The client we will be discussing this week is William Thomas, a 38-year-old African American male. During William’s introduction video he seemed to be nervous or anxious while on camera. He also seemed to be nonchalant or possibly irritated about his diagnosis of Posttraumatic Stress Disorder (PTSD), irritability is a common behavior associated with clients who are diagnosed with PTSD.
According to the DSM-5 (American Psychiatric Association, 2013, pp. 271–276), PTSD can develop in individuals that are exposed to severe psychological trauma such as a threat to their life or others’ lives, or of severe bodily harm to others or their selves, or rape. William is a retired Captain in the armed forces and Iraq war veteran, which fits the first criterion for PTSD. His file also states that he is now homeless and his current job as a lawyer is in jeopardy due to his issue with alcohol abuse and his symptoms of PTSD, these behaviors are self-destructive and reckless which are also common in this disorder (American Psychiatric Association, 2013, pp. 271–276). Studies have shown that alcohol abuse has been found to be highly prevalent in veterans who are diagnosed with PTSD (Black & et al., 2018). Psychotherapy is typically the first and most common intervention that is attempted when treating clients with PTSD. “Of the wide variety of psychotherapies available, cognitive-behavioral therapy (CBT) is considered to have the strongest evidence for reducing the symptoms of PTSD in veterans and has been shown to be more effective than any other nondrug treatment” (Reisman, 2016, pp. 623-634). I would use CBT with Mr. Thomas; it can also help to treat his alcohol abuse. It might also be beneficial to prescribe Mr. Thomas an antidepressant, he may be drinking more to mask the depression that he is probably dealing with due to his current living situation.
When initiating a psychopharmacologic intervention, antidepressant medication is usually the first medication prescribed (Reisman, 2016). The expected outcomes for Mr. Thomas based on the treatment plan would be to improve his adaptive functioning, treat the alcohol abuse, reduce the severity of the symptoms that he is experiencing, teach coping mechanisms, and then prevent relapse (Wheeler, 2014). References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edition). Amer Psychiatric Pub Incorporated. Black, A. C., Cooney, N. L., Sartor, C. E., Arias, A. J., & Rosen, M. I. (2018). Impulsivity interacts with momentary PTSD symptom worsening to predict alcohol use in male veterans. American Journal of Drug & Alcohol Abuse, 44(5), 524–531. https://doiorg.ezp.waldenulibrary.org/10.1080/00952990.2018.1454935 Knopf, A. (2017). Koob: Even in medication age, prevent relapse with CBT. Alcoholism & Drug Abuse Weekly, 29(28), 4–6. https://doi-org.ezp.waldenulibrary.org/10.1002/adaw.31018 Reisman M. (2016). PTSD Treatment for Veterans: What’s Working, What’s New, and What’s Next. P & T : a peer-reviewed journal for formulary management, 41(10), 623–634. Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
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