NRNP 6635 Assignment: Posttraumatic Stress Disorder

NRNP 6635 Assignment: Posttraumatic Stress Disorder

The media ‘Presentation Example: Posttraumatic Stress Disorder (PTSD)’ demonstrates a case presentation of an eight-year-old boy who was involved in a minor motor vehicle accident with his father. The patient was not injured. However, his father sustained a minor injury to his knee. The driver of the other vehicle involved in the accident however threatened the patient’s father, following him in a pursuit to the point that the patient’s father had to call the police. The patient displayed avoidance behavior of the stimuli, sleeping problems, nightmares, physical aggression, outburst in the middle of class at school, dangerous behaviors frightening others, and fighting. The patient was diagnosed with PTSD in addition to comorbidities such as ODD, CD, MDD, ADHD, SAD, and phobia for spiders. The purpose of this paper is to analyze the process of diagnosis and management of PTSD as demonstrated in the provided media, in addition to the neurological basis involved with the development of this mental disorder.

Neurobiological Basis for PTSD

The neurobiology of PTSD is a complex process involving the neurochemical, neuroanatomical, and neuroendocrine changes in the neural pathways. Regarding the neuroendocrine features, the hypothalamic-pituitary-adrenal axis (HPA) is considered the central coordinator of the response mechanism of individuals to stress (Dunlop & Wong, 2019). Cortisol, a stress hormone, on the other hand, exerts negative feedback on the HPA. The hormone also reduces the noradrenergic stress response. As such, a sustained release of cortisol as a result of PTSD leads to adverse effects on the brain, especially the hippocampal neurons, leading to impaired neuroplasticity and neurogenesis (Jaworska-Andryszewska& Rybakowski,2019). Neurochemical features such as noradrenaline, serotonin, and dopamine are also associated with stress responses contributing to PTSD symptoms.

DSM-5 Diagnostic Criteria for PTSD

            According to the DSM-V diagnostic criteria, the patient requires to be exposed to a

NRNP 6635 Assignment Posttraumatic Stress Disorder
NRNP 6635 Assignment Posttraumatic Stress Disorder

traumatic experience


NRNP 6635 Assignment Posttraumatic Stress Disorder
NRNP 6635 Assignment Posttraumatic Stress Disorder

which in this case was a minor motor vehicle accident. He also needs to display at least one intrusion symptom such as nightmares, recurrent memories, and flashbacks, for the past one month (Grant et al., 2020). At least one persistent avoidance symptom and two negative alterations in mood and cognition such as inability to recall key features and persistent negative beliefs are also required. Alteration in reactivity and arousal by displaying reckless behavior and hyper-vigilance has also been reported in the case study. Lastly, the presenting symptoms must have a functional significance on the patient’s psychological and social life. The video provides an adequate amount of information necessary to support the diagnosis of PTSD as demonstrated above.

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The other diagnoses such as ODD, CD, MDD, and SAD which were made after the accident are quite ambiguous since most of these disorders display the same symptoms as PTHD and should have not been considered as comorbidities during this time (Miao et al., 2018). However, ADHD and phobia for spiders were diagnosed before the incidence, hence the psychiatrist must have had adequate reasons to support these diagnoses.

Psychotherapy Treatment Option

Other than CBT, I would consider the use of prolonged exposure (PE) therapy which is recommended as first-line therapy for PTSD in most clinical practice guidelines (Bastien et al., 2020). PE is a gold standard treatment approach for PTSD as it has been subjected to several clinical trials reporting great effectiveness in managing PTSD symptoms even among complex and comorbid patients. PE mainly entails psychoeducation, imaginal exposure, in vivo exposure, and emotional processing.


The media presentation demonstrates the relevance of adopting the appropriate psychiatric practice in diagnosing and managing patients with mental health problems. The patient described in the video was poorly diagnosed with several comorbidities, which complicated the choice of treatment. However, with PTSD as the primary diagnosis, the patient could benefit greatly from PE therapy.




Bastien, R. J. B., Jongsma, H. E., Kabadayi, M., & Billings, J. (2020). The effectiveness of psychological interventions for post-traumatic stress disorder in children, adolescents, and young adults: a systematic review and meta-analysis. Psychological Medicine50(10), 1598-1612.

Dunlop, B. W., & Wong, A. (2019). The hypothalamic-pituitary-adrenal axis in PTSD: Pathophysiology and treatment interventions. Progress in neuro-psychopharmacology and biological psychiatry89, 361-379.

Grant, B. R., O’Loughlin, K., Holbrook, H. M., Althoff, R. R., Kearney, C., Perepletchikova, F., … & Kaufman, J. (2020). A multi-method and multi-informant approach to assessing post-traumatic stress disorder (PTSD) in children. International Review of Psychiatry32(3), 212-220.

Jaworska-Andryszewska, P., & Rybakowski, J. K. (2019). Childhood trauma in mood disorders: neurobiological mechanisms and implications for treatment. Pharmacological Reports71(1), 112-120.DOI: 10.1016/j.pharep.2018.10.004.

Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research5(1), 1-7.

Post-Traumatic Stress Disorder (PTSD) refers to a psychiatriccondition which follows encounter with a terrifying event like violence, sexual assault, natural calamities. PTSD is associated with several neurobiological changes that usually alters one’s brain functioning leading to re-experiencing, avoidance arousal, cognition and mood symptoms. The paper aims to expound on the evaluation and management of patients with PTSD.

Neurobiological Basis for PTSD Illness

The neurobiological basis for PTSD is complex and not yet fully understood. However, research has shown that PTSD can be associated with alterations in structural and functioning in the prefrontal cortex, and other parts of the cortex such as the amygdala. The prefrontal cortex regulates emotions, thoughts, and behaviors, and changes in this area may contribute to PTSD symptoms such as hypervigilance and difficulty controlling emotions. The amygdala is involved in processing emotions and threat detection, and alterations in this area may contribute to hyperarousal symptoms in PTSD. The hippocampus is responsible for memory consolidation, and changes in this area may contribute to intrusive memories and flashbacks in PTSD. Additionally, research has shown that chronic stress, such as that experienced by individuals with PTSD, can lead to dysregulation of the hypothalamus associated with the body’s stress response. These changes may contribute to alterations in arousal and reactivity seen in PTSD.

 Criteria forDiagnosis of PTSD

The DSM-5 (APA, 2013) diagnostic criteria for PTSD involves exposure to a terrifying experience, intrusive symptoms, avoidance symptoms, negative changes in cognition and mood, and alterations in arousal and reactivity. It requires the individual to either have experienced a death threat, physical injury, or offensive sexual advance through direct experience or learning about the dreadful event occurring in a loved one (Sherin et al., 2022). The patient must also experience at least one intrusive symptom, such as distressing memories, nightmares, or flashbacks. They also portray avoidance behavior, like avoiding memories of the traumatic event or the thoughts.

The case presented in the video meets the criteria for PTSD diagnosis. Joe was involved in a minor motor vehicle accident with his father, although he did not sustain injuries, and his father had a minor bruise on his knee which did not warrant treatment, the event that followed triggered the illness on Joe. He felt frightened when the guy who hit them started chasing them while threatening his father. Joe is reported to be experiencing intrusive symptoms such as nightmares and aggressive behavior at school and home. He also has trouble sleeping and has anxiety (Shiavone et al., 2018). Furthermore, Joe has negative alterations in cognition and mood; he has negative feelings that he should not be away from his father since something dreadful might happen to his father. He also has hyperarousal and poor memory of the accident and the following events, which he does not want to discuss.

I disagree with the diagnoses of Major Depressive Disorder, ADHD, ODD, conduct disorder, and Separate anxiety disorder. However, I agree with Specific Phobia, portrayed by his extreme fear of spiders. For MDD, he does not have a depressed mood, a loss of interest in pleasurable activities, or difficulty concentrating, though he has trouble sleeping (Barbano et al., 2019). For ADHD, he has no hyperactivity or impulsiveness, which have interfered with normal functioning.

Treatment of PTSD

Another treatment option for Joe is Eye Movement Desensitization and Reprocessing (EMDR), as ithelps patients negate the traumatic event and reduce their emotional distress. EMDR also involves identifying negative beliefs associated with the traumatic event and replacing them with more positive beliefs (Kuijpers et al., 2020).EMDR is considered the treatment of choicefor PTSD. EMDR is recommended by the American Psychiatric Association, and the World Health Organization as an effective psychotherapy for PTSD.By using evidence-based treatments, PMHNPs can be confident that they provide their patients with the most effective treatments. This is important not only for the patient’s recovery but also for the credibility and reputation of the PMHNP.


PTSD is a mental disorder that may arise after an individual experiences or witnesses a terrifying event like violence, sexual abuse, or a natural disaster. Structurally, it is associated with changes in the brain in areas associated with memory, emotional regulation, and fear processing. Psychotherapy with modalities such as trauma-focused therapy, EMDR, and behavioral activations form the gold standard for management of the condition. A better response is reported with other psychotherapies such as trauma-focused cognitive therapy.


























Barbano, A. C., Der Mei, W. F., deRoon‐Cassini, T. A., Grauer, E., Lowe, S. R., Matsuoka, Y. J., O’Donnell, M., Olff, M., Qi, W., Ratanatharathorn, A., Schnyder, U., Seedat, S., Kessler, R. C., Koenen, K. C., Shalev, A. Y., & the International Consortium to Prevent PTSD. (2019). Differentiating PTSD from anxiety and depression: Lessons from the ICD‐11 PTSD diagnostic criteria. Depression and Anxiety, 36(6), 490–498.

Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018). Mindfulness-based treatments for posttraumatic stress disorder: A review of the treatment literature and neurobiological evidence. Journal of Psychiatry & Neuroscience, 43(1), 7–25.

Cuijpers, P., Veen, S. C. V., Sijbrandij, M., Yoder, W., & Cristea, I. A. (2020). Eye movement desensitization and reprocessing for mental health problems: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 49(3), 165–180.

Schiavone, F. L., Frewen, P., McKinnon, M., & Lanius, R. A. (2018). The dissociative subtype of PTSD: an update of the literature. PTSD Research Quarterly, 29(3), 1-13.

Sherin, J. E., & Nemeroff, C. B. (2022). Posttraumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in clinical neuroscience.