Category: Disorders

Central Nervous System (CNS) associated disorders represent one of the major health issues globally. In this regard, the present description is aimed at highlighting a research proposal related to Posttraumatic stress disorder (PTSD).

Target Population Characteristics

The target population that is in dire need of change in behavior and/or health status is individuals who have Posttraumatic stress disorder (PTSD). The population being studied will be distinguished by the following demographic: African-American/European. The inclusion criteria for participants in the present study is:

1. be male;
2. self-identify as African-American/European
3. be at a minimum age of 18 years;
4. have had a history of PTSD related symptoms like anxiety, depression in the last 12 months;
5. be drug adductors or abusers.

These individuals engage in several traumatic behaviors which may result in PTSD. These include war, terrorist attack, Sexual or physical abuse, Assault, Childhood neglect, Natural disasters and Sudden death of a loved one. (Smith & Segal, 2010). These behaviors may lead to anxiety disorder that is stimulated by the exposure to trauma (Meltzer-Brody et al, 2004). Individuals develop PTSD at a rate of one in four (Meltzer-Brody et al, 2004).

There is a need to identify individuals who require change in the form of remedy or rehabilitation from various corners of the health care. Earlier, a study described about women attending gynecology clinic. They were evaluated for their clinical history and hygienic conditions which revealed PTSD symptoms. It was found that majority of women were eligible for considering them under PTSD category (Meltzer-Brody et al, 2004). The demographic and ethnicity information reveled that they are African American with mean age of 34 years (Meltzer-Brody et al, 2004). Hence, the target population to be involved in this study would be African American women attending gynecological units at outpatient blocks (Meltzer-Brody et al, 2004).

The exclusion criteria will be set for those patients who are without PTSD symptoms.

Briefly this criteria includes:

1. non African-American/NonEuropean;
2. age below 18 years;
3. had symptoms unrelated to PTSD.,
4. have no history of drug addiction, abuse, assaults
5. have not involved in acts that could have lead to trauma in the last 12 months.

Gnanadesikan, Novins and Beals (2005) reported about high risk PTSD individuals who are American Indian children and adolescents. These are found with variety of traumatic experiences and sexual trauma. Characteristics like age at first trauma, number of traumas, sex, kind of trauma are considered as they are associated with the PTSD (Gnanadesikan et al, 2005). In addition, they are also independent variables described to be associated with PTSD (Gnanadesikan et al, 2005). Therefore, identifying population characteristics is essential in the predicting the risky outcome of PTSD.

Independent Variable

In this study, the independent variable will represent two levels. The first will be the intervention being experimented and the second will be the education group. The first intervention that will be focused on PTSD management like cognitive-behavioral approaches like anxiety management, reprocessing, removing the sensation of eye movement, exposure therapy may improve the conditions of PTSD (Choi, Rothbaum, Gerardi & Ressler, 2010).

Cognitive-behavioral approaches like anxiety management, reprocessing, removing the sensation of eye movement, exposure therapy may improve the conditions of PTSD (Choi, Rothbaum, Gerardi & Ressler, 2010). In addition, NMDA agonist D-cycloserine, virtual reality-based exposure therapy were also proven to be important in ensuring the exposure therapy to ameliorate the efficacy of treating anxiety disorders and has implications for novel pharmacological developments in the area of behavioral therapy (Choi et al, 2010). The association between psychotherapy and the present pharmacological methods are significantly important for the success of psychosocial treatments (Choi et al, 2010).

There is a need to identify the flaws in the treatment interventions with regard to the psychodynamic therapy and anxiety treatments of hypnosis as they may contribute to inconsistencies on the efficacy of these treatment techniques (Choi et al, 2010).This has supported an earlier description on the treatment plans focused on posttraumatic stress disorder (PTSD). The second intervention is based on therapies like education oriented trauma management therapies. Here much emphasis was given on a spectrum of interventions that are frequently exploited in treating the patients with PTSD(Robertson, et al , 2004).These are cognitive therapy, trauma management therapy, stress inoculation therapy, exposure therapy, psychoeducation, hypnotherapy and psychodynamic psychotherapy(Robertson, et al , 2004).

Here the education will be focused keeping in view of strategies that are considered to improve the problem behavior or health status are dialectical behavior therapy, interpersonal psychotherapy, memory structure intervention, imagery rehearsal (Robertson et al, 2004). There is need to arrange 2 hour educational session to develop awareness for PTSD patients who present morbidity, and symptoms leading to decrease occupational interpersonal, and social adjustments (Robertson, et al, 2004). This program should be assonated with appropriate psychotherapeutic interventions without fail in connection with various modes of treatment under specialized treatment schemes (Robertson et al, 2004).

Moderator Variable

Type of Work atmosphere. This variable constitutes the influence of society actions on the behavior of victims susceptible for PTSD.

It was shown that male participants face severe work potential with negative appraisals of the world (Matthews, Harris, & Cumming, 2009). This would lead to the development of PTSD symptoms and altered cognitive coping(Matthews et al, 2009). Majority of the subjects were found with the symptoms of PTSD where there was diminished work orientation.

These subjects need encouragement about their self and worldly appraisals (Matthews et al, 2009). This may indicate that male individuals in a work atmosphere are more prone to PTSD (Matthews, et al, 2009).From the self-described trauma-related appraisals given by these subjects, it may indicate that PTSD is largely associated with the cognitive variables and work potential (Matthews et al , 2009). Therefore, PTSD management is dependant on coping strategies and Trauma-related appraisals that might influence the psychosocial behavior in male easily.

In contrast, PTSD symptom severity for women was found to be more than men. This could be because in college settings intimate relationships frequently get altered through abuses physically and sexually ultimately leading to posttraumatic stress (Avant, Swopes , Davis, & Elhai , 2010). Psychological abuse at the college level is a serious issue today and may have a negative emotional influence (Avant et al, 2010). PTSD outcome may be poor among certain college students but evaluating the psychological abuse is mandatory with regard to the earlier years of education in the colleges and the regulation of other factors like lifetime trauma history (Avant et al, 2010).

The research finings have revealed that in women trauma history is a god indicator of PTSD symptom severity compared to men (Avant et al, 2010). This could indicate that women pursuing college education may be more prone to PTSD and need to be largely screened (Avant et al, 2010). Thus, it is reasonable to mention that PTSD may influence males at the work place or females in colleges, which needs further investigation.

Dependent Variables

Blood pressure, C-reactive protein, cholesterol levels Next, it was described that PTSD is associated with the metabolic syndromes where blood pressure, obesity and insulin resistance play important role (Heppner et al, 2009).

Brunner et al described about the markers linked to stress-associated autonomic and neuroendocrine stimulation like high C-reactive protein, IL-6, blood viscosity, low heart rate(Heppner et al, 2009). This could be due to stress in the work place as noted earlier. This was revealed when a cohort of veterans have participated in a study where details on educational history, sociodemographic information and military service were sought in questionnaire(Heppner et al, 2009). It was found that moderating variables like serum triglycerides, high total cholesterol/HDL ratios were elevated (Heppner et al, 2009).

This has association with exposure to frequent loads of stress. Here, involvement of other factors like lifestyle, developmental and genetic factors were shown to be important in modulating the traumatic stressors.

This has strengthened the connection between metabolic syndrome and PTSD indicating that metabolic syndrome may serve as an important is a useful clinical indicator in influencing its quantitative effects on PTSD (Heppner et al, 2009). This may shed light on the need of important variables like body mass index and blood pressure which are more prone to deviation from the normal indices. Hence, the clinical outcome of PTSD could be largely dependant on these parameters.

Studies need to be carried out in evaluating the connection between PTSD and physical morbidity and mortality and examine whether there is concerted affects of metabolic syndrome on PTSD (Heppner et al, 2009). Therefore, moderating variables could be identified keeping in view of characteristics related to metabolic syndrome (Heppner et al, 2009). Here, apart from blood pressure, CRP levels, triglycerides HDL or LDL cholesterol levels also furnish better information. Basing on the conceptualizations described previously, a theory can be described. Firstly, a group of people from various ethnic or demographic regions need to be identified. The age of individuals is central to include in the study.

Recruitment at outpatient clinics is a good practice as they furnish information on gender, type and number of traumas associated with PTSD symptoms. The behavior of patients suspected for PTSD needs evaluation when cognitive skills deteriorate. This could be due to association of PTSD with the psychosocial functions. Equal opportunity for male and female participants is a mandatory factor while identifying the study characteristics.

This might positively influence the PTSD outcome. Variables help to asses the severity of PTSD. They could be dependant or independent variables. Drug addition may predispose an individual to PTSD through anxiety and altered behavior. It could disturb normal physiological process and corresponding variations in the dependant variables.

For example, drug addition may induce stress related symptoms like blood pressure alterations, increased hormonal production in response to stress. Here, interventions have great role to play. They have potential to assess the level of drugs in victims which furnishes insights on the severity of stress, previous exposure to violence, physical mental or sexual abuse and negative appraisal. This also reflects the type of environment the victim has chosen to work. Multiple studies would prove to be reliable in understanding the outcome of PTSD. Incidence reports may help to provide association with the drug and type of trauma.

It is likely that the PTSD victims arrested on the charges of drug abuse could revert back to the earlier life after release from the prison. Studies might prove beneficial when focused on memory structure intervention, interpersonal psychotherapy and dialectical behavior therapy. Costs associated with the PTSD vary significantly with the type or the severity of PTSD. For example, individuals who present PTSD along with depression require mental health drugs especially available and spent more compare to the depressed patients without PTSD (Chan, Cheadle, Reiber, Unützer, & Chaney, 2009). This could be due to the complexity of the problems associated with the PTSD (Chan et al, 2009).

Like PTSD patients with depression have mental health checkups at specialty centers, outpatient visits and have greater degree of emotional distress (Chan et al, 2009). They nee antidepressants in great quantity. Similarly, PTSD patients who have previously met with motor vehicle accidents also experience increased health and economic costs (Chan, Medicine, Air, & McFarlane,2003). This could be because motor vehicle accidents contribute to increased psychiatric consequences and medico legal and treatment aspects which are very closely related to posttraumatic stress disorder (PTSD) (Chan et al 2003).

Therefore, psychiatric disorders having deep connection with the motor vehicle accidents result in significant health and economic expenses quantitatively (Chan et al 2003). From the studies it was revealed that most victims were recognized with anxiety and others with depression (Chan et al 2003). In contrast, untreated PTSD patients experienced huge financial loss when compared with treated and non treated PTSD cases (Chan et al 2003).

This may indicate that treatment plans and severity of PTSD, its combination with other mental disorders greatly influence the financial burden to be incurred (Chan et al 2003). Therefore, the conceptualizations outlined here follow a sequence of information flow starting from the identification of characteristics on demographic and ethnic grounds, gender, drug addiction, and motor vehicle accidents. It is important to note that the outcome of a variable is largely dependant on the follow up period investigated by the health care professionals while assessing the severity of PSD.

The Theory of Causation

The Dependent Variables

Data Collection Procedures

The instruments being used for data collection will be the Clinician Administered PTSD Scale (CAPS).

It has a range between 0 and 136. This needs to used along with the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) criteria. Most important variable blood pressure should be tested n combination with other physical tests like waist-to-hip ratio laboratory based 12-hour fasting lipids, glucose. While assessing hypertension, systolic and diastolic blood pressure values need to be united to reflect one condition.

Cut-off values should be utilized for high blood pressure, serum triglycerides, high-density lipoprotein, plasma glucose concentration. For PTSD data management, an accessor should seek information from the eligible participants.

Before this, a medical and psychological examination need to be conducted initially for the screening the subjects. Informed consent should be obtained such that the data can be utilized for other studies in the area of psychiatry. If the study is planned at University or Hospital, it needs approval from the concerned Institutional Review Board or Health care Department. Exclusion criteria should be followed for the participants, who do not present data from the any one of the variables under study, whose laboratory findings are not in agreement with the standard deviations (SD) from the group mean.

Similarly, those with very high laboratory findings should be excluded to facilitate efficient scrutiny of physiological burden on quantitative scale. These exclusion criteria would precisely yield the eligible participants. Sociodemographic information like educational history, military service and deployment (for veterans) need to be sought from the questionnaires. In addition, the questionnaire will assess and measure the following domains:

1. demographics, anxiety, psychological distress,
2. socio-cultural factors: type of work atmosphere, physical or sexual abuse
3. developmental factors (perceptions of acquiring illicit drugs,
4. alcohol and drug use;
5. Trauma risk behaviors.

Measures related to PTSD severity like Clinician Administered PTSD Scale (CAPS), should be included. It has a range between 0 and 136. This needs to used along with the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) criteria. Most important variable blood pressure should be tested n combination with other physical tests like waist-to-hip ratio laboratory based 12-hour fasting lipids, glucose. While assessing hypertension, systolic and diastolic blood pressure values need to be united to reflect one condition. Cut-off values should be utilized for high blood pressure, serum triglycerides, high-density lipoprotein, plasma glucose concentration. NCEP criteria should be followed for serum triglycerides and WHO and NCEP criteria should be followed for other parameters.

Here, although blood pressure is the important variable, its utility in connection with the severity of PTSD should be assessed in combination with other parameters. Finally, the important aspect of this description is about the threat measurement while collecting the data. A threat is a component that contributes to the outcome of the experiment. Here, there is need to describe about internal validity which is the treatment option that influences a dependant variable. The more the potential of an investigator to contribute to a change, the more will be degree of confidence that the intervention would lead to that effect.

The important threats to be considered for internal validity include testing, maturation, history, instrumentation, selection and experimental mortality. Therefore, while collecting the data emphasis should be given to year long reports on PTSD and related writing methodologies in a Hospital that may become erroneous by mismanagement. PTSD patients involved in long-term study on PTSD may show a decrease in the visits to a psychiatry clinic due to increasing PTSD cases instead of other treatment prescription.

Therefore, history and maturation may become more probably important for young individuals with PTSD and in longitudinal studies. Next, threat to measure is testing. To ensure the data quality, written formats and questionnaires need to be thoroughly evaluated for the kind of information to be sought, screening of PTSD patients at various clinical settings is important to enable the identification of perfect cases with significant study characteristics. Next threat to be measured is testing that result when changes take effect due to repeated testing instead of intervention. This issue is frequently encountered when the investigators come forward with the similar tests.

For example, PTSD patients need to be monitored for their behaviors, IQs and memory influenced by the prescriptions. When the physician or a doctor repeatedly prescribes the same drug or writes a questionnaire based prescription and obtains the similar results always, it could be due to earlier report on that particular strategy.

This would not demonstrate his or her natural habit of improved prescribing. Therefore, to ensure the quality of the data in this context PTSD based prescriptions should be changed according to the individual circumstances by the psychiatrist. The ultimate objective is to avoid repetition and try novel therapeutic strategies aimed at lessening the PTSD symptoms. The next threat to be measured while collecting the data is about the selection, PTSD patients referred from gynecology units receive should pharmacy-based educational intervention. Without this changes induced by the confounding variables like age, race, hysterectomy status, and menopausal status may become obvious.

To ensure the quality of the data on pharmacological interventions, relevant educational awareness programs need to be arranged for the PTSD patients. Similarly, experimental mortality is another threat that results due to a sudden cessation of experiment/treatment in advance without the completion of the experiment. PTSD investigations that are streamlined for the comparison of the anxiety drug effectiveness, for example, should take precautions that there is no loss of loss of subjects from the comparison that might lead to inequalities. Lastly, there is need to shed light on External validity which is emphasized on methodological procedures.

PTSD sample selection should be performed on random basis from the population. Otherwise characteristics like ethnic, racial, socio-economic, household, religious and/or income may become one sided partial and effect the outcome. Hence, sample collection process should be performed on a random basis. In view of the above information, PTSD is a severe anxiety disorder influenced by a spectrum of clinical characteristics that are dependant and independent. The relationships between Interventions and disease severity largely influence the outcome. Follow up studies might reveal significant information on many variables. An evidence based approach is necessary for the PTSD disease management and research modifications.

Table Design of the project depicting the interrelationships between the variables and outcomes related to PTSD

Design Table

References

Avant, E, M., Swopes, R, M., Davis, J, L., Elhai, J, D. (2010). Psychological Abuse and Posttraumatic Stress Symptoms in College Students. J Interpers Violence.

Brunner, E, J., Hemingway, H, Walker, B,R., Page, M., Clarke, P., Juneja, M., Shipley, M,J., Kumari, M., Andrew, R., Seckl, J,R, et al (2002). Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome: nested case-control study. Circulation, 106, 2659-2665.

Chan, A,O., Medicine, M., Air, T,M., McFarlane, A,C. (2003). Posttraumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South australia. J Clin Psychiatry,64,175-81.

Chan, D., Cheadle, A,D., Reiber, G., Unützer, J., Chaney, E,F. (2009). Health care utilization and its costs for depressed veterans with and without comorbid PTSD symptoms. Psychiatr Serv, 60, 1612-7.

Choi, D,C., Rothbaum, B,O., Gerardi, M., Ressler, K.J. (2010). Pharmacological enhancement of behavioral therapy: focus on posttraumatic stress disorder. Curr Top Behav Neurosci, 2, 279-99.

Gnanadesikan, M., Novins, D, K., Beals, J (2005). The relationship of gender and trauma characteristics to posttraumatic stress disorder in a community sample of traumatized northern plains American Indian adolescents and young adults. J Clin Psychiatry, 66, 1176-83.

Heppner Pia, S., Crawford Eric F., Haji Uzair A, Afari Niloofar, Hauger Richard, L., Dashevsky Boris, A., et al. (2009). The association of posttraumatic stress disorder and metabolic syndrome: a study of increased health risk in veteran. BMC Medicine,7, 1-8.

Matthews, L,R., Harris, L,M., Cumming, S. (2009). Trauma-related appraisals and coping styles of injured adults with and without symptoms of PTSD and their relationship to work potential. Disabil Rehabil, 31, 1577-83.

Melinda Smith & Jeanne Segal (2010). Post-traumatic Stress Disorder (PTSD) Symptoms, Treatment and Self Help. Web.

Meltzer-Brody, S., Hartmann, K., Miller, W, C., Scott, J., Garrett, J., Davidson, J.(2004). A brief screening instrument to detect posttraumatic stress disorder in outpatient gynecology. Obstet Gynecol, 104, 770-6.

Robertson, M., Humphreys, L., Ray, R. (2004). Psychological treatments for posttraumatic stress disorder: recommendations for the clinician based on a review of the literature. J Psychiatr Pract, 10, 106-18.

Social Research Methods. Web.

Introduction

An eating disorder is becoming a major problem in the country. The obesity epidemic is thought to be responsible for increased incidences of an eating disorders. National wide concern with reducing weight to avoid obesity has significantly affected the eating habits of many people. In some cases, some individuals opt for unnatural ways of reducing weight. Healthy eating and exercising are vital for health, however, overemphasis on the need for weight loss seems to be having negative effects as some individuals become obsessed with the ideal weight (Bearman, Martinez, Stice & Presenell, 2006).

Incidences of eating disorders are widespread in the United States where they cut across different age groups and ethnicity. Although the problem is widespread, it is considered to be a problem for adolescents and young adults with the highest number of cases. Societys perception of beauty and health has a big role in the increase of eating disorders. In American society individuals that are slender and slim are considered healthy and beautiful while those who are overweight are being considered lazy and unattractive. Without a check, Americans may move from an obesity epidemic to an epidemic in eating disorders. The essay reviews Management of Eating Disorder (AHRQ Evidence Reports, 2006), a literature review on eating disorders. The literature review addresses the problem of eating disorders with a focus on treatment options.

Eating Disorder as a psychological disorder

Although eating disorders appear to be physiological problems, they can also be considered psychological issues. They are considered as mental effects by the fact that they mainly occur because of obsession with health, weight, and beauty. Eating disorders are caused by unhealthy eating behaviors. Unhealthy heating behaviors may range from extreme and unhealthy reduction in food intake that leads to unhealthy growth to excessive eating. When an individual is affected by an eating disorder, he or she shows negative feelings about eating, figure, weight, or all three.

Range of Literature in the Literature Review

Various articles are included in the literature review. Articles generally addressing the problem were included. Although varied articles are included, the review mainly focuses on remedies. The review starts by comparing different definitions of eating disorders as provided by different authors. Manifestation of the problem among individuals of different demographic backgrounds is then addressed. There is a demonstration of interest in the causes of eating disorders. Most authors agree that the problem results from obsession over health and beauty. Authors however differ on the actual causes of the problem as some authors provide varying opinions. Various eating disorders are addressed in the review. Bulimia nervosa, anorexia nervosa, and binge eating disorders are the most common (AHRQ Evidence Reports, 2006).

Methodology

The Methodology used in a meta-analysis has a high contribution to the validity of the outcomes. The meta-analysis is focused on methods of treatment for eating disorders and the outcome of these methods. Before the conduction of the analysis, key questions that would guide the study were set. Six questions were identified for the review. The questions sought answers to the efficacy of different methods of treating eating disorders; evidence of harm resulting from each method, and factors used to determine the efficacy of the methods (Bearman, Martinez, Stice & Presenell, 2006). The questions also sought to determine whether the efficacy of treatment methods differed in different groups such as gender, ethnicity, age, or cultural groups. They also sought to provide answers to the factors that determined the outcome, and whether the outcome differed in gender, sex, ethnicity, age, and cultural group. The review covers the key questions about the treatment method and its outcome. These questions provided the main analytical framework for the review. After setting the key questions, criteria for searching relevant material, and exclusion and exclusion criteria were stipulated.

The review considered treatment and outcomes of the three major eating disorders: Bulimia nervosa, anorexia nervosa, and binge eating disorder. The review intended to include treatment and outcome of eating disorders not otherwise specified but because of the scarcity of materials majored on binge eating disorders (Vitousek, Watson & Wilson, 1998). Issues regarding each eating disorder including treatment and outcome of the treatments were considered separately. The outcomes of having a specific eating disorder were examined by reviewing observational studies. The outcomes constituted eating, psychological or psychiatric, biomarker variables as well as death. Although the review considered the efficacy of treatment, it focussed more on disease level and other challenges that persist over time.

Exclusion and exclusion criteria are paramount in a meta-analysis. A literature review cannot cover all literature on a particular topic. Criteria are required to narrow down a study to specific objectives. The literature review was first limited to human studies that constituted individuals above five years. Although there is growing interest in eating disorders in children, studies on that subject were ruled out as being beyond the scope of the review (Vitousek, Watson & Wilson, 1998). The review consisted of studies that were published between 1981 and 2006. Studies with both male and female participants were considered in the study. However, the participants had to be diagnosed with any of the three eating disorders. Studies that combined diseases were excluded from the review. Such data were excluded, as they would have interfered with the study on specific disorders. Also excluded were commentaries, editorials, articles that were not related to the key questions, letters, and the studies that provided insufficient information (AHRQ Evidence Reports, 2006). Studies to be included were expected to give information on one or more of the outcome categories which included eating, psychological, or biomarker measures.

Search Strategy

Systematic searches were conducted to obtain articles to be reviewed. The searches were conducted based on search terms while hand search was used in some cases. The searches were conducted on standard databases on health cases. The databases used for search consisted of PsycINFO, Cumulative Index to Nursing and Applied Health, MEDLINE, Information Resources Information Centre (ERIC), and National Agricultural Online Access (AHRQ Evidence Reports, 2006). Using the inclusion/ exclusion criteria specified for the study, a list of search terms was generated. The search terms were supplemented by MEDLINEs keyword searches. Search terms used for the study constituted the terms bulimia, anorexia, anorexia nervosa, treatment, eating, prevention, and intervention. The searches were limited depending on the type of study that included random allocation, single and double-blind searches were conducted using the search terms. The articles obtained were rated using appropriate rating criteria to assist in article selection (AHRQ Evidence Reports, 2006).

Findings

The literature review shows that the treatment methods used are being advocated for by different medical professionals. Apart from the proposed treatment methods, the review shows the outcomes that result from the different eating disorders. For binge eating disorders, psychological and dietary measures that control weight was used (AHRQ Evidence Reports, 2006). Other treatment methods for binge eating disorders were found to be mental behavior and interpersonal analysis, and nutritional advancement such as taking food with low-fat content. The review also shows that the above interventions were of great help in helping binge disorder victims. Many scholars in the review feel that the treatment of mental disorders resulting indirectly from the eating disorders was a communal role.

Outcomes of the three eating disorders among various groups of people were well featured in the review. As demonstrated in the review, the outcome varies depending on sex, gender, masculinity, maturity, ethnicity, and cultural background (Bearman, Martinez, Stice & Presenell, 2006). The outcome for each eating disorder was stated separately. Four main concerns are featured in the review. These include those associated with eating, mental variables, and those calculated through biological mechanisms such as weight, menstrual cycles, and fatality.

The review extensively discusses factors that influence the use of a particular therapy for the treatment of eating disorders. Apart from behavioral measures, which were rated moderate, other treatment and intervention measures were rated low. The outcome for treatments was found to vary with age, sex community, gender, and racial differences. However, the treatment of the three eating disorders does put these factors into consideration (AHRQ Evidence Reports, 2006). Treatment using medication alone, behavioral intervention alone, and a combination of the two is featured in the review. For individuals treated using medicine alone, various side effects were reported. For instance, there could be a change in weight and moods because of the antidepressants.

Learning Outcomes and Conclusion

The literature review shows that eating disorders are major health challenges currently and in the future if appropriate measures are not taken. It becomes imperative from the study that each individual should take a closer look at health issues. The initiative to cut weight should not lead an individual into adopting poor eating habits that lead to eating disorders. Obsessions with ideal physic are the dominant cause of eating disorders. To avoid the looming epidemic, there is a need for the provision of health education to all.

Reference List

AHRQ Evidence Reports. (2006). Management of Eating Disorders .

Bearman, S., Martinez, E., Stice, E., & Presenell, K. (2006). The skinny on body dissatisfaction: A longitudinal study of adolescent girls and boys. Journal of Youth and Adolescence, 35, 217-229

Vitousek, K., Watson, S. & Wilson, T. (1998). Enhancing motivation for change in treatment-resistant eating disorder. Clinical Psychology Review 18(4), 391-420.

The musculoskeletal system consists of such major elements as the skeleton and the muscles. No doctor specializes in one of these components as they are closely connected and function in terms of the processes taking place in this complex system. At that, it could be important to specialize further to learn more about the functioning of the system, diseases, their treatment, and prevention. This brief report is concerned with rheumatoid arthritis as this autoimmune disorder of the joints affects up to 1% of the US population and has a considerable adverse effect on patients quality of life (Sharif et al., 2018). Joints consist of muscles, bones, synovium, ligaments, tendon, and cartilage. In healthy joints, the synovium that is a connective-tissue membrane is constituted by up to three layers of cells. This membrane secretes synovial fluid that is essential for proper movement. In joints affected by the disorder, the synovium is sickened and inflamed, which causes pain and swelling.

Rheumatoid arthritis destroys joints and bones (in some cases), as well as the disintegration of ligament and tendon laxity (Sharif et al., 2018). These changes may lead to such deformities as hand boutonniere deformity, swan neck deformity, wrist flexion deformity, and others (Sharif et al., 2018). The symptoms of this disorder include pain in joints, swelling and stiffness of joints, the same sign on the two sides of the body, fever, weight loss, fatigue, and weakness (Centers for Disease Control and Prevention [CDC], 2019). Rheumatoid arthritis is diagnosed by physical examinations, a review of symptoms, an X-ray, and some laboratory tests. Early diagnosis leads to effective treatment of the symptoms and the damaging effects of the disorder. Treatment involves the subscription of medications (disease-modifying antirheumatic drugs) that slow down the progress of the disorder and the destruction of joints, as well as soothe the pain. Self-management involves physical activities, weight control, joint protection, and regular visits to a doctor. Effective prevention is yet to be developed for rheumatoid arthritis, and only early diagnosis can help in slowing down the progress of the disorder.

Responses to Peers Posts

I agree with your point regarding the benefits of specialization in specific systems rather than complex areas. I also believe that doctors will be able to help patients more effectively if they are concentrated on quite a narrow field, but their knowledge is deep. However, it occurred to me that excessively narrow focus of healthcare professionals can be rather harmful or ineffective. It can be difficult to identify the cause and the effect of certain conditions, so a patient will have to address many doctors whose treatment can be conflicting. The interdisciplinary approach is a potential solution to this problem as different healthcare practitioners can collaborate to develop the most appropriate treatment plan. So, although I believe a focus on a specific system is beneficial, it is critical to make sure that this division is well-thought and evidence-based. Your point regarding the historical aspect is also relevant, so doctors will need particular training and years of practice before the division can be possible.

Having a more profound understanding of the functioning and possible issues related to a system in the human body is critical for effective diagnosis and treatment. I also agree that a physician is a central figure in the process of diagnosis who knows all systems to the extent necessary for the identification of the cause of the malfunction. Patients often have comorbid conditions so several systems may be affected and may need specific attention. Hence, I think that interdisciplinary teams may become the core of the provision of high-quality care at all stages (be it diagnosis or treatment). The appearance of professionals specializing in muscular and skeletal systems may be a near future that is justified and beneficial for health care. However, further advances in the utilization of the interdisciplinary approach are also necessary.

References

Centers for Disease Control and Prevention. (2019). Rheumatoid arthritis (RA).

Sharif, K., Sharif, A., Jumah, F., Oskouian, R., & Tubbs, R. S. (2018). Rheumatoid arthritis in review: Clinical, anatomical, cellular and molecular points of view. Clinical Anatomy, 31(2), 216-223.

In the case of schizophrenia, the evidence suggests that such patients usually tend to have low levels of norepinephrine and high levels of serotonin (Schimelpfening, 2021). There is also a hypothesis in regards to dopamines role in the development and progression of the disease, which is induced by the proper functioning of the system (Schimelpfening, 2021). Dopamine plays a central role in memory formation, which was introduced later in the evolutionary stage of humans, where the persistent hunting style led to central nervous system changes.

The coverage of large geographical areas forced humans to develop stronger mapping capabilities by memorizing key features of the corresponding territory, which required stronger utilization of dopamine. In other words, the memory issues of schizophrenia can be the result of improper functioning of dopamine and dopaminergic system within the brain.

Bipolar I disorder is also implicated by neurotransmitter imbalance, where there is no clear indication of whether dopamine or serotonin have a direct causal relationship with the disease. However, it is evident that high levels of noradrenaline are strongly associated with mania, which is the key distinguishing factor of Bipolar I and Bipolar II, where the former has a full manic episode, and the latter has only hypomanic episodes. In other words, the implication of neurotransmitters can be manifested in either a certain imbalance between all of three elements or over expression or high concentration of norepinephrine, which induces a more prominent fight-or-flight response, which, in turn, leads to a manic episode.

In the case of a major depressive disorder or depression, all three neurotransmitters play a critical role in the development of the disease. Major depression is a common mental disorder that is one of the most common causes of disability (Schimelpfening, 2021). This disease occurs in all age groups and affects people of both sexes in any region of the world. The experience of recent decades has shown that the prospects for studying depression are associated with its neurobiology.

The molecular hypothesis is widely used to explain the pathogenetic mechanisms of depression. According to the latter, adverse environmental factors, such as stress, affect genetic vulnerability, which causes maladaptive changes in the chain of neurotransmitters, among which monoamines play the main role. Most of the available advances in the treatment of the disease have also implemented the effects on the deciphered mediator mechanisms of pathogenesis. Dopamine affects depression because it is responsible for inducing a sense of motivation, which drives the majority of behavioral tendencies (Schimelpfening, 2021). The reduction in dopamine levels can lead to a reduced desire for normal behaviors.

Similarly, norepinephrine, which both hormone and neurotransmitter, take part in the fight-or-flight response, where its low concentration makes a person less active and dynamic. However, the serotonin system is one of the most important systems of cerebral neuromodulation involved in the pathogenesis of depression. This neurotransmitter system has a long evolutionary history and is involved in a variety of behavioral acts and emotional manifestations (Schimelpfening, 2021).

In order to better understand the integration of the serotonin system into the brain processes of mood regulation, one should, first of all, consider the available data on the influence of different cerebral regions on affective manifestations. Thus, executive functions, including the modulation of emotional behavior, which may be related to the formation of cognitive symptoms of depression, are associated with hypoactivation of the left frontal cortex.

Reference

Schimelpfening, N. (2021). The chemistry of depression: What is the biochemical basis of depression? Verywellmind. Web.

Introduction

This paper was about a very interesting article published in the spring of 2004 at the British Journal of Nursing by two prominent authors, Thomas Aird and Michelle McIntosh. Thomas is a lecturer at the Faculty of Nursing of the London South Bank University and Michelle is a senior staff nurse at the Acute Brain Injury Unit of the National Hospital of Neurology and Neurosurgery in London.

The main topic of the paper relates to the problems arising among nursing staff when trying to diagnose and treat patients with cognitive disorders. The authors argue that today nurses tend to focus more on the physical aspects of a patient. A crucial problem is that clinicians do not assess properly cognitive deficits and they fail to understand the importance of such status which influences the physical and daily life activities of patients at all levels.

Summary of the article

The authors begin their paper study by assessing the importance of the problem. Cognitive deficits are mostly misunderstood or eat least not fully understood today by practicing nurses. Many times they fail to correctly diagnose their patients and, as a result, fail to give them proper care. They also point out that some of those nurses who may understand the issue, still do not evaluate it as important. This is what makes this article important for every nurse to read.

There is a broad agreement among scholars that sexuality is one of the key elements in defining human identity both on a personal and communal level. Some go as far as to make it one of the key factors determining the meaning of life itself (Aird and McIntosh, 2004). But there is a strong correlation in our culture between the sexual feelings, sexual life of an individual, and physical body shape.

Here is where the authors of the article raise their research question. They want to explore and analyze why attitudes toward sexuality and sexual behavior have generated devaluing reactions from society regarding older adults (Aird and McIntosh, 2004).

They go on to describe the strong paradigm that sexuality is something related to youth and most of the time is neglected or misunderstood by older adults. The authors here see a potential rising problem for society in general and the nurse community in particular. Since the portion of the adult population is increasing rapidly over the younger generation and their chronic health problems are doing the same, nurses will find themselves in a very difficult position shortly. Only those who have an educational background or training in gerontology or sexuality will be more able to consult older adults about these issues.

The rest of the nurses, given the current educational apparatus and what it transmits them, will find themselves in a difficult position.

The authors give practical examples of the problems in the current education of nurses and the lack of training they receive in this area. After this assessment, they continue to provide their solution to this problem. The implementation of such policies will ensure the recognition of the problem, the older adult sexuality behavioral disorders, and will also facilitate the recognition of the rights for this portion of society. All of this aims at enhancing the quality of life for these individuals and preventing social tensions. By doing so, the authors argue that these research and implementation policy efforts will have a direct impact on social justice.

Evaluation of the article

The authors of the article have posed a very interesting research question and very well presented their rationale and argumentation for the case. They have tried to tackle an issue that is not in focus in the nursing profession at the moment. This gives them credit along with the professionalism they have presented and argued their case. Nevertheless, there are certain points in the article that seem to be forced. It is quite strange that the authors do argue very well the lack of preparation and training for nurses coming out of school about this issue, but instead of offering a solution related to education, they propose an increase in efforts in research and policy development in medical institutions. The main question that arises is how can nurses that have not been educated or trained adequately about such a problem be able to design a policy that will tackle the problem. Furthermore, if the bulk of the nurses is not trained or educated about older adult sexual problems, how can a researcher base his / her policy implementation on them. Would it not be better if the nurses were the first to properly understand the issue the policy is addressing before they reach out to patients.

Conclusion

This paper was about a very interesting article published in the spring of 2004 at the British Journal of Nursing by two prominent authors, Thomas Aird and Michelle McIntosh. Thomas is a lecturer at the Faculty of Nursing of the London South Bank University and Michelle is a senior staff nurse at the Acute Brain Injury Unit of the National Hospital of Neurology and Neurosurgery in London.

The article relates to the problems and confusion arising among nursing staff when trying to diagnose and treat patients with cognitive disorders. The authors argue that today nurses tend to focus more on the physical aspects of a patient. A crucial problem is that clinicians do not assess properly cognitive deficits and they fail to understand the importance of such status which influences the physical and daily life activities of patients at all levels.

References

Aird, Th. and McIntosh, M. (2000) Nursing tools and strategies to assess cognition and confusion, British Journal of Nursing, vol. 19, no. 10.

According to the case scenario, Agnes is most certainly suffering from post-traumatic stress disorder (PTSD). She was traumatized by the previous account of the storm in which her grandfather and her father who were fishing were washed away by the force of nature. Despite the fact that relatives did not die, the tragedy left her scarred. Because it was sparked by a previous occurrence that damaged her folks, it is obvious that it is post-traumatic disorder. It is also clear that it is PTSD because she is having problems coping and is afraid that the incident may occur again. Post-traumatic stress disorder is a condition that can occur within a short period after the terrible experience. In this case, the illnesses began to appear years after the storm.

The recurring traumatic memories of what had happened and her having flashbacks to that particular event are the noticeable signs that can substantiate this patients diagnosis. Her negative thoughts of the event reoccurring, as well as her anxiety-related habits such as hiding behind windows during the storm are prominent indicators as well. It is evident from the case scenario that her problems began years later and continue to worsen whenever there is a chance of a storm. Agnes also exhibits evasion signs and hides behind closed doors. She is avoiding places that may trigger memories of the horrible experience. Furthermore, her repeated recollections and hallucinations of the storm help to explain the diagnosis. These are known as intrusive memories of post-traumatic stress disorder. Given that the DSM-5 technique of diagnosing mental disorders was utilized, identifying the diagnosis was not an easy task. Identifying a psychological condition can be difficult because there are many mental disorders that are related to one another.

Study summary

A study was carried out to investigate variations between restrictive and bingeing/ purging eating disorders. Claes et al. (2012) assessed the two types of inhibition, executive and reactive inhibition, using personality and neuropsychological examinations. Executive adaptations are top-down approaches that help a person gain control of their eating habits and include interference control, cognitive inhibition, and motor inhibition. Reactive behavioral mechanisms are bottom-up approaches that rely on disrupting existing behaviors whenever they arise due to fear of punishment.

Hypothesis

The hypothesis for the study was rooted in the understanding that cognitive and personality traits emanate from the same neurological systems. It was therefore expected that positive correlations would be witnessed between measures for the personality and mental traits in participants suffering from eating disorders (ED). Previous studies showed that the association between nature and cognitive measures was minimal. Other previous studies had witnessed negative correlations between these phenomena. Claes et al. (2012) incorporated both reactive and executive inhibition alongside both personality and cognitive tests, a feature absent in previous studies. The research targetted to fill a gap in the studies on eating disorders causes and characteristics using both tests and both varieties of EDs.

Participants and Setting

There were 48 female participants in the study, all admitted to an in-patient facility for eating disorders. All the participants consented to participate in the study, and it was approved satisfactorily. A questionnaire was used for data collection, and all the patients underwent the necessary cognitive tests in a test room. The study utilized the IntegNeuroTM software to assess executive inhibition on the cognitive level.

The Effortful Control Scale was used to measure executive control at the personality level. Reactive control was not assessed on the cognitive level, but the Behavioral Inhibition Activation System (BIAS) was used to measure reactive control at the personality level. Data analysis involved the use of MANOVA and MANCOVA, with the latter using current patient BMI as a covariate. Pearson correlation coefficient was used to calculate the associations between personality and cognitive traits in measuring executive and reactive eating disorders.

Findings

There was a significant difference between patients with restrictive ED from those with bingeing/purging behavior ED with a p=0.017. Lower levels of attention and motor inhibition control were observed in patients with bingeing /purging ED contrasted to those with restrictive ED. After controlling for current BMI, MANCOVA analysis discovered that executive inhibition in patients with bingeing/purging ED still reported lower attention levels with a p=0.009. Patients with bingeing/purging ED still had a slower mean concentration-time in the Trail Making Test after adjustments for BMI in MANCOVA.

Discussion

Patients with bingeing/purging ED behaviors generally have more problems with executive control compared to their reactive counterparts. Bingeing/purging ED patients also demonstrated more behavioral inhibition compared to the restrictive ED patients. The impulsive behavior in bingeing/purging patients can be explained by their diminished psychological controls and scores. Minimal differences in the cognitive scores for patients with both types of EDs were significant in showing that the disorders did not emanate from intellectual deficiencies.

Implications in Real Life

A weakness of the study was its use of a small sample size which tampered with the generalizability of the study. Claes et al. (2012) recommend the use of larger samples in future similar studies that incorporate varied populations and genders. The study is essential in the development of treatment criteria for EDs as they are poised to focus on behavioral phenomena rather than cognitive treatments. The study has filled a crucial gap in the literature on EDs while encouraging the exploration of deficiencies in the study, such as a cognitive study of restrictive ED. This study is a crucial tool that is capable of forming a study element for people with ED to enable them to comprehend their situation better and regulate it appropriately.

Reference

Claes, L., Mitchell, J. E., & Vandereycken, W. (2012). Out of control?: Inhibition processes in eating disorders from a personality and cognitive perspective. International Journal of Eating Disorders, 45(3), 407414. Web.

Introduction

Gastrointestinal Tract (GI) or the so-called digestive tract is a long tube, which has a different width in some of its parts as well as a large number of flexures. Several sphincters are also the essential fractions of this system. Some sections of the digestive tract can be distinguished anatomically. Moreover, the entire system can be defined by its functional features. All the parts of the digestive tract must have a similar structure beginning with the esophagus. With respect to the whole body, in general, the gastrointestinal cavity represents the environment, and its sides represent the proper internal environment of the body (Greenberger, Blumberg, & Burakoff, 2015). Thus, the functionality of the system is essential for the whole organism. The purpose of this paper is to analyze the normal activity of the GI as well as to review the disorders of motility.

The GI is sensitive towards the effects of external and internal environment such as food, stress, hormonal disorders, and so on. The increased number of deleterious effects result in a significant increase in gastrointestinal diseases. Notably, the systems hormones, acids, and enzymes can affect the condition of GI, and they can harm it. Motility is the normal activity of the GI. Such factors as food and hormones provoke the contraction of muscles of the GI (Greenberger et al., 2015). Any dysfunctional work of the tract can lead to motility disorders and the improper functioning of the GI in general. The most common motility disorders are GERD, gastritis, and so on.

Normal Pathophysiology

The basal secretion of hydrochloric acid is a circadian process with the lowest level of secretion in the morning, and the maximum  at night. The secretion of acid in the stomach is subject to cholinergic regulation via the vagus nerve. In addition, the crucial aspect is the local release of histamine (Johnson, 2013). The main stimulant of acid production is the food. Acid production process is divided into three stages cephalic, gastric, and intestinal. The cephalic phase occurs in cholinergic stimulation of gastric acid secretion by n. Vagus. As soon as the food enters the stomach, the gastric phase of secretion begins.

Some substances (amines and amino acids) directly stimulate the synthesis and secretion of gastrin, which, in its turn, stimulates the secretion of acid. When food enters the intestine, the final phase of stimulation of acid secretion begins (Johnson, 2013). The basic mechanisms in the stimulation phase include tensile bowel action of proteins and their degradation products. The discharge of somatostatin is the most important in the balance of the secretory process. Thus, the acid is the results of the successive processes in the GI. The gastric cells release the gastrin, which influences the production of enterochromaffin. It results in the discharge of histamine.

Disorders

In terms of GERD, PUD, and gastritis, the gastric acid stimulation is dysfunctional. In particular, when the inflammation of the GI is present, the sphincter muscle does not rise properly. It leads to the failure of the muscle to close. In the normal condition, it closes as soon as the substance comes to the stomach. When it cannot close when needed, some acids get into the esophagus (Trowers & Tischler, 2014). Thus, they start digesting its lining. The muscle dysfunction results in gastritis and GERD. Several factors can contribute to the emergence of GI disorders. For instance, beverages rich in carbonates including alcohol, medications (aspirin and so on), physiological issues including obesity, and resting on the back after having a large meal can also lead to disorders.

Patients Behavior and Pathophysiology

Notably, the behavior and the unhealthy habits can have a direct impact on the pathophysiology of GERD, PUD, and gastritis. For instance, it has been proven that the majority of smokers have a rather distinct cough. In its turn, cough provokes the undesired contractions of the sphincter muscle (Pandolfino, 2014). In the process of these contractions, the stomach acid would get to esophagus. It generates burning actions in this part of the GI. That is to say, it results in digestion of the gut sides.

Further on, overeating and alcohol consumption could lead to the same effects. In particular, the acid from stomach would move to the esophagus. It happens due to the fact that when a person who has eaten excessive amount of food lies flat, the acid can easily get to the esophagus (Pandolfino, 2014). Moreover, different types of alcohol can cause different levels of acid in the GI. Nevertheless, alcohol causes the relaxation of the esophageal sphincter, which enables the acid to move freely to another part of the GI causing the burning actions.

Treatment

Rather often, different indicators of motility disorders are evident in patients. The typical symptoms of GERD, PUD, and gastritis include the following:

• heartburns;
• regurgitation;
• bloating bloody;
• nausea;
• chest pain;
• weight loss;
• dry cough (Trowers & Tischler, 2014).

However, these indications are not always present in patients. It is rather easy to treat a patient with these symptoms when he or she has the motility disorder due to particular behavior. It should be advised to break the food intakes into smaller amounts and avoid lying flat on the stomach or back right after eating. The patient should not consume heavy or irritating foods, which cause the increased amounts of the acid production. In addition, the patient should be advised not to consume alcohol or to reduce the amount of its intake as well as to quit smoking. Nevertheless, if these symptoms are not present in the patient, it makes it rather difficult to diagnose the disorder. In that case, conducting diagnostic tests (ECGs, biopsy, blood tests) should be essential to determine the presence of health complications (Trowers & Tischler, 2014).

In terms of PUD, the patient should be prescribed with acid-blocking meds. A patient must change his or her lifestyle to avoid the emergence of larger ulcers. Gastritis can be diagnosed through blood tests or biopsy (Pandolfino, 2014). Such treatment as antacids prescription will improve the production of the acid. Importantly, B12 can also be prescribed in case of pernicious anemia.

Mind map

Conclusion

Thus, it can be concluded that disorders of motility can be the consequence of the physiological issues or the particular behavior of a patient. The gastrointestinal tract is one of the most significant systems of the human body, and its proper functioning is essential for the healthy life of a person. In case of disorder, it is crucial to conduct a timely assessment and to take the necessary lab tests to evaluate the condition of the patient and to propose the appropriate measures to improve the acid production and stimulation as well as to advise the individual on the healthy practices of eating and his or her lifestyle.

References

Greenberger, N., Blumberg, R., & Burakoff, R. (2015). Current diagnosis & treatment. New York, NY: McGraw Hill.

Johnson, L. (2013). Gastrointestinal physiology. New York, NY: Elsevier.

Pandolfino, J. (2014). Esophageal function testing. New York, NY: Elsevier.

Trowers, E., & Tischler, M. (2014). Gastrointestinal physiology. New York, NY: Springer.

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12.

The article, Watkins et al. review different psychotherapy interventions that can be applied in treating Post Traumatic Stress Disorder (PTSD) among adults. Most patients that experience PTSD tend to have or are undergoing a traumatic life happening (Watkins et al., 2018).Watkins et al. suggest possible therapeutic solutions that psychotherapists apply to PTSD, such as cognitive processing therapy, trauma-focused cognitive behavioral therapy, and prolonged exposure. The authors continue to define how each of the therapies aids the trauma-related cases.

According to the authors, the American Psychology Association needs to verify psychotherapy techniques by highlighting the strength, benefit, patient values, and applicability of the psychotherapy techniques (Watkins et al., 2018). The research article is important to my topic as Watkins et al. explain how psychotherapy interventions are applied. Prolonged exposure insists that acquaintance with stressful situations leads to the patients development of strength and courage. Cognitive processing therapy suggests that the main of the therapy is to help the patient accommodate the stressful situations without reacting negatively to stress situations (Watkins et al., 2018). Cognitive Behavioral Therapy insists on the restructuring of the behavioral patterns of the patients reducing stress symptoms. The main limitation of the article is that patients tend to drop out of psychotherapy treatment as soon as they start experiencing positive results, thus increasing their chances for trauma. The article forms the basis for future research and offers scientific solutions in dealing with Post-traumatic Stress Disorder cases.

Kintzle, S., Barr, N., Corletto, G., & Castro, C. (2018). Post-traumatic stress disorder in U.S. veterans: The role of social connectedness, Combat experience, and discharge. Healthcare, 6(3), 102. 

In this article, Kintzle et al. explain the effects of Post-Traumatic Stress Disorder on veterans and the methods used to correct the stress situations. According to the authors, combat exposure is a risk factor leading to post-traumatic stress disorder (Kintzle et al., 2018). The transition from military to civilian life causes veterans to experience stressful experiences. Among the methods used by the authors to experiment with the level of PTSD in the veterans was the study of social variables such as discharge status and social correctness among the discharged veterans.

This article is important in understanding the effects of combat experiences on veterans, thus leading to Post Traumatic Stress Disorder. The results of the article indicate that social connectedness causes stress symptoms among veterans. According to the authors, combat experiences and non-honorable discharge status were also found to have an indirect effect on PTSD. (Kintzle et al., 2018). The main limitation of this article is that it only highlights stress symptoms caused by combat exposure. The article is important as it educates the risk of combat exposure in causing Post-traumatic Stress Disorder and provides possible techniques that veterans can use to ensure the smooth social transition into civilian life.

Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psych-traumatology, 11(1), 1729633.

In this article, Lewis et al. define Post-traumatic stress disorder as a mental disorder that develops due to exposure to a series of traumatizing events. The authors use randomized controlled trials as the research methods in researching the level of PTSD. The results show that cognitive behavior therapy supports up to a third of applied measures by psychiatrists to support patients with post-traumatic stress disorder (Lewis et al.,2020). According to the authors, group therapies are best indulged when dealing with patients with a similar trauma focus.

The article is important in understanding the topic as it aids the students in understanding data extraction and synthesis processes when determining PTSD symptoms (Lewis et al., 2020). However, the main limitation of the article is that the study exclude disorders such as substance dependence and depression, which are end effects PTSD. The article is useful in understanding the risk factors associated with PTSD. It highlights possible psychotherapy trials such as control groups that educate medical students especially psychotherapy specialists on the definition of PTSD and educate them about psychotherapy analyses that improve stress management treatment.

The topic of Post-traumatic Stress Disorder is important as it aids an individual to understand the common issues in the trauma psychology field. Being a medical student, the study of PTSD in psychology, aids in understanding possible therapies to be applied to remedy traumatic experiences in a Post-traumatic Stress Disorder patient. The study of PTSD also educates possible techniques such as meditation that aids in dealing with stressful situations.

References

Kintzle, S., Barr, N., Corletto, G., & Castro, C. (2018). Post-Traumatic Stress Disorder in U.S. Veterans: The role of social connectedness, Combat experience, and discharge. Healthcare, 6(3), 102.

Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psych-traumatology, 11(1), 1729633.

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A Review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12.

Introduction

Post-traumatic stress disorder (PTSD) is a medical definition of the condition closely associated with depression and the consequences of trauma. As a diagnosis, it was discovered and labeled in 1980 after the American Psychological Association incorporated it in its disease testing and Statistical Manual for mental health professionals (Crocq & Crocq, 2000). The story of PTSD is a combination of the role of society and politics in the steps of the invention. It has links with the American war in Vietnam, where military personnel who served there were being blamed for their roles in the fight against defenseless masses. This negative reception was a factor for soldiers, and it affected them in a way that some had difficulties, including antisocial behavior (Rivers, 1918). A number of them who sought to consult psychiatrists were diagnosed with anxiety state, depression, substance misuse, personality disorder, or schizophrenia; these diagnoses were later supplanted by PTSD. This paper will examine the prerequisites and manifestations of PTSD during and after World War I, despite the absence of this term at that time, and how diagnosis and treatment are made.

Methodology

The information for this research paper was collected through secondary methods. This type of data is already available from studies that have either been published online or printed as books, articles, and journals. It is data gathered from primary sources and used to provide further insights into the research question or topic. Additionally, these are the pieces of evidence that are derived from existing knowledge. The technique involved searching for themes relevant to the study topic from online articles, journals, websites, and reports.

Context analysis was used to identify patterns and themes in the data from various sources, including primary resources, articles, journals, and websites. It helped the researcher derive the purpose and meanings that related to and answered the research topic. The method of revealing the semantic relationship of relevant concepts with the subject in question is a potentially successful approach. This technique is suitable for unobtrusive data gathering, where information is analyzed without the direct involvement of the participants, and therefore, the presence of the researcher does not influence the results. Such a method can provide reliable findings because it follows a systematic procedure.

Results

Early Recognition of Post-Traumatic Stress Disorder

Although the term PTSD itself first appeared after World War I, the first evidence that this diagnosis could be studied at that time may be obtained from primary sources. In the letters of the participants in that war, soldiers talk about the battles, telling their friends and relatives about the tragedies and horrors of military operations (Trenches, n.d.). One of the soldiers describes the medical condition of a colleague known to the letters recipient as being in a shocking state (Trenches, n.d.). Although PTSD was not labeled as a phenomenon associated with negative experiences and trauma from what they saw, the symptoms were similar to the conditions that are today assessed as those of PTSD.

Another primary source from that period provides more accurate clinical data on patients who survived the fighting during World War I. Among the symptoms mentioned in his academic work, Mott (1916) lists amnesia, headache, gait, tremors, sensory, cardiac, and vasomotor disturbances, loss of hearing, speech, sight, and terrifying dreams. Being a military doctor, the author also details how some of his patients recovered from the condition (Mott, 1916). Although the term neurosis is used, the symptoms and prerequisites for the development of the aforementioned problems are consistent with those found in patients with PTSD.

During World War I, the study of mental problems in patients who had experienced negative experiences in combat operations was not common. However, in his research of the period, Myers (1915) assesses the conditions of several patients and gives the appropriate symptomatology by observing the manifestations of the psychological trauma experienced. While revealing the corresponding manifestations of the problem and its causes, the author most often uses the concept of shell shock (Myers, 1915). However, this definition cannot be considered synonymous with that of PTSD because, along with physical problems resulting from mental trauma due to intense experiences, psychological disorders are characteristic of PTSD.

Given the lack of evidence base, researchers had to rely on existing medical terms and concepts to interpret the relevant clinical manifestations. In his work, Rivers (1918) describes anxiety states in World War I soldiers based on other researchers earlier findings. One of the authors main findings is that any attempt to reassure soldiers that their participation in hostilities will not happen again does not work because anxiety symptoms persist (Rivers, 1918). As a result, of not being able to influence patients mental states, doctors of that period could only ascertain neurotic states in soldiers who had experienced a traumatic experience and correlate their assessments with existing cases.

PTSD After World War I

World War I can be considered an event that significantly catalyzed the dynamics of research on analysis and symptomatology related to PTSD. Crocq and Crocq (2000) describe the experience of research after the war and note that by the time it ended, different researchers had already had extensive data to interpret and determine the impacts on the human psyche. Particular attention was paid to the clinical picture of the problems that combatants reported. For the medicine of the post-war period, much data appeared, which made it possible to interpret different pieces of evidence and place the corresponding symptomatic manifestations in a separate group. As a result, based on the information already available, researchers and doctors were able to identify how the condition under consideration differed from those documented in earlier times. This contributed to drawing conclusions about the ambiguous nature of a potentially new disorder. It was believed to affect the mental state in a distinctive way than normal neurosis and to be stimulated by traumatic experiences, as a rule, due to patients military background.

As the symptoms in question were studied, scholars and doctors came to the conclusion that patients mental disorders did not arise only as a result of physical injuries. Myers (2012) describes the findings related to the evaluation of the mental state of patients with hysteria, dissociation, and mental repression. When assessing these conditions, the author argues that the initial beliefs of doctors of that time that only explosions experienced on the battlefield caused mental disorders were incorrect (Myers, 2012). It was crucial to consider not individual events but the experience of participating in hostilities in general as a driver for the development of anxiety states that manifested themselves through the aforementioned symptoms. According to the study by Chamberlin (2012, 362), during World War II, the concept of shell shock gave way to the term combat fatigue. The author also cites the example of the Vietnam War, during which much attention was paid to both the medical and social manifestations of PTSD (Chamberlin, 2012). As a result, a more extensive and reliable research base had been collected by the time the existence of such a diagnosis as PTSD was officially announced.

Benchmarking associated with the emergence of the new medical condition was increasingly reported in clinical documentation after World War I. According to Jones et al. (2003), who describe cases of diagnosing a disorder resembling PTSD based on earlier reports, flashbacks, and hallucinations were documented as common symptoms of ex-combatants. It is noteworthy that doctors paid particular attention to the interpretation of the experienced events by patients themselves. Jones et al. (2003) compare the clinical presentations of two men, one of whom could control his memories of the war while the other could not. The state of the latter, in this case, strongly resembles the type of disorder that corresponds to post-traumatic stress, when negative emotions and memories cannot be contained. Thus, after World War I, more data allowed researchers and doctors to gather an expanded clinical base to draw conclusions about the new form of mental disorder.

Diagnosis and Treatment of PTSD

Given the lack of theoretical background, diagnosing PTSD during and even after World War I was difficult, let alone treated. As Chamberlin (2012) states, there was no apparent pathology, and any conclusions could be drawn based on empirical data only without valid scientific reasoning. As a result, patients with PTSD symptoms were unwittingly stigmatized, and it was only after World War II that real breakthroughs in treatment were achieved. Psychiatric screening by medical professionals helped identify the telltale signs of the disease and create an environment in which patients could receive the support and care they needed (Chamberlin, 2012). Doctors used treatment approaches similar to those utilized to treat depression and psychological trauma, which was partly rational and allowed for improving the morale of the target patients.

Particularly noteworthy are the ideas of some experts regarding the nature of PTSD, namely the role of cultural drivers and not only experienced traumas. Jones et al. (2003) describe this situation by explaining it as a lack of knowledge about the problem and, consequently, alternative treatment options associated with social rather than medical interventions. However, although from a social perspective, PTSD patients need the support of loved ones, help from qualified professionals is a necessary factor in mitigating symptoms.

Conclusion

Post-traumatic stress disorder (PTSD) was discovered and labeled as a diagnosable condition in 1980 after the American Psychological Association incorporated it in its disease testing and Statistical Manual for mental health professionals. During World War I, researchers and doctors lacked the appropriate rationale and often interpreted conditions comparable to those of PTSD as neuroses and anxiety disorders. During the subsequent wars, more evidence emerged, which made it possible to highlight both the medical and social aspects of the disorder. The comparative analysis became a valuable factor in favor of studying PTSD and documenting cases where patients could not contain their negative memories. Stigmatization was one of the consequences of little knowledge about treatment, but the use of approaches similar to those utilized for the treatment of depression reduced the anxiety of the target audience. World War I was the period that gave the actual start to research on the outcomes of experienced stress and trauma.

References

Chamberlin, Sheena M. Eagan. 2012. Emasculated by Trauma: A Social History of Post-Traumatic Stress Disorder, Stigma, and Masculinity. The Journal of American Culture 35 (4): 358-365.

Crocq, Marc-Antoine, and Louis Crocq. 2000. From Shell Shock and War Neurosis to Posttraumatic Stress Disorder: A History of Psychotraumatology. Dialogues in Clinical Neuroscience 2 (1): 47-55.

Jones, Edgar, Robert Hodgins Vermaas, Helen McCartney, Charlotte Beech, Ian Palmer, Kenneth Hyams, and Simon Wessely. 2003. Flashbacks and Post-Traumatic Stress Disorder: The Genesis of a 20th-Century Diagnosis. The British Journal of Psychiatry 182 (2): 158-163.

Mott, Frederick W. 1916. The Lettsomian Lectures on the Effects of High Explosives upon the Central Nervous System. The Lancet 190 (4828): 441-553.

Myers, Charles S. 1915. A Contribution to the Study of Shell Shock: Being an Account of Three Cases of Loss of Memory, Vision, Smell, and Taste, Admitted into the Duchess of Westminsters War Hospital, Le Touquet. The Lancet 185 (4772): 316-320.

Myers, Charles S. 2012. Shell shock in France, 1914-1918: Based on a war diary. Cambridge: Cambridge University Press.

Rivers, William H. R. 1918. The Repression of War Experience. Proceedings of the Royal Society of Medicine 11 (Sect_Psych): 1-20.

Trenches. n.d. Letters from the First World War, 1915. The National Archives. Web.