Evidence and Non-Evidence Based Treatment Options
The Patient: Ivan S.
Background Info:
The patient is believed to be between the ages of 20 and 26. The patient is male and from Navajo descent. The patient reportedly did two deployment tours in Iraq. Upon the return of his first deployment, the patient began exhibiting anger management issues. This caused strain and strife in the patient’s marriage and home life. The patient deployed a second time and returned home with more severe problems due to being adversely impacted by the war. Though the patient is reported to be more stoic, the patient’s behavior became more aggressive with his abusive tendencies escalating to include physical abuse against his wife and children. The patient suffers from nightmares and night sweats, and has reportedly began consuming alcohol and having run-ins with law enforcement. Though the patient was going to counseling, the counseling was not helping the patient improve. Further, no additional conventional interventions were/are being implemented.
Provisional Diagnosis:
Based on the aforementioned information, I would provide a provisional diagnosis of Post-traumatic Stress Disorder (PTSD). It would be imperative, however, to rule out other medical conditions, such as mood and anxiety disorders, as well as substance use disorders. Additionally, while intermittent explosive disorder would explain the patient’s aggressive/abusive behavior, I am convinced it would be a misdiagnosis, as people with this disorder lack the traumatic history that is prevalent in PTSD patients. This patient has likely been exposed to trauma in combat. As maintained by the DSM-5 diagnostic manual, “Individuals with PTSD may be quick tempered and may even engage in aggressive verbal and/or physical behavior with little provocation… Problems with sleep onset and maintenance are common and may be associated with nightmares” (APA. 2013, section 2).
Evidence-based Treatment:
For this patient, I would implement a mixture of Evidence-based psychotherapy and pharmacological treatments to treat the patient. Evidence-based psychotherapy is the most typically implemented treatment for patients with PTSD (Garcia et al., 2015; Wilk et al., 2013). Moreover, along with EBP, pharmacological interventions, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), have the strongest recommendation when it comes to helping treat PTSD (Wilk et al., 2013). I believe a combination of the two therapies would be more beneficial to helping ease the symptoms and behaviors of this condition. While less severe cases of PTSD could be treated with EBP or possibly even CBT, this patient seems to have an extreme case that may require more than one intervention.
References:
American Psychological Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Garcia, H. A., McGeary, C. A., Finley, E. P., Ketchum, N. S., McGeary, D. D., & Peterson, A. L. (2015). Evidence-based treatments for PTSD and VHA provider burnout: The impact of cognitive processing and prolonged exposure therapies. Traumatology, 21(1), 7-13. doi:10.1037/trm0000014
Wilk, J. E., West, J. C., Duffy, F. F., Herrell, R. K., Rae, D. S., & Hoge, C. W. (2013). Use of Evidence-Based Treatment for Posttraumatic Stress Disorder in Army Behavioral Healthcare. Psychiatry: Interpersonal & Biological Processes, 76(4), 336-348. doi:10.1521/psyc.2013.76.4.336
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