Neurobiological Basis, Diagnostic Criteria, and Treatment Options

NURSING AND HEALTHCARE

## Neurobiological Basis for PTSD

Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition that arises following exposure to a traumatic event. Neurobiologically, PTSD is characterized by alterations in brain regions involved in fear processing and memory, particularly the amygdala, hippocampus, and prefrontal cortex (Shin & Liberzon, 2010). The amygdala, which is critical for fear response, is often hyperactive in individuals with PTSD, leading to heightened fear and anxiety. The hippocampus, involved in contextualizing memories, tends to be smaller and less active, contributing to difficulties in distinguishing between past and present threats. The prefrontal cortex, which modulates the amygdala, often shows reduced activity, leading to impaired regulation of emotions and heightened stress responses.

## DSM-5-TR Diagnostic Criteria for PTSD

The DSM-5-TR outlines specific criteria for diagnosing PTSD:

1. **Exposure to actual or threatened death, serious injury, or sexual violence** through direct experience, witnessing, learning of events happening to a close family member or friend, or repeated exposure to traumatic events.
2. **Intrusive symptoms** such as distressing memories, nightmares, flashbacks, and intense psychological or physiological distress upon exposure to cues related to the trauma.
3. **Persistent avoidance** of stimuli associated with the trauma, including thoughts, feelings, or external reminders.
4. **Negative alterations in cognitions and mood** such as inability to remember aspects of the trauma, persistent negative beliefs about oneself or the world, distorted blame, persistent negative emotional state, and diminished interest in significant activities.
5. **Marked alterations in arousal and reactivity** such as irritability, reckless behavior, hypervigilance, exaggerated startle response, and sleep disturbances.

These symptoms must persist for more than a month, cause significant distress or impairment in functioning, and cannot be attributed to substance use or another medical condition.

## Case Study Analysis

The video case presentation by Dr. Grande provides an in-depth look at a hypothetical patient with PTSD symptoms. The case details are consistent with DSM-5-TR criteria, including the presence of intrusive symptoms (e.g., flashbacks and nightmares), avoidance behaviors, negative changes in cognition and mood, and heightened arousal (Grande, 2019). The information provided in the video is sufficient to derive a PTSD diagnosis as it comprehensively covers the required diagnostic criteria.

The case also presents diagnoses such as major depressive disorder and generalized anxiety disorder. These comorbidities are common in PTSD patients (Flory & Yehuda, 2015). However, without more detailed symptomatology and differential diagnosis processes, it is difficult to fully agree or disagree with the additional diagnoses.

## Alternative Psychotherapy Treatment: Cognitive Processing Therapy (CPT)

One alternative psychotherapy treatment for PTSD is Cognitive Processing Therapy (CPT), which is considered a gold standard treatment. CPT involves cognitive restructuring, helping patients challenge and modify distressing beliefs related to the trauma (Resick et al., 2016). This treatment is supported by clinical practice guidelines due to its strong evidence base demonstrating efficacy in reducing PTSD symptoms.

Using gold standard, evidence-based treatments is crucial for psychiatric-mental health nurse practitioners as it ensures that patients receive interventions with proven effectiveness, improving outcomes and maintaining high standards of care (Watkins et al., 2018).

## Conclusion

Understanding the neurobiological basis of PTSD and applying DSM-5-TR criteria are essential for accurate diagnosis and effective treatment planning. The video case study provides sufficient information to diagnose PTSD and suggests additional diagnoses that require further exploration. Cognitive Processing Therapy stands out as an effective, evidence-based treatment option, highlighting the importance of adhering to clinical practice guidelines in psychiatric care.

## References

Flory, J. D., & Yehuda, R. (2015). Comorbidity between post-traumatic stress disorder and major depressive disorder: Alternative explanations and treatment considerations. *Dialogues in Clinical Neuroscience, 17*(2), 141-150.

Grande, T. (2019, August 21). Presentation example: Posttraumatic stress disorder (PTSD). [Video]. YouTube. https://www.youtube.com/watch?v=RkSv_zPH-M4

Resick, P. A., Monson, C. M., & Chard, K. M. (2016). *Cognitive processing therapy for PTSD: A comprehensive manual*. Guilford Publications.

Shin, L. M., & Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. *Neuropsychopharmacology, 35*(1), 169-191.

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. *Frontiers in Behavioral Neuroscience, 12*, 258.

## Attachments

[Shin & Liberzon, 2010]
[Flory & Yehuda, 2015]
[Resick et al., 2016]
[Watkins et al., 2018]

*Note: Attach the PDFs of the referenced sources as required.*

 

THE ASSIGNMENT

Succinctly, in 1–2 pages, address the following:

  • Briefly explain the neurobiological basis for PTSD illness.
  • Discuss the DSM-5-TR diagnostic criteria for PTSD and relate these criteria to the symptomology presented in the case study. Does the video case presentation provide sufficient information to derive a PTSD diagnosis? Justify your reasoning. Do you agree with the other diagnoses in the case presentation? Why or why not?
  • Discuss one other psychotherapy treatment option for the client in this case study. Explain whether your treatment option is considered a “gold standard treatment” from a clinical practice guideline perspective, and why using gold standard, evidence-based treatments from clinical practice guidelines is important for psychiatric-mental health nurse practitioners.

Support your Assignment with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.

 

 

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