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Hello Gabriela,
Thank you for your video case presentation.
I will address the third discussion prompts, which are the advantages and disadvantages of the treatment options provided in your video case presentation. I agree that a combination of pharmacological and non-pharmacological interventions is needed to effectively manage post-traumatic stress disorder (PTSD) symptoms in J.M. It is impressive that you recommended Quetiapine as an effective medication for ameliorating global PTSD symptoms. However, I would weigh its overall safety for this patient, considering its sedating effects. Since Quetiapine is a second-generation antipsychotic typically used as a second-line monotherapy or third-line augmentation strategy for PTSD, Prazosin could be an alternative prescription for this patient. Prazosin is a first-line agent for managing PTSD-related nightmares by reducing their frequency and severity, thereby improving sleep quality. Additionally, prescribing Sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI), is approved for managing the broader spectrum of PTSD symptoms, including intrusive thoughts, flashbacks, and general anxiety, by stabilizing mood and reducing the intensity of traumatic memories. (de Moraes Costa et al, 2020).
As mental health providers, we should carefully consider the advantages and disadvantages of these treatment options. Prazosin has a strong efficacy in reducing nightmares, which can significantly improve sleep and daytime functioning. Zoloft helps manage a wide range of PTSD symptoms, contributing to an overall improvement in mood and anxiety levels. (de Moraes Costa et al, 2020). However, Prazosin may cause potential side effects such as dizziness and hypotension, which need to be monitored. Zoloft’s common side effects include nausea, insomnia, and potential sexual dysfunction, and it may take several weeks to observe the full therapeutic effect. (de Moraes Costa et al, 2020).
Furthermore, non-pharmacologic treatments like Cognitive Behavioral Therapy (CBT) are highly effective in addressing the root causes of PTSD, helping patients develop healthier coping mechanisms and reduce symptom severity without medication side effects. (Eriksson, 2024). Alternative therapies, such as exposure therapy, have been indicated for managing PTSD patients by helping them process their emotions and overcome their fears. Additionally, play therapy and art therapy provide expressive outlets for children, allowing them to process and communicate their emotions in a safe environment. (Eriksson, 2024). Nonetheless, these non-pharmacologic treatments, like CBT, require a high level of commitment and regular attendance, which might be challenging for some patients and their families. While beneficial for emotional expression, alternative therapies may not address core PTSD symptoms as directly as evidence-based treatments like CBT.
Lastly, the PMHNP must educate the patient and his mother about the nature of PTSD, the importance of adhering to the treatment plan and monitoring for side effects. Combining pharmacological and non-pharmacological interventions often yields the best outcomes. It is also crucial to provide a supportive and understanding environment at home and school to facilitate his recovery. This comprehensive approach, involving medication management, therapy, and supportive care, will help address his symptoms holistically and promote long-term healing and adjustment. (de Moraes Costa et al, 2020).
References:
de Moraes Costa, G., Zanatta, F. B., Ziegelmann, P. K., Barros, A. J. S., & Mello, C. F. (2020). Pharmacological treatments for adults with post-traumatic stress disorder: A network meta-analysis of comparative efficacy and acceptability. Journal of psychiatric research, 130, 412-420.
Eriksson, A. M. (2024). Treatment Strategies for Post-Traumatic Stress Disorder (PTSD).