD as he showed that ” they state I have PTSD.”
The non-pharmacological approach that I will use to treat William will be Cognitive Behavioral Therapy (CBT). This is because Cognitive Behavioral Therapy (CBT) investigates the connections between considerations, feelings, and conduct. It is an order, time-restricted, organized methodology used to treat an assortment of emotional well-being messes. It intends to ease trouble by helping patients to grow more versatile insights and practices. It is the most broadly explored and observationally upheld psychotherapeutic strategy. CBT eventually expects to instruct patients to be their advisor, by helping them to comprehend their present perspectives and acting, and by outfitting them with the apparatuses to change their maladaptive psychological and standards of conduct (Fenn and Byrne, 2013). CBT focuses on learning to diminish problematic behaviors linked to substance abuse, in this case, alcohol.
Therapeutic Approach outcomes
The expected results with CBT are that of learning relational abilities to addresses avoidance identified with PTSD, relationship issues, and testing injury-related convictions. The advantage of CBT will make the customer know about his well-being-related concerns and the need to get the intercession (Flanagan et al., 2018). Likewise, with CBT, another typical result is the capacity to oppose liquor use as a few examinations have exhibited that CBT altogether lessens liquor use issue.
Dworkin, E. R., Bergman, H. E., Walton, T. O., Walker, D. D., & Kaysen, D. L. (2018). Co-Occurring Post-Traumatic Stress Disorder and Alcohol Use Disorder in U.S. Military and Veteran Populations. Alcohol Research: Current Reviews, 39(2), e1e9. Retrieved from Walden Library databases
Fenn, K., & Byrne, M. (2013). The key principles of cognitive-behavioral therapy. innovation: Education and Inspiration for General Practice, 6(9), 579585. https://doi.org/10.1177/1755738012471029
Flanagan, J. C., Jones, J. L., Jarnecke, A. M., & Back, S. E. (2018). Behavioral Treatments for Alcohol Use Disorder and Post-Traumatic Stress Disorder. Alcohol Research: Current Reviews, 39(2), e1e12. Retrieved from Walden Library databases
Kobayashi, T. M., Patel, M., &Lotito (2015). Pharmacotherapy for posttraumatic stress disorder at a Veterans Affairs facility. American Journal of Health-System Pharmacy, 72(S1), S11S15. DOI: 10.2146/ajhp150095
Lancaster, C. L., Teeters, J. B., & Back, S. E. (2016). Posttraumatic stress disorder: Overview of evidence-based assessment and treatment. Journal of Clinical Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC51268…
Laureate Education (Producer). (2012a). Academic year in residence: Thompson family case study [Multimedia file]. Baltimore, MD: Author.
National Institute of Mental Health. (2019, February 8). NIMH?» Post-Traumatic Stress Disorder. Nih.Gov. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml?
Paintain, E., & Cassidy, S. (2018). First?line therapy for post?traumatic stress disorder: A systematic review of cognitive-behavioral therapy and psychodynamic approaches. Counselling & Psychotherapy Research, 18(3), 237250. DOI:10.1002/capr.12174
Ramesh, M., Parthasarathi, G., Ram, D., & Lucca, J. (2015). Incidence and factors associated with medication nonadherence in patients with mental illness: A cross-sectional study. Journal of Postgraduate Medicine, 61(4), 251. https://doi.org/10.4103/0022-3859.166514
Substance Abuse and mental Health Services Administration. (, 2016). Behavioral Health Issues Among Afghanistan and Iraq U.S. War Veterans | Publications and Digital Products. Store.Samhsa.Gov. https://store.samhsa.gov/product/Behavioral-Health…
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