NRNP 6645 WEEK 9 Posttraumatic Stress Disorder
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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 bur