Vignette Analysis 2 Assessment and diagnosis Anthony ✓ Solved

Anthony was exposed to traumatic events which has developed to Posttraumatic Stress Disorder (PTSD). The condition can be diagnosed after one month from the time a person is exposed to a traumatic event. The condition starts as Acute Stress Disorder (ASD) and progresses to PTSD. Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the symptoms include what is expressed by Anthony.

It is evident that he has intrusive recollections of traumatic occurrences through flashbacks, avoidance of moving outside, increased efforts to avoid any association with trauma, and irritability. Studies show PTSD can differ in frequency and severity and can lead to disabilities ranging from distress to severe incapacitation (Swartz, 2014). Moreover, the lag period linking exposure to indications is dependent and in many cases long. Anthony’s case presents a delayed onset as symptoms were expressed six months after the war.

PTSD can be recurrent and chronic; however, many patients also experience major depressive disorder following the manifestation of PTSD. This paper focuses on the diagnosis and assessment of PTSD from the point when Anthony met the diagnostic criteria for the condition, as explained in the DSM-IV.

Diagnostic Criteria for PTSD

The modern criteria for diagnosing PTSD began with DSM-III. These criteria have remained consistent with the introduction of DSM-IV. The evidence-based diagnosis for patients, based on DSM-IV, includes several factors:

  • Exposure to a traumatic event (post-war)

  • Intrusive re-experiencing of the event

  • Avoidance (Anthony did not want to leave the house)

  • Hyperarousal

  • Distress that can lead to trauma

In Anthony’s case, he experienced and witnessed an American war that involved actual death and serious injury, putting his life in constant danger. Survivor guilt may also be a factor in Anthony's situation, as he exhibits signs of traumatic disorder.

Clinical Diagnosis

The symptoms and diagnostic process is variable and assessments depend on the patient’s symptoms, mental health, and willingness to work with a health professional. Typically, Anthony should be evaluated in a confidential setting through a one-on-one consultation with a health specialist, considering his signs and accounts of the traumatic events, to determine if he meets DSM-IV standards for PTSD (Courtois & Ford, 2015).

In Anthony’s specific case, he acknowledges his avoidance of anything related to trauma. Adequate time needs to be allocated for clinical assessment. Given his background as ex-military and his readiness to interact with health experts, the diagnosis process may take about one hour. A primary indicator of PTSD is determining if an individual has faced disturbing events, which a war environment typically provides.

Assessment Procedures

In addition to the official diagnostic procedure, a comprehensive review of the patient is essential to determine comorbidity, functional status, symptom severity, and potential malingering (Courtois & Ford, 2015). Assessing comorbidity is crucial, as PTSD is often accompanied by high rates of depressive disorders, with reports indicating that approximately 22% of war veterans suffering from PTSD also struggle with alcohol abuse or dependence (Rytwinski & Scur, 2013).

For a comprehensive evaluation, standardized self-report questionnaires can be valuable in assessing symptom severity, as noted in Anthony’s case, especially since his ability to function socially, such as fulfilling his role as a husband, is impaired. If it is determined that Anthony has PTSD, assessments should also characterize any neurocognitive and neurobehavioral impairments (Courtois & Ford, 2015).

Possible Standardized Assessments

Some standardized assessments that can be utilized include the Rey Auditory Verbal Test, Continuous Visual Memory Test, and other verbal and non-verbal tests. It is essential to address that while some individuals may exhibit signs of PTSD, such as Anthony, there is a possibility of malingering or exaggeration of conditions.

Treatment Options

Once a thorough assessment indicates that Anthony has PTSD, a range of therapeutic options can be pursued. The condition is reversible through psychotherapy and medications, with the primary goals being to restore self-esteem, alleviate symptoms, and teach coping strategies (Courtois & Ford, 2015). Among the available therapies, Cognitive Behavioral Therapy (CBT) is particularly noted for its effectiveness in transforming maladaptive thought patterns (Hamblen & Kivlahan, 2016).

Cognitive Processing Therapy (CPT)

CPT typically involves 12 weeks of treatment, during which the patient discusses the trauma with the therapist. This process helps patients reassess how their thoughts related to the trauma impact their personal lives, assisting them in coping with events that were beyond their control (Curran, Bauer, & Mittman, 2012).

Prolonged Exposure Therapy (PE)

Given Anthony’s tendency to avoid reminders of his trauma, PE can prove beneficial. This therapy involves 8-15 sessions where the therapist educates the patient on techniques to alleviate anxiety during exposures to traumatic memories and stimuli.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is another effective therapy, wherein patients process traumatic memories while engaging in specific eye movements or other stimuli to decrease distress associated with these memories. Research indicates that the outcomes of EMDR are comparable to those observed in CBT (Curran, Bauer, & Mittman, 2012).

Group Therapy

Group therapy provides additional support by allowing patients to share experiences and learn coping mechanisms together. In this context, Anthony can benefit from the collective experience of others facing similar challenges.

Conclusion

In conclusion, the assessment and treatment of PTSD, particularly in cases like Anthony’s, require a multifaceted approach. By employing standardized assessments, understanding comorbid conditions, and utilizing an array of therapeutic techniques, it is possible to guide patients towards recovery. Therapists must strive to create a safe environment conducive to healing, where patients can rebuild their sense of self and cope with the aftermath of trauma effectively.

References

  • Abdul-Hamid, W., & Hughes, J. (2014). Nothing new under the sun: post-traumatic stress disorders in the ancient world. Early Science Medicine, 19, 549–557.

  • Courtois, C., & Ford, J. (2015). Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach. The Guilford Press.

  • Curran, G., Bauer, M., & Mittman, B. (2012). Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50(3), 217–226.

  • Foa, E., Hembree, E., & Rothbaum, B. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. New York: Oxford University Press.

  • Hamblen, J., & Kivlahan, D. (2016). PTSD and substance use disorders in veterans. U.S. Department of Veterans Affairs.

  • Richardson, L., Frueh, B., & Acierno, R. (2010). Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Journal of Psychiatry, 44, 4–19.

  • Rytwinski, N., & Scur, M. (2013). The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. Journal of Trauma Stress, 26, 299–309.

  • Swartz, M. (2014). Textbook of Physical Diagnosis: History and Examination. Philadelphia, Pennsylvania: Elsevier.