Psychotherapy of individuals NURS 6640
Post-Traumatic Psychiatric Disorders: The Case of post-traumatic stress disorder or PTSD
Introduction
Jason (not his real name) is a 41 year-old male who presented for counselling with regard to his substance abuse problem. He was diagnosed with post-traumatic stress disorder (PTSD) three years ago and has been on treatment ever since, though he is not very compliant to it (he complains of sometimes severe constipation which started after treatment). PTSD is a disorder that affects persons who have been through events in which they experienced death or near-death in real time. Although it can be successfully treated, it has been shown that there is a poor prognosis and a high chance of successful suicide attempts by PTSD patients who also take alcohol or other substances (ANA, 2014; Katzung, 2018). This paper takes a look at the case of Jason, his diagnosis, any effective therapies available for him, and ethico-legal factors surrounding his management. Psychotherapy of individuals NURS 6640
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History, Background, and Current Treatment
Jason is a decorated Gulf War veteran who was honourably discharged from the military after completion of his service. He is married with two children, although lately he has been having marital problems which he attributes to his drinking behavior. In the last one year, his symptoms have worsened leading him to indulge in even more alcohol. The ones he most frequently experiences are insomnia, hyper-alertness (he easily gets startled), unexplained anger, and social detachment, including from his wife of seven years. He is currently on a single psychoactive pharmacologic agent and no other supportive therapies. He takes the second generation antipsychotic drug quetiapine ER 300mg per day (Katzung, 2018). His psychiatrist had recently suggested sending him to a therapist to start the introduction of other non-pharmacologic interventions (psychotherapy). However, he admits that he has of late not been honouring his appointments with the doctor as required.
The Diagnosis of PTSD
This patient had already been diagnosed with PTSD as stated above, but a confirmation of the diagnosis is paramount if any of the other therapies is to be introduced. According to the PTSD diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), Jason is indeed suffering from the condition. Criteria A1-4 are applicable to him in that he is a war veteran who saw his colleagues die and most certainly almost died himself (American Psychiatric Association, 2013). His hyper-alertness and the fact that he gets easily startled satisfy criteria E3-4, his anger and detachment meet criteria D4 & 6, and the insomnia satisfies criterion E6 (American Psychiatric Association, 2013).
Possible Effective Psychoanalytic Therapies for Jason
Jason is already on quetiapine ER (Seroquel XR) monotherapy. From the assessment, what he needs most is not another drug, but counselling for medication compliance an addition of psychotherapy to treatment. Some of the psychotherapeutic approaches that could benefit him are cognitive behavioral therapy (CBT), Cognitive processing therapy (CPT), and eye movement desensitization and reprocessing or EMDR (Campbell et al., 2016; Corey, 2017). According to Campbell et al. (2016) CPT is an important evidence-tested therapy for PTSD. Corey (2017) on his part avers that CBT proven and recommended as psychotherapy, as well as EMDR. The expected treatment outcomes of any of these therapies are a remission of symptoms and a return to normalcy. A combination of drugs and psychotherapy has been proved to be effective in PTSD (Cukor & Difede, 2013), although consensus is still elusive as to the standard approach to treatment (Bernardy & Friedman, 2015). On ethics, there is always the risk of re-traumatizing this kind of PTSD patient as you “confront” them on the sensitive matter of substance abuse (Barrette, n.d.). Psychotherapy of individuals NURS 6640
References
American Nurses Association [ANA] (2014). Psychiatric-mental health nursing: Scope and standards of practice, 2nd ed. Silver Spring, MD: ANA.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington, VA: APA.
Barrette, M.S. (n.d.). Ethical issues and decision making in the treatment of trauma. Retrieved from https://dhss.delaware.gov/dsamh/files/si2013_ethicalissuesandtrauma.pdf
Bernardy, N.C. & Friedman, M.J. (2015). Psychopharmacological strategies in the management of post-traumatic stress disorder (PTSD): what have we Learned? Current Psychiatry Reports, 17(4), 1-10. DOI: DOI 10.1007/s11920-015-0564-2
Campbell, M., Decker, K.P., Kruk, K., & Deaver, S.P. (2016). Art Therapy and Cognitive Processing Therapy for Combat-Related PTSD: A Randomized Controlled Trial. Art Therapy: Journal of the American Art Therapy Association, 33(4), 1–9. DOI: 10.1080/07421656.2016.1226643
Corey, G. (2017). Theory and practice of counselling and psychotherapy, 10th ed. Boston, MA: Cengage Learning.
Cukor, J & Difede, J. (2013). Review: Psychotherapy, somatic therapy and pharmacotherapy are all more effective than control for the treatment of PTSD. Evidence-Based Mental Health, 17(1). DOI: 10.1136/eb-2013-101527
Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. New York, NY: McGraw-Hill Education.
Psychotherapy of individuals NURS 6640
