6640 week 5 response 1

Standard 3 “Outcomes Identification” (pages 48-49)
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

Chapter 13, “Stabilization for Trauma and Dissociation” (pp. 469–508)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC:

Required Media
Laureate Education (Producer). (2012a). Academic year in residence: Thompson family case study [Multimedia file]. Baltimore, MD: Author.

Ochberg, F. (2012). Psychotherapy for chronic PTSD [Video file]. Mill Valley, CA: Psychotherapy.net

Optional Resources
Substance Abuse and Mental Health Services Administration. (2012). Behavioral health issues among Afghanistan and Iraq U.S. war veterans. In Brief, 7(1), 1–7. Retrieved from http://store.samhsa.gov/shin/content//SMA12-4670/SMA12-4670.pdf

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Rockville, MD: Author. Retrieved from http://store.samhsa.gov/shin/content//SMA14-4884/SMA14-4884.pdf

Wolpe, J. (n.d.). Joseph Wolpe on systematic desensitization [Video file]. Mill Valley, CA: Psychotherapy.net.

Bruce, T., & Jongsma, A. (2010b). Evidence-based treatment planning for post-traumatic stress disorder [Video file]. Mill Valley, CA: Psychotherapy.net.

Wilson, R. (2012). Exposure therapy for phobias [Video file]. Mill Valley, CA: Psychotherapy

Andreas post
Andrea Oakes
Main discussion post, week 5
COLLAPSE
Main discussion post

William is a 38-year-old, African American males, recently married, no children, currently living with brother’s family. This is William’s first time in this setting however he does report previous mental health treatment. Patient reports, “I hit some hard times and I actually had to move in with my brother and his wife, Rosita…They say I have PTSD, but that’s all another story.” William was a captain in the military and is an Iraq war veteran. Religion is Catholic. Reports alcohol abuse. Occupation as a lawyer at risk. Patient general appearance is clean, and his behavior is calm and cooperative, eye contact is good. Patient’s mood appears euthymic, and his affect is consistent to mood. Patient’s thought processes and content are clear and coherent, and the patient’s speech is normal. The patient is alert and oriented.

DSM-5 criteria met: a history of exposure to threatened death possible to himself or witnessed the death of others, possibly repeated exposure, need to ask if he is experiencing distressing memories or dreams related to traumatic events, or flashbacks (American Psychiatric Association, 2013). Patient displays avoidance of memories (2013). Need to ask the patient about his mood since returning from war (2013). Significant distress demonstrated by alcohol abuse with subsequent homelessness and risk of losing job (2013).

Appropriate therapeutic approaches for William include safety, with the number one goal to reduce the abuse of alcohol by integrating a 12-step program (Wheeler, 2014). Cognitive Behavioral Therapy (CBT) and eye movement desensitization reprocessing (EMDR) therapy are recommended by evidence-based practice (2014). Cognitive behavioral therapy stabilization measures will work to increase patient resources and mindfulness activities help the patient respond to their experiences rather than react (2014). A meta-analytic review found group cognitive behavioral therapy to be an efficacious way to treat those with PTSD (Barrera, Mott, Hofstein, & Teng, 2013). Psychotropic medications I would consider for William would be Zoloft, Trazadone if he is having difficulty sleeping, and Prazosin if he is having nightmares (Wheeler, 2014).

Expected outcomes for William based on the therapeutic approach of CBT and EMDR will be the ability to process traumatic events in a healthy way. Abstinence from alcohol as a coping mechanism, sleep quality and quantity enhanced, and decrease or disappearance of nightmares.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC

Barrera, T. L., Mott, J. M., Hofstein, R. F., & Teng, E. J. (2013, February). A meta-analytic review of exposure in group cognitive behavioral therapy for posttraumatic stress disorder. Clinical Psychology Review, 33(1), 24-32. https://doi.org/10.1016/j.cpr.2012.09.005

Wheeler, K. (2014). The nurse psychotherapist and a framework for practice. In K. Wheeler (Ed.), Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed. (pp. 3-52). New York, NY: Springer Publishing.

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