The following is a semi-structured report for a comprehensive analysis of posttraumatic stress disorder (PTSD). It outlines an overview of PTSD, its presence, the symptoms, and severity associated with it. The assessment report corresponds to the updated version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and can be used as an evidence base for the systematic approach to PTSD.
Overview of Post-Traumatic Stress Disorder
It is a mental condition that occurs due to prior experience of extremely frightening, distressing, or stressful events. These could range from witnessing fatal road accidents and severe attacks such as robbery or rape. PTSD may start instantly after the violent experience or may take weeks and years to develop. About 30 % of the people exposed to traumatic events end up with PTSD ( Miao et al., 2018) .
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Symptom Presentation
Re-experiences
It is the archetypal indicator of PTSD. It occurs when a victim unwillingly and intensely relives the past hurtful experiences either as nightmares, flashbacks, repetitive sensations or disturbing images, and physical feelings of pain, sweat, trembling, or feeling sick ( Miao et al., 2018) .
Also evident by the constant negativity of thought about their experiences by asking questions that cannot let them come to terms with their situations. Sometimes their thoughts and experiences can often lead to guilt or shame.
Avoidance and Numbing of Emotions
Individuals tend to avoid situations, people, places, or talk that could tick them into thinking about the experience. The patients may push the memories of the experience from their minds by getting into hobbies and work. Others shun the feelings by trying not to feel at all, a situation termed as emotional numbing ( Miao et al., 2018) . These conditions could create isolation and social withdrawal or even abandoning past interests.
Hyperarousal
Most PTSD patients are easily startled and maybe highly irritable, showcase angry outbursts, have sleeping challenges, and concentration challenges.
DSM-5 Diagnostic Criteria for PTSD
These criteria are applicable for the diagnosis of PTSD among adults, adolescents, and children aged six years or more. A satisfactory diagnosis requires certain types or levels of traumatic events, a combination of valid symptoms, and the absence of an exclusionary criterion ( American Psychiatric Association [APA], 2013) .
Experience to a severe injury, forceful sexual activity, and actual or threats of death in any of the following means:
An individual encounter with trauma
A witness of the trauma as it unfolds
Knowledge that the violent trauma involved a close friend or close relative.
A repeated experience or excessive exposure to the details of the trauma- for example, first on the scene to collect human remains. Note: Criterion 4 excludes exposure via electronic media, including television, pictures, or movie, unless it is work related.
Showcasing some of the disturbance indicators that relate to traumatic events and commencing after the traumatizing experience:
Repeated, unintentional, intrusive, and troubling thoughts of the traumatizing episode(s). For children aged six and beyond, repetitive play with themes of the traumatic events may be expressed.
Repeated disturbing dreams related to the traumatic experience. In children aged six and beyond, the recurrent frightening dreams may contain unrecognizable content.
Dissociative responses such as flashbacks, almost as vivid as though the traumatic event was reoccurring. The most punishing dissociative response leads to momentary loss of consciousness of one's environs. For children aged six and beyond, the dissociative reactions may occur in the play
Prolonged deep mental anguish upon seeing or hearing to cues of the traumatizing experience
Known biological responses to the signals which bear a resemblance to aspects of the distressing experience.
Continued evasion of stimuli related to the distressing episode. It begins once the traumatic event has occurred. Evidenced by:
Evading or effort thereof, of memory, thought or feeling which are can be connected with the disturbing episode.
Evading or effort thereof of places, people, conversations, items, circumstances, and any external reminder that arouse the distressing memories of the trauma.
Undesirable changes in perception and attitude due to the shocking occurrence. Begins or worsens once the disturbing incident occurs, and shown by:
Dissociative amnesia causing an incapacity to recollect an vital feature of the disturbing incident
Incoherent cognitions on the reason for and/or consequences of the traumatic experience, causing individual guilt or blaming other people.
A recurrent undesirable state of emotion such as fear, anger, shame, or guilt.
Lost interest and/ or reduced participation in a wide range of activities.
Detachment from others
Reduced ability to experience positive emotions such as satisfaction, happiness, and love.
Exaggerated negative beliefs or reduced positive expectations such as the world is overly dangerous, I am permanently ruined, and no one can be trusted.
Marked changes in sensitivity and reactivity, commencing after the distressing incident. Evidenced by some of the following:
Extreme irritability, outbursts of anger even under minimal provocation, verbal or physical aggressiveness directed to people, objects, or animals.
Self-harming or reckless deeds
Extreme watchfulness
Extreme shock reaction
Lack of attentiveness
Poor sleeping patterns- struggle to sleep or stay asleep. Sometimes fidgety sleep.
Period of manifestation of the disturbances in criteria B, S, D, and E extends over four weeks.
Disturbances create social, occupational or any form of functional impairment that is clinically significant
The disturbances do not have a correlation with physiological effects of other substances added to the body such as alcohol, medication or any underlying illness.
Specify if:
The diagnosis comes with dissociative symptoms : The signs displayed by the individual satisfy the PTSD criteria, also, under the conditions of the stressor, the patient’s experiences co-include with the recurrent symptoms of at least one of the fowling:
Depersonalization: Patient persistently experiences a detachment from their mental or physiological processes, as if they are in the mind of the observer. There is a sense of unreality, or as if time is moving slowly ( APA, 2013) .
De-realization: The patient recurrently experiences a sense of unreality surrounding the world around them. The world seems distant, unreal or dreamlike, sometimes very distorted. Note: Using this subtype requires that the symptoms are not relatable to the physiological effects of other substances such as behaviors associated with alcohol intoxication or underlying medical conditions ( APA, 2013) .
Specify if:
With prolonged manifestation: in case the signs do not meet the full diagnostic criteria within the first six months after the traumatizing event ( APA, 2013) . The manifestation of certain signs may be instantaneous.
Treatment Options for Post-Traumatic Stress Disorder
Individuals experiencing difficulty in coming to terms with traumatic events can confront their feelings by seeking professional help. There is evidence of successful treatment of PTSD many years after the initial contact with the traumatic event; this is an indication that there is no time barrier to the effective treatment of PTSD. Regardless, it is advisable that a patient seeks help earlier enough to be able to restore normalcy to the quality of life sooner. Prior to deciding on a treatment option, the healthcare professional must carry out an initial assessment so as to provide a treatment option tailored to the individual needs of the patient. For patients who have suffered mild symptoms, especially lasting shorter than four weeks, should be directed to watchful waiting. Watchful waiting is an observatory period where the healthcare professional monitors the patient's condition carefully to note improvement, determination, or the absence thereof, of the patient's symptoms. Watchful waiting should last one month, upon which a follow-up appointment is made.
If symptoms persist, the patient can be directed to psychological therapies, pharmacological therapies, or a combination of the two.
Psychological Interventions
Psychological intervention is the first treatment option recommended for patients with persistent indications of PTSD. Depending on the seriousness of the signs, psychotherapeutic interventions may be accompanied by medications. The three baseline psychological therapies for PTSD are cognitive behavior therapy, eye movement desensitization and reprocessing, and group therapy ( Miao et al., 2018) .
Cognitive Behavior Therapy
Cognitive behavior therapy (CBT) is a therapeutic intervention targeting a reduction of the severity of the trauma symptoms by means of helping the patients change their thinking and acting processes ( Miao et al., 2018) . Focus is directed to the relationship of thoughts, feelings, and outward behaviors – especially on how a positive change in one of them will enhance the functioning of the other two domains. The effectiveness of CBT can be explained in two ways: one, emotional processing theory and two, social cognition theory ( Miao et al., 2018) .
The first approach of using CBT is for trauma-focused treatment requires the patient to confront the traumatizing memories by thinking and explaining it to the therapist in detail. In the process, the therapist would employ the emotional processing theory. This theory suggests that victims of traumatic experiences develop associations of past vents with present safe reminders such as stories, news, people, and situations that imitate the past. They can then respond either through fear and acting numbing of feelings. The therapy should then focus on changing the patient's perception of safe reminders, which contribute to unhealthy functioning. Helping the patient identify a misinterpretation they have about an experience is the key to the treatment of PTSD.
The social cognitive theory suggests that most patients tend to contextualize their experiences with existing social beliefs. Take, for instance, the notion that bad things happen for bad people. A rape victim would be tempted to believe that she was raped for being a bad girl. By identifying such disoriented thought patterns, the therapist can gradually restore the patient's control of their fears and distresses by substituting the negative thought process with positive ones.
This approach is the most effective and usually takes between 8 to 12 weekly sessions lasting about an hour ( Miao et al., 2018) .
Eye movement desensitization and reprocessing (EMDR)
EMDR is a newly-coined intervention for reducing the symptom of PTSD. The procedure entails engaging the patient with left-to-right eye movements, often by folding the movement of the finger of the therapist, while the patient recalls the disturbing event. The therapist can further tap her finger or paly a tone. There is little evidence on the mechanism of the effectiveness of EMDR. Regardless, it is reportedly helpful in helping the client change their overall perception of the traumatic experience.
Group therapy
Group therapy would involve the sharing of individual experiences with colleagues with PTSD symptoms. It is thought to ab an alternative to helping individuals learn about alternative ways of managing their symptoms understanding the condition.
Pharmacological Interventions
Certain antidepressants effectively treat PTSD in adults. These include paroxetine, sertraline, mirtazapine, amitriptyline, and phenelzine. The most commonly used depressants are paroxetine and sertraline, which have a proven proficiency for reducing PTSD symptoms.
The antidepressants will most likely be used under notable conditions: (a) the patient opts to avoid trauma-focused psychotherapies; (b) psychotherapy alone is not going to be effective due to additional threats such as ongoing domestic violence; (c) there is negligible benefit from a complete course of psychological treatments; (d) there is an underlying comorbidity severe depression that hampers the potential to benefit from psychological interventions ( Miao et al., 2018) .
Most importantly, the use of phenelzine or amitriptyline must be accompanied by strict supervision from a mental health specialist. These antidepressants must not be prescribed to anyone under the age of 18 unless under the prescription of a mental health specialist. Dosage for medication may be increased if the symptoms fail to go off. If it is not effective, even after continued use for 12 months of increased dosage, then it will be withdrawn gradually for at least four weeks.
The most evident side effects of the treatment are feelings of sickness, burry vision diarrhea, and sometimes constipation ( Miao et al., 2018) . The medication should be withdrawn gradually to prevent the occurrence of withdrawal symptoms.
Article Summary
Miao, Chen, Wei, Tao, and Lu’s article, Posttraumatic Stress Disorder: From Diagnosis to Prevention, covers the topic of PTSD in its entirety. These authors undertook a selective review of literature on the general outlook and attitudes towards PTSD. Their work underscores the definitions and differential diagnoses to PTSD and focusses on the numerous investigations and the multiple versions that have shaped the diagnostic criteria used in the current clinical diagnosis for PTSD. The authors point out the existence of various versions of PTSD diagnostic criteria but acknowledge DSM-5 as being the latest version and one which is accepted as the best. The article further clusters the universally accepted symptoms that are used in diagnosing PTSD. This also combines knowledge of the pathogenesis of the disorder, which is both psychological and biological in nature. Primarily PTSD is a result of the morphological alterations in the brain structures, which increase the susceptibility of an individual to extreme thoughts, emotions, and hyper reactivity. The article also offers statistics on PTSD’s prevalence; it emerges that the disorder is 80% more likely to co-occur with other psychological comorbidities ( Miao et al., 2018) . Lastly, an interesting aspect is the higher prevalence of the condition among the veterans, which the authors attribute to the rise in global terrorism and military conflicts. It is, therefore, asserted that the incidence of PTSD among the veterans needs to receive more attention. The article closes by reviewing the predictive factors for the disorder and the associated intervention options, which include both the prevention mechanisms and treatment alternatives that have been proven to efficiently reduce the severity of PTSD.
This article has contributed significantly to the pool of knowledge about PTSD that has been used in creating this assessment report. The article covers a range of sub-topics that provide detailed analyses for all the topics in the report- including the overview, the symptoms, the diagnostic criteria, and the interventions. Perhaps the most vital details from the article are on the molecular mechanism and predictive factors. These two areas have not been sufficiently covered by many studies and remain a resourceful piece of information. Part of this information is readily incorporated in the assessment report because it is direct and self-explanatory. Other subtopics such as definition and differential diagnosis have also contributed a larger percentage of the contents of DSM-5 diagnosis criteria in this report. Overall, the article is a resourceful reference material recommended for anyone with interest in the assessment, diagnosis, and intervention of posttraumatic stress disorder.
Conclusion
Careful assessment of mental disorders is a vital part of evidence-based practice. Based on this assessment report, the initial assessments can help determine the possible intervention options and periodic monitoring for the progress of persons living with PTSD.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) . American Psychiatric Pub.
Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research , 5 (1), 32.
