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Post-Traumatic Stress Disorder Pathophysiology
Post-traumatic stress disorder (PTSD) is a psychiatric disorder resulting from exposure to actual or threatened injury, death, or sexual assault and is associated with functional and cognitive impairment. Early interventions and diagnosis are essential for effective treatment and minimizing the long-term effects of PTSD (Mann & Marwaha, 2022). The pathophysiology can be described as interference with the neurotransmitter’s functionality and neurohormonal functioning. Patients with PTSD, despite their ongoing stress, portray lower levels of cortisol and higher levels of corticotropin-releasing factor (CRF). It tends to speed up the release of norepinephrine through the anterior cingulate cortex, which is responsible for the elevated sympathetic response, which leads to increased heart rate, blood pressure, and startle response (Mann & Marwaha, 2022). Furthermore, PTSD is linked with interfering with neurophysiology and anatomy of the brain. Moreover, the hippocampus’ size is reduced, and the amygdala, the process of emotions and modulation of fear response, is highly sensible amongst individuals with PTSD.
For the pharmacological treatment to control PTSD, the recent symptomatology experienced, comorbid conditions, and evidence of the efficiency of treatments before medication initiation are the factors that a clinician has to consider. Psychological therapies are the recommended primary treatment for PTSD (Lewis et al., 2020). In addition, medicines like paroxetine and sertraline are types of antidepressants called selective serotonin reuptake inhibitors and SSRIs (Ehret, 2019). Trauma-focused cognitive-behavioral therapy (TF-CBT) is effective at reducing symptoms of PTSD in adults, and self-help with support shows that it is an effective post-treatment (Lewis et al., 2020). The main symptoms of PTSD are avoidance, negative alterations in the mood, arousals, and reactivity that cause distress in social, occupational, and other essential areas of functioning. Therefore, PTSD co-occurs with other disorders like anxiety disorder and is associated with reduced quality of life and dangerous physical health outcomes.
Additional Analysis of the Case
In diagnosing any disease, there are specified guidelines to be followed. For PTSD, the procedures were followed step-by-step until the conclusion on the patient to be diagnosed with PTSD was attained. The criteria mainly apply to adults and involve the following steps; firstly, exposure to actual or threatened death through witnessing traumatic events considering the patient is a former servant in the military. Secondly, the availability of one or more intrusion symptoms linked to traumatic events like flashbacks when the individual feels the event reoccurs (Sanders & Hall, 2017). Thirdly, negative interference with mood and cognitions linked to traumatic events, like the inability to experience happiness, satisfaction, or love, sometimes makes it hard to sleep. The family history is reviewed to develop a better diagnosis of the patient’s condition.
Furthermore, the care was unique since the past medical history (PMHX), past surgical history (PSHX), the history of previous illness (HPI), current medications, and the demographics of the patient are highlighted and considered in the process of diagnosing the patient and give a general overview of what to look for when diagnosing the patient. The national criterion for diagnosing adults with PTSD is followed and applied adequately.
Follow-Up
Active monitoring for this scenario is recommended because the patient is experiencing moderate symptoms of PTSD. Active monitoring implies a close evaluation of the symptoms to see if they are getting worse or improving. Healing from PTSD occurs in a sequence that is not instant; hence, the symptoms can aggravate or ameliorate. In active monitoring when the symptoms persist in the next visit, talking therapies, TF-CBT, and eye movement desensitization and reprocessing (EMDR) should be conducted severally (Ehret, 2019). EMDR involves remembering traumatic events while focusing on specific eye movements as directed by the therapist. It focuses on ensuring the traumatic events are not intense since the brain processes and memorizes them, and becomes familiar to the brain.
Quality
In this scenario concerning a 35-year-old Caucasian male diagnosed with PTSD, a few changes can be learned from the scenario and help patients with similar symptoms and problems in future cases. Advising patients with similar conditions in the future to stay a healthy lifestyle includes ensuring enough time to sleep and less consumption of drugs. It would be important for institutions such as the military to include therapy sessions for retired military officers and after military combat to reduce cases of ex-military officers having PTSD caused by the traumatic events they encounter during their mission. Guidelines for diagnosing an adult patient with PTSD are essential for a clinical officer or therapist to follow the laid criterion. Furthermore, it is crucial to have a thorough background check about the patient, including the demographics, social history, current medication, family history, PSHX, PMHX, and HPI.
Coding and Billing
International Statistical Classification of Diseases and Related Health Problem version ten, ICD-10, is billable and is a code used in the healthcare diagnosis reimbursement of PTSD and other chronic diseases. ICD-10 replaces the ICD-9 developed by the World Health Organization (WHO) to help them code and identify health conditions (Sanders & Hall, 2017). Physicians and healthcare assistors require ICD-10 under the Health Insurance Portability and Accountability Act, HIPAA. Some codes can be identified in the case including F01-F09 for mental illness due to known physiological situations; F10-F19 for mental and behavioral illness due to psychoactive substance use; F30-F39 for mood disorders; F40-F48 for anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorder, and F60-F69 Disorders of adult personality and behavior, and F43.1 for PTSD.
References
Ehret, M. (2019). Treatment of posttraumatic stress disorder: Focus on pharmacotherapy.Mental Health Clinician, 9(6), 373-382. Web.
Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for posttraumatic stress disorder in adults: Systematic review and meta-analysis.European journal of psychotraumatology, 11(1), 17-33. Web.
Mann, S. K., & Marwaha, R. (2020). Posttraumatic Stress Disorder (PTSD).
Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N., & Stockton, S. et al. (2020). Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychological Medicine, 50(4), 542-555. Web.
Sanders, M., & Hall, S. (2017). Trauma-informed care in the new-born intensive care unit: promoting safety, security and connectedness. Journal of Perinatology, 38(1), 3-10. Web.
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