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***********************************APA 7th edition**************************** Respond to your colleagues by comparing the differential diagnostic features of the Panic disorder to the diagnostic features of PTSD Difference Between an Adjustment Disorder and Anxiety Disorder The DSM V diagnostic criteria defines adjustment disorder as the development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor and lasts no longer than 6 months after the stressor or its consequences have ceased (Zelviene & Kazlauskas, 2018). In anxiety disorders, clients experience excessive fear and anxiety and related behavioral disturbances. The fear is usually an emotional response to real or perceived imminent threat, while the anxiety is anticipation of future threat (American Psychiatric Association, 2013). Though the reaction to stressors in anxiety disorders and adjustment disorder persists beyond developmentally appropriate periods, adjustment disorder symptoms lasts less than 6 months while some forms of anxiety disorders like GAD last a minimum of 6 months and can persists for a lifetime ceased (Zelviene & Kazlauskas, 2018). Also, treatment options for adjustment disorder depend on a variety of factors but often include just psychotherapy such as individual, family or group peer therapy. However, only mild forms of anxiety disorders can be treated with psychotherapy only. Patients with moderate to severe anxiety often require pharmacologic interventions in addition to psychotherapy for effective management (Gabbard, 2014). In addition, unlike in adjustment where the distress is always as a reaction to a stressor, some forms of anxiety disorder such as panic disorder may be abrupt for no actual reason or as a result of a perceived threat in disorders like social anxiety or agoraphobia (American Psychiatric Association, 2013). Diagnostic Criteria for PTSD The American Psychiatric Association defines posttraumatic stress disorder (PTSD) as a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault (American Psychiatric Association, 2013). The American Psychiatric Association (2013) lists the following DSM 5 diagnostic criteria lists the following criteria that must be met for a diagnosis of PTSD to be made. 1. Directly or indirectly exposed to actual or threatened death, serious injury, or sexual violence. 2. Experiencing reoccurring involuntary memories, flashback, upsetting dreams and strong bodily reactions upon exposure to a reminder of the traumatic event. 3. Frequent avoidance of people, places, activities or thoughts and feelings related to the traumatic event. 4. Negative alterations in cognitions and mood associated with the traumatic event that began or worsened after the event. 5. Marked alterations in arousal and reactivity associated with the traumatic event such as angry outburst, reckless behavior, sleep disturbance and problems with concentration. 6. Symptoms have cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 7. Symptoms are not attributed to the physiological effects of a substance or another medical condition. Evidenced-based Psychotherapy Treatment for PTSD First-line treatments for PTSD consist of psychotherapies that focus on exposure and/or cognitive restructuring. Evidence based options include; Cognitive Processing: Therapy which focuses on modifying painful negative emotions and beliefs due to the trauma and helps the client confront associated distressing memories and emotions (Gabbard, 2014). Eye Movement Desensitization and Reprocessing (EMDR): EMDR is an eight-phase treatment that utilizes bilateral sensory input such as side-to-side eye movements to help you process difficult memories, thoughts, and emotions related to your trauma (Gabbard, 2014). Prolonged Exposure: Therapy This method uses repeated, detailed imagining of the trauma or progressive exposures to symptom “triggers” in a safe, controlled way to help the client face and gain control of fear and distress and learn to cope (Gabbard, 2014). Group therapy: Group sessions can be used to encourages survivors of similar traumatic events to share their experiences and reactions in a comfortable and non-judgmental setting. It allows group members to help one another realize that many people would have responded the same way and felt the same emotions. Family therapy may also help because the behavior and distress of the person with PTSD can affect the entire family (Gabbard, 2014). Evidenced-based Psychopharmacologic Treatment for PTSD Although there are no medications that have been specifically designed to treat PTSD, several studies have shown that antidepressants, usually selective serotonin reuptake inhibitors (SSRIs) and the serotonin-norepinephrine reuptake inhibitor (SNRI) can be effectively used to treat PTSD symptoms (Gabbard, 2014). Examples of common SSRIs that may be used includes Sertraline, Paroxetine and Fluoxetine (Stahl, 2014). Venlafaxine is an SNRI that has been found to be particularly effective in the treatment of PTSD (Gabbard, 2014). Other categories of medications such as the atypical antipsychotics and the anti-hypertensive alpha-blocker prazosin may also be used to decrease PTSD symptoms (Gabbard, 2014). References American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders. [electronic resource]: DSM-5. (2013). Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=cat06423a&AN=wal.DSM5&site=eds-live&scope=site Gabbard, G.O. (2014). Gabbard’s treatments of psychiatric disorders. (5th Ed.). Washington, D.C. American Psychiatric Publications. Stahl, S.M. (2014). Prescriber’s Guide: Stahl’s Essential Pharmacology. (5th Ed.). New York, NY: Cambridge Press. Zelviene, P., & Kazlauskas, E. (2018). Adjustment disorder: current perspectives. Neuropsychiatric disease and treatment, 14, 375–381. https://doi.org/10.2147/NDT.S121072

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