Patient Analysis Arleen has been a police officer for ten years. Currently she is on paid medical leave for three months and has three weeks left before she is due back at work. Arleen's parents have been divorced for sixteen years. She still keeps in touch with her mother, and talks to her on a regular basis. Her father is an alcoholic with a history of physical and mental abuse towards his children. Arleen has two brothers, one that she keeps in contact with and one that she does not.
She stated that her aspirations to become a police officer originate from her not being able to protect her family from her father when she was a child. On her first visit, Arlene seemed very tense and said that she had been feeling very stressed since leaving the force following her incident. Her and her husband have also not been getting along due to her nervousness. She has not been able to sleep, does not want to go back to work and dreads visiting any of her fellow colleagues.
Arleen also stated that she has been having dreams and flashbacks about the incident causing her leave. This incident occurred during a routine traffic stop while Arleen was on duty. The suspect in the car was a known drug dealer, after being asked to get out of the car the suspect brandished a firearm, then fired a single shot ricocheting off Arleen's arm. The bullet then went into oncoming traffic striking the passenger side door of a passing car, causing that car to crash, in turn killing a five year old boy that was inside. Arleen has feelings of guilt and responsibility for the boys' death.
Even though there was nothing she could have done. She still feels she could have done more to prevent what happen. She has daydreams and nightmares of seeing herself killing the boy. These feelings of guilt have plagued Arleen since the incident happen, over two months ago.
Diagnosis It is because of these behaviors and duration of time that I diagnosis Arleen McCoy with Posttraumatic Stress Disorder (PTSD). PTSD is an Axis I Disorder found in the DSM. The characteristics of PTSD as described by the DSM are: response to an extreme traumatic event elicits fear, helplessness, or horror (CCU 1). Characteristic symptoms include: dreams, recurrent feelings of event, psychological distress and physiological reactivity. Arleen has said several times with me that when she closes her eyes she has flashbacks of the event. She also has even worse recurrences while intoxicated.
Avoidance of stimuli related to event is another characteristic, in Arleen's case; seeing coworkers, her gun, badge, uniform, even the thought of going back to work, anything remotely relating to her profession. Another set of characteristics for PTSD demonstrated by Arleen is hyper arousal; sleep disturbances, angry outbursts, and difficulty concentrating. Odds of developing PTSD are twice as greater for females if traumatized by assault violence, and even greater if previously traumatized (CCU 2). Arleen's past with her family, especially her abusive alcoholic father leads me to believe Arleen had an even greater risk for developing this disorder. Physical, Psychological, or Social/Environmental conditions predispose patient As stated before, Arleen has come from a broken home.
PTSD development can be increased if the individual has been abused and / or traumatized in the past, before the event causing the disorder happen. The prevalence for PTSD can also be increased with what could be considered "high stress" professions. In which, Arleen's choice of professions can also be said increase her predisposition for this disorder. Being in any type of law enforcement can become extremely stressful. Dealing with traumatic events on a daily basis can wear on anybody and especially increase their predisposition for a mental disorder. The details of this particular incident could also be a major factor for Arleen's development of PTSD.
The boy who was killed in this accident was only 5 years of age. Arleen herself has two young sons who are 5 and 12. For Arleen to not relate this horrible incident back to her own boys, and interpret it as such, would be ridiculous. I'm not saying that if she did not have kids this might not have happen, but her having children of her own around the same age as the child that died could have defiantly increased her predisposition for developing PTSD, in this particular case. Other conditions to rule out At first thought, I believed that Arleen could possibly have general anxiety disorder (GAD) or depression. Both of the symptoms for these disorders were present.
I thought she might have GAD because she seemed very uneasy around the company of others due to the incident and she seemed to not be able to relax. She also seemed extremely shaky, and irritable, as well as trembling and twitching that we witnessed. She would also constantly touch the bandages around her arm from the bullet wound that occurred form the incident. The symptoms for depression were also there, depressed mood, sleep patterns, and hyper arousal. She also had no want, or feels a need to socialize in anyway with anybody. She seemed to have negative feelings of self worth as well.
The PTSD diagnosis came from Arleen indicating that she had been experiencing flashbacks in forms of dreams and vivid memories. She claimed she could not get the images out of her head not matter how hard she tried. She also explained feelings of guilt and mentioned she felt like if she could change something things would be different. Besides for GAD the symptoms would need to be present for six months or more and it had not been that long since the incident. Specific areas of the brain affected and how Memory formation, stress response mechanisms and sensory input are all influenced in patients that are diagnosed with PTSD. The main areas of the brain concerned with memory processes that are affected in PTSD patients are the hippocampus, frontal cortex and amygdala.
The amygdala is located in the limbic system, and links the cortex with the hypothalamus. Amygdala incorporate the behavioral, autonomic, and hormonal components of emotions. The hippocampus is the memory and learning center for storing information from our senses. A patient with PTSD may have a damaged or reduced size hippocampus due to the stress induced cortisol levels. There is also proof from MRI studies that the volume of the hippocampus is reduced in PTSD patients as well. The degenerate of the hippocampus is also considered to represent diminished neuronal density too.
Nonetheless, different studies suggest that hippocampus alterations are explained by entire brain atrophy, and patients with PTSD exhibit generalized white matter atrophy. This seems more relevant in Mrs. McCoy case due to her extreme anxiety and continual, extreme fear of going back to her job. Neurotransmitters involved in this condition and evidence to supports this Dopamine (DA), Norepinephrine (NE), and Serotonin (5-HT) are all neurotransmitters affected in PTSD patients. More recent findings show that changes in 5-HT could be related to the PTSD symptoms: Hypervigilence, exaggerated startle, irritability, impulsivity, aggression and intrusive memories. Both what serotonin helps regulate and the symptoms of PTSD are comparable.
Cortisol is also implicated in PTSD because lower levels of cortisol are associated with stress. Glutamate, GABA and amino acid transmitters are closely related in the processes of realistic memory registration, and suggest that amine neurotransmitters, norepinephrine and serotonin, are involved in encoding emotional memory. This would account for Arleen's feelings of complete responsibility and emotional state there of. How might this condition be treated? How do these treatments work to address the specific physical and psychological conditions? What side effects are associated with your treatments? If appropriate, be sure to include different types of treatments. PTSD can be treated in a pharmacological method and a therapeutic method. Or those two methods can be combined to create a Multi-Modality method, which consists of education, psychological, social support, , and self-help.
Unfortunately there is no recognized tested cure for PTSD, but diverse forms of treatments have given numerous positive results. Certain prescription drugs will work on some symptoms of the diagnosis as well. Select serotonin re uptake inhibitors (SSRI's) like Prozac, Zoloft and Paxil will help with the intense, continual, intrusive recollections that many PTSD patients have. These SSRI's will also facilitate by regulating some of the flashbacks. The primary side effect of the SSRI's is the sexual side effect. Benzodiazepines are another class of drugs that helps to elevate some of the central symptoms of PTSD such as, hyper arousal, and nightmares.
These drugs include Valium and Xanax, which are the two primary ones and prescribed most often. Despite the fact that are widely prescribed they are not very effective or specific. Xanax and Valium can produce dangerous dependency and harsh withdrawal symptoms. MAOI's are another class of drugs that are used to treat the depression, insomnia, flashbacks and persistent thoughts that all plague individuals diagnosed with PTSD. The MAOI's are not as widely used as the other classes of drugs due to their many, many food restrictions. They also cannot be combined with other prescription and over the counter drugs.
Of course drugs are not always the answer, they might be a quick fix, but nothing long term. I have always agreed that a therapy along with some drugs can have the best and most lasting effects. The best ways for patients with PTSD to get through such a traumatic experience in my professional opinion is to commit to treatment and try to establish a therapeutic alliance with their psychologist. The next step would be to acknowledge and accept the trauma and its effects on the survivors and their relationships. From there both patient and counselor can breakdown any barriers that may arise in the future. References Cross Country University.
Posttraumatic Stress Disorder: Effective Diagnostic and Treatment Options. Course Materials Dr. Martha Rosenthal. Study guide packet for test two 'Emotions' Gerald C.
Davison, John M. Neale, Ann M. King. Abnormal Psychology (9 th edition) Neil Carson, Allyn and Bacon. Foundations of Physiological Psychology (5 th edition).