Post Traumatic Stress Disorder

Question: Discuss about the Post Traumatic Stress Disorder. Answer: Introduction Post traumatic stress disorder is a kind of anxiety disorder. It is a chronic illness which consists of a set of reactions that occur when an individual has gone through a traumatic event of shock. There many factors associated with development of this mental disorder. Trauma is the main reasons, which means a situation where people are trapped and could not find a way to rescue (National Institute for Clinical Excellence, 2005). Such traumatic events lead to Post traumatic stress disorder. Aetiology Post-Traumatic Stress Disorder is a kind of anxiety disorder. The people, who have directly witnessed any kind of traumatic event, and experience repeated and severe exposure to the aversive details of the traumatic event, may suffer from Post-Traumatic Stress Disorder. When an individual goes through a life threatening event such as natural disaster, physical or sexual assault in childhood or adult, serious accident etc. such people can develop PSTD due to the stress reaction (National Institute for Clinical Excellence, 2005). PSTD can also occur, when an individual suffer from the death of loved one then he may develop symptoms of PSTD, not immediately, but even after many years. The scientists are trying to study that why some people develop PSTD and other does not. The studies are also focusing on the genes that lead to creation of fearful memories and some others are involving studies of brain (Ursano et al, 2010). Incidence The incidence of Post Traumatic Stress Disorder are very sever and dangerous. Researchers have explained that most incidences of PTSD appear in vulnerable people, who have gone through some kind of dangerous of severe traumatic event. The prevalence of PTSD is also seen in the victims of rape, assault, physical abuse, and war. Such people are more vulnerable and more likely to develop the symptoms of PTSD. The stage of this anxiety disorder can be set by the genes and specific difference in the brain (Forbes et al, 2007). History of mental illness, head injury or childhood trauma and many other environmental factors can increase the risk of PTSD and hinders the growth of the brain. The prevalence and incidence of Post traumatic stress disorder also depends on the cognitive skills and personality of the individual. The level of optimism and coping skills can have positive and negative impact on the severity of the disorder. Social support of the people also becomes an important factor in such incidence, as social support of an individual will display that how he or she will cope with traumatic events. According to the reports of Australian Bureau of Statistics, 1.4 million people in Australia suffer from Post traumatic stress disorder at any one time, which makes 6.4% of the total population (Hoskins et al, 2015). Many people live with the disorder and they do not even know about their real problem. Predisposing factors People from every age can suffer from PTSD. However, it has been noted that there are some factors that increase the risk of the disease. These factors are mainly the traumatic events, which involves experiencing trauma in early childhood (neglect and childhood abuse), having a job with increased level of exposure towards traumatic events, suffering from mental problems such as anxiety and depression, lack of support from family and friends, family history of mental illness, depression or PTSD (Carniaux-Moran, 2008). Thus, PTSD can be characterized by the direct exposure to the traumatic events. Here, the primacy of the trauma is more important than vulnerability of an individual. Mental State Examination A brief mental state examination is very important for the patients of PTSD and for DSM-IV mental disorders. Mental state examination is very helpful in explaining the existence of the disorder, extent and frequency of the signs and symptoms, examining that how signs and symptoms relate with social functioning and employment (Carniaux-Moran, 2008). The examination includes: Examination is conducted to identify the impairment of communication and though process. Identify any signs of hallucinations, delusions and persistence of such signs. Examination involves the interaction of the patient, eye contact and any kind of inappropriate behavior cited with an example (Carniaux-Moran, 2008). Examination involves identification of any signs, intent or plans of suicide, suicidal thoughts and homicidal thoughts (Carniaux-Moran, 2008). Examining the ability to maintain minimal hygiene and ability to carry out basic activities. Examination involves identifying signs of short or long term memory loss. Presence of any kind of obsessive and ritualistic behavior that can hinder routine activities. Examination of flow and rate of speech in context with obscure speech patterns, irrelevant or illogical speech pattern, and constant or intermittent speech (Carniaux-Moran, 2008). Examination also involves reporting of the panic attacks, their severity, frequency, duration and effect of the attacks on independent functioning of the patient. Examination involves identifying signs of depression, and anxiety. Presence of impaired impulse control in patient and effect on mood and motivation. Any kind of problem in sleeping pattern and interference with day time activities. Examination of the other symptoms and disorder that interfere with the daily activities (National Collaborating Centre for Mental Health, 2005). Three Problems associated with Patients condition and Rational: Substance use and alcoholism: The patient suffering from PTSD may start substance abuse, alcohol and nicotine in order to cope with their stress and anxiety. Such patients believe that these things can reduce their stress. Substance abuse and alcoholism also increases hallucinations and delusion (Fox et al, 2012). Depression: The traumatic situations can lead the patients towards severe depression. The patient may feel helpless and problems with concentration may also occur (Fortinash Holoday-Worret, 2008). Suicidal Thoughts: The patient suffering with deterioration condition of PTSD may have increased risk of suicide. People suffering with PTSD and other anxiety disorder are more prone to commit suicides (Pitman et al, 2012). Medication Post traumatic stress disorder comes with co-morbidities. These co morbidities include depression and anxiety. Thus, medication of PTSD must mainly focus on reducing depression and anxiety in patients. Selective Serotonin-Reuptake Inhibitors (SSRIs) is the first and most effective medication in treating patients with PTSD. This medication includes SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro) (Andrade, 2014). This kind of medication is well known for controlling anxiety and mood disorder. In some of the individuals suffering from PTSD, it has been found that they have deficiency of amygdala serotonin. This neurotransmitter is very important for brain to control mood. Selective serotonin reuptake inhibitors (SSRIs) modulate the level of amygdala serotonin in the central nervous system as well as in the peripheral system (Andrade, 2014). This is the only medication for PTSD, which have been approved by FDA. This medication is also the only medication that has been supported by empirical evidences in randomized controlled trials (RCTs) of reducing the symptoms of PTSD (Jeffreys, 2009). This is the initial part of medication, which is preferred for all the cases of PTSD. Exceptions may occur of the medical history of the patient about any side effects, co-morbidities, response and personal preferences. The exception could also be in the cases, where the patient is suffering from PTSD as well as bipolar disorder. In bipolar disorder, antidepressant can result into mood instability. In this condition mood stabilizing medication such as lithium or an anti-epileptic medication is given to the patient before SSRIs (Laddis, 2011). Nursing Intervention: SSRIs are very important for the patient suffering from Post traumatic stress disorder. This medication facilitates better tolerability and safety for patient. Patient must be encouraged to take medication in order to improve mental health. Patient suffering from mental disorder often refuse to take medication on time. Medication is an essential therapy for such patients. Identifying any signs of the side effects of medication, such as insomnia, anxiety or agitation. This is important to known so that dosage of the medication can be controlled (Ursano et al, 2010) Antidepressant for Post Traumatic Stress Disorder Antidepressants are helpful in balancing serotonergic and noradrenergic neurotransmission. Also this kind of medication is helpful in altering serotonin neurotransmission through different mechanism are helpful in PTSD. Some of the antidepressents are Mirtazapine (Remeron), Venlafaxine (Effexor) and Nefazodone (Serzone) (Jeffreys, 2009). The major use of the antidepressant is to treat the co-morbid Major Depressive Disorder (MDD). This disorder accompanies PTSD in 50% cases. Nursing Intervention: Antidepressant can result into different kind of sexual dysfunctions, which could be very depressive for patient itself. Thus nurse requires to support patient. While administering this medication, the quantity must be controlled and should be cautiously interpreted. Without cautious control it can lead to sever sexual dysfunction, impotency in males and anorgasmia (Ursano et al, 2010). Weight gain is another side effect of this medication, which requires being managed. Patients weight should be monitored regularly (Ursano et al, 2010). Recovery Focused Practice Recovery focused practice is based on the perspective of the individual suffering from mental disorder like PTSD. Recovery refers to retain hope and gain it through good practice. It also involves understanding about the abilities and disabilities of the patient, his active engagement in life, autonomy, and purpose of life, social identity and to develop a positive sense towards life. For this approach, it is essential to understand that recovery of a patient is not a cure, while recovery refers to internal condition and external conditions (Hoskins et al, 2015). Internal conditions are the perspective of the individual about themselves, which includes hope, empowerment, healing and recovery. External conditions include the conditions, which are helpful in making recovery. External conditions are positive culture of healing, implementing human rights and providing recovery oriented service (Stuart, 2014). The participants in recovery based practice will learn to identify the multiple evidence based practice approaches, while providing the trauma therapy to the patient. This practice also facilitates the opportunity for the care providers to implement and integrate the cognitive processing therapy as well. Recovery focused practice also focuses on supportive psychotherapy that help patients to overcome their traumas (Peterson, Prout, Schwarz, 2013). The Goals of Recovery Focused Practice It focuses on recognizing the uniqueness of every individual. It considers that recovery is not just the cure, but it must also involve individuals choices and to improve quality of life. It should be accepted that recovery outcomes are different in every patient, and not same level of recovery can be expected in every patient. Patients should be supported and empowered to have trust in the care providing setting (Peterson, Prout, Schwarz, 2013). Every individual must be supported to make their own choices. Their decision about how they want to spend their life must be accepted. Individual must be supported in a way that they understand importance of their lives and take every possible responsibility of their life. Care providers must also maintain balance between duty of care and supporting individuals. The care providers focus on listening, learning and actively communicating all aspects related to the patient. The care providers are also liable to protect individuals rights, and citizenship. Individuals are also supported to maintain recreational, social, vocational and occupational activities (Peterson, Prout, Schwarz, 2013). Dignity and respect of every individual is very important. Care providers focus on being respectful, courteous and honest. They also respect the values, beliefs and culture of every individual. It also challenges any kind of prevailing discriminations. Working in partnership is another goal of this recovery focused approach. Every individual has the right over their life and recovery can be done by working in partnership with them. It further values importance of sharing relevant clinical information and promotes communication. Goals, aspirations and values of every individual are considered (Review Examination for Post-Traumatic Stress Disorder (PTSD), 2007). Evaluating recovery on different levels is another major goal of recovery focused practice. Individuals are also involved in tracking their progress. Care providers will use their personal experience to improve quality of care. It also focuses on improving employment, housing, social and family relationships, education and well-being of every individual (Peterson, Prout, Schwarz, 2013). Deficits in nursing knowledge can hinder the recovery and progress of the patient. If the nurse do not understand the identification of the co-morbidity and associated psychiatric conditions than success actions can be hindered. It is important to understand the co-morbidities associated with PTSD to improve the quality of care (Wetherell et al, 2013). There could be many clinical and environmental factors associated with PTSD, which can hinder the implementation of actions. These factors may involve ineffective nursing practice, ineffective coping skills of the individual, exposure to substance abuse and alcoholism and risk of self destruction and suicide (Wetherell et al, 2013). Methods to Overcome Barriers Evaluation of suicidal and homicidal behavior. Encourage safety of the patient Providing support and enhancing family support. Identifying ineffective coping and developing acceptance towards emotions. Conclusion Post traumatic stress disorder is the condition, which arises due to exposure to long term traumatic events or reoccurrence of traumatic events. Medication is the best therapy suggested for PTSD, as it helps to control depression and anxiety. There are many different practices to help individuals with this disorder. The paper reviewed Recovery Focused Practice and its goals to help patients suffering from PTSD. References Andrade, C. (2014). Selective serotonin reuptake inhibitor drug interactions in patients receiving statins.The Journal of clinical psychiatry,75(2), 95-99. Carniaux-Moran, C. (2008). The psychiatric nursing assessment.Psychiatric mental health nursing: An introduction to theory and practice, 41-43. Forbes, D., Creamer, M., Phelps, A., Bryant, R., McFarlane, A., Devilly, G. J., ... Newton, S. (2007). Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder.Australian and New Zealand Journal of Psychiatry,41(8), 637-648. Fox, H. C., Anderson, G. M., Tuit, K., Hansen, J., Kimmerling, A., Siedlarz, K. M., Morgan, P. T., Sinha, R. (2012). Prazosin effects on stress- and cue-induced craving and stress response in alcohol-dependent individuals: Preliminary findings. Alcoholism,Clinical and Experimental Research, 36,351-360. Fortinash, K. M., Holoday-Worret, P. A. (2008).Psychiatric mental health nursing. Mosby. Hoskins, M., Pearce, J., Bethell, A., Dankova, L., Barbui, C., Tol, W. A., Bisson, J. I. (2015). Pharmacotherapy for post-traumatic stress disorder: Systematic review and meta-analysis.The British Journal of Psychiatry : The Journal of Mental Science, 206(2), 93-100. Jeffreys, M. (2009). Clinicians guide to medications for PTSD.National Center for PTSD. US Department of Veterans Affairs. Laddis, A. (2011). Medication for complex posttraumatic stress disorders.Journal of Aggression, Maltreatment Trauma, 20,645-668 National Institute for Clinical Excellence. (2005). Post-traumatic stress disorder (PTSD): The management of PTSD in adults and children in primary and secondary care.Clinical guideline,26. National Collaborating Centre for Mental Health (UK. (2005). Post-traumatic stress disorder. Peterson, K. C., Prout, M. F., Schwarz, R. A. (2013).Post-traumatic stress disorder: A clinicians guide. Springer Science Business Media. Pitman, R. K., Rasmusson, A. M., Koenen, K. C., Shin, L. M., Orr, S. P., Gilbertson, M. W., ... Liberzon, I. (2012). Biological studies of post-traumatic stress disorder.Nature Reviews Neuroscience,13(11), 769-787. Review Examination for Post-Traumatic Stress Disorder (PTSD). (2007). Retrieved From: https://www.benefits.va.gov/predischarge/docs/disexm56.pdf Stuart, G. W. (2014).Principles and practice of psychiatric nursing. Elsevier Health Sciences. Ursano, R. J., Bell, C., Eth, S., Friedman, M., Norwood, A., Pfefferbaum, B., ... Zatzick, D. F. (2010). Treatment of Patients With Acute Stress Disorder and Posttraumatic Stress Disorder. Wetherell, J. L., Petkus, A. J., Thorp, S. R., Stein, M. B., Chavira, D. A., Campbell-Sills, L., Roy-Byrne, P. (2013). Age differences in treatment response to a collaborative care intervention for anxiety disorders.The British Journal of Psychiatry : The Journal of Mental Science, 203,65-72.