Main Question Post
The American Psychiatric Association (APA) classifies post-traumatic stress disorder (PTSD) under trauma and stress related disorders. For adults to meet the diagnostic criteria for PTSD a person must have personally experienced or witnessed traumatic events, learned of death or harm to friends or family, or has been continually exposed to traumatic events). Additional symptoms such as nightmares, flashbacks, avoiding reminders of the traumatic events, alterations in cognition, sleep disturbances, behavioral changes, and social and occupational functioning can be affected (American Psychiatric Association, 2013). The purpose of this discussion is to explain my observations regarding post-traumatic stress disorder of William Thomson in the Thompson family case study. I will also explain therapeutic approaches and outcomes expected.
Based on the information provided in the case study, William Thompson is a 38-year-old married African American male who is an Iraq war veteran. He was a captain while enlisted in the military. William is a finance lawyer who is now homeless as a result of being unable to pay his mortgage. Additionally, his job is in jeopardy due to alcohol and PTSD concerns. William reports that he has hit some hard times which resulted in him and his wife moving in with his older brother and his family.
The information provided indicates that the member has previously sought treatment as he states “they say I have PTSD”. It is not known if he sought treatment on his own, or if it was an employment requirement, or possibly a stipulation made by his wife. He also provides a dissociative response with his response “they say I have PTSD…that’s a whole other story”. A Dissociative Experience Scale (DES) is a tool that could be utilized to gain further insight.
As indicated by Wheeler (2014), included in the goals of treatment for PTSD is to reduce the symptoms, restoring feelings of safety, and the ability to trust, and preventing relapse. Cognitive Behavioral Therapy (CBT), trauma focused, would be the approach used to treat William. CBT has been shown to effective in the treatment of PTSD by improving psychosocial functioning included work and social life (Reich, Nemeth, & Acierno, 2019). Paintain, & Cassidy (2018) indicate in their study of PTSD treatment, that studies have indicated that re-exposing clients to traumatic memories may re-traumatize. However, I would continue to evaluate the progress of William and his ability to reprocess past events. Medications would be prescribed in collaboration with William based on his symptoms and his ability to function at work, and at home. Alcohol use would be evaluated to determine if inpatient, or outpatient treatment is needed.
Additionally, in a meta-analysis completed by Xue et al. (2015) to determine combat related risk factor for PTSD, they found that combat exposure and the lack of discharge supports increases the risk for PTSD. Discussing with William the availability of social support groups for combat veterans would be addressed as social support is associated with decreased PTSD severity (Armenta, 2018).
The expected outcomes would include that William PTSD symptoms decrease. He would not experience sleep disturbances, he would have the ability to return to his normal activities in regards to working, and paying his bills. Additionally, he would stop drinking alcohol.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Author.
Armenta, R. F., Rush, T., LeardMann, C. A., Millegan, J., Cooper, A., & Hoge, C. W. (2018). Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans. BMC Psychiatry, 18(1), 48. https://doi:10.1186/s12888-018-1590-5
Paintain, E., & Cassidy, S. (2018). First-line therapy for post-traumatic stress disorder: A systematic review of cognitive behavioural therapy and psychodynamic approaches. Counselling and psychotherapy research, 18(3), 237–250. https://doi.org/10.1002/capr.12174
Reich, K., Nemeth, L., & Acierno, R. (2019). Evidence-based psychotherapy interventions to improve psychosocial functioning in veterans with PTSD: An integrative review. Journal of Psychosocial Nursing & Mental Health Services, 57(10), 24-33. http://doi: /10.3928/02793695-20190531-04
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. Springer Publishing Company.
Xue, C., Ge, Y., Tang, B., Liu, Y., Kang, P., Wang, M., & Zhang, L. (2015). A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PloS One, 10(3), e0120270. https://doi:10.1371/journal.pone.0120270
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