PYB306: Psychopathology - Post Accident Trauma Case Study Analysis Assessment Answer

February 27, 2018
Author : Syd Howell

Solution Code: 1AGHH

Question : Psychopathology - Post Accident Trauma Case Study Analysis

This assignment falls underPsychopathology - Post Accident Trauma Case Study Analysiswhich was successfully solved by the assignment writing experts at My Assignment Services AU under assignment help service.

Psychopathology - Post Accident Trauma Case Study Analysis Assingment

Assignment Task:

Read the Case study carefully and provide an analysis for the same.

CASE HISTORY: Dean

Dean, an 18-year-old university student, was referred to a psychologist after being involved in a car accident 2 weeks earlier. On the day of the accident, Dean was riding in the front passenger seat when, as the car was pulling out of a driveway, it was struck by an oncoming car that was speeding through an amber light. The car he was in was hit on the driver’s side, which caused the car to roll over once and come to rest right side up. The collision of metal on metal made an extremely loud noise and there was a lot of broken glass at the scene. The driver of the car, a university classmate, was knocked out briefly and there was a lot of blood coming from a gash in his forehead. Upon seeing his injured friend, Dean became afraid that his friend might be dead or dying. His friend in the back seat of the car was frantically trying to unlatch her seat belt and was screaming. Dean’s door was jammed, and Dean feared that their car might catch fire while he and the others were stuck in it. After what “seemed like hours”, according to Dean, but could have been just a few minutes, the driver, Dean, and the other passenger were able to exit through the passenger doors and move away from the car. They realised that the driver of the car that hit them was unharmed and had already called the police. An ambulance was on its way. All three were transported to a local hospital. All three underwent a number of tests at the hospital including a brain CT scan. Dean was also asked to recall the details of the accident, but he found it difficult to explain what happened, and was not able to say how he exited the car. Dean was kept under observation for about 30-minutes, and then he was released from hospital into his parents’ care.

Dean had not had a good night’s sleep since the accident. He often awoke in the middle of the night with his heart racing, visualising oncoming headlights. He was having trouble concentrating and was unable to effectively complete his studies. Since the accident, he complained of headaches daily. His girlfriend, who had begun to drive him to and from university, noticed that he was anxious every time they pulled out of a driveway or crossed an intersection. Although he had recently received his “L plates” for driving, he refused to practice driving. He was also unusually short-tempered with his girlfriend, parents, his younger sisters, and his friends. A week before seeing the psychologist he had gone to see a movie but had walked out of the theatre before the movie started; he complained that the sound was too loud and the lighting was disturbing. His concerned parents tried to talk to him about his behaviour, but he would irritably cut them off. However, after doing poorly on an important exam and discussing it with his favourite teacher, he accepted their encouragement to go to a psychologist.

When seen, Dean described additional difficulties. He stated that he was “jumpy” around loud noises, and he could not shake the image of his injured and unresponsive friend. He had waves of anger toward the driver of the car that hit them. He said that he felt a strong urge to take “revenge” for the harm done. He reported feeling embarrassed and disappointed in himself for being reluctant to practice driving. He said the he had previously had to deal with stressful situations, including an event about 5 years earlier (he had witnessed the near-drowning of one of his younger sisters), and that this past month was the first anniversary of his grandfather’s death. He described himself as “a bit snappy lately” in the way that he was responding to others, but “on the inside” he was “at breaking point.” He was even contemplating quitting study, apparently because of a feeling that “his life was ruined” and everything was “badly affected.”

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Solution:

Abstract The purpose of this paper is to identify the psychopathological procedures that can be used in the treatment of post traumatic stressing disorders from the car accident patients. Dean is suffering from a post traumatic disorder that faces many people who engage in car accidents. Dean is showing symptoms that indicate that he is suffering acute levels of post-traumatic stress. That is because Dean is having flashbacks and dreams regarding the car accident he was involved. He is also showing withdrawal symptoms. He is unable to drive himself. Dean is also showing signs of revenge. Dean is also experiencing some symptoms that are related to the cues in the environment. For example, he complains that loud sounds affect him and in most cases that will take him back to the bad memories of the car accident. Dean is also irritated easily and in most cases he is arguing with the parents. The best treatment method for this case is to engage a physician who will engage in the therapy. The therapist will be required to ask three questions which if affirmed will act as an indicator that the patient is suffering from acute stress levels from the accident. The best method of treatment will be varied depending on the condition of the patient and his response to therapy. In case of recurrence the patient will be subjected to drugs like beta blockers and Benzodiazepines. However, this will come in as a last resort since the best way of treatment is usually through psychological counselling. Introduction

In most cases recovering from traumas become difficult especially if one was involved in a horrible accident. According to the case study and the scenario Dean is showing emotional and psychological trauma after the accident. Such traumas always result from extra ordinary events that shutter down the sense of security and hence leave the patients to be helpless and very outrageous (Walker, Newman, Koss, & A, 2013). In most cases such traumatic incidences that are leading to psychological stress are usually considered life threatening even if they did not result to direct harm. According to recent research 25%of the frequently associated traumas are experienced by males while only 13% are experienced by the females in the US (Ursano R, 2012). However, it must be noted that such stresses may be caused by one time event like in Dean’s case or ongoing relentless stresses similar to what Dean is experiencing. In most cases traumas occur because the incidences happened unexpectedly meaning that one was not really prepared for it. A sense of trauma also sets in if the patient involved felt powerless to control or prevent it from happening. Under certain circumstances the sense of trauma also sets in if the incidence was a result of cruelty (Ozer E, 2013). It is therefore possible that such people will feel agitated and angry most of the time. It is for this reason that Dean feels like taking a revenge on the driver that hit their car causing the accident. This paper discuss the series of events that take place to Dean who has experienced posttraumatic motor car accident.

Criteria for Diagnosis of Post-Traumatic Stress after a Car Accident

Dean experienced an event which involved a life threatening injury to his life and those whom were involved near him. Dean was shaken and was helpless during the process. The experience is usually felt several times in terms of thought dreams, recollection or events including images. There is also a possibility of a recurrent distressing dreams of the event that is destabilizing Dean. There is also the physiological exposure to the cues that happened during the accident (Velden P, 2014). That can be confirmed by the fact that Dean complained of loud noise while he went to a theater to watch a movie. That is associated with the loud bang that he experienced during the accident. According to the scenario it is evident that Dean is suffering from the PTSD that is associated with most of the survivors of motor vehicles. The recurrence and the flashbacks is mostly associated with the environmental cues that the victim experiences. It has also been noted that such victims usually cause severe accidents especially if they are allowed to drive and yet they have not fully recovered from the trauma (Bryant, 2014). However, such patients usually show manifestation of symptoms by the manner in which they alter their behaviors. In certain circumstances they also develop driving phobia, anxiety especially while they are passengers on the vehicle. The same thing is experienced by Dean. Secondary phobic behavior may also develop in response to the environment. Fear and in circumstances the resistance to medical examination may also manifest itself through the patients. Accidents are manmade and the trauma experienced are usually internalized. In most cases some of the victims may blame themselves for that behavior and tend to assume that the accident was their fault like in the case with Dean (Murray J, 2012).

Psychological Consequence after the Accident

The most common incident that affect people like Dean is that they will always experience the post-traumatic stress after experiencing motor car accidents. The stress is usually caused by the anxiety involving the actual life threatening experience. For people like Dean the common symptom is the re-experiencing of the trauma. This is a condition in which the patient keeps dreaming or recounting the events of the accident the way it is happening to Dean. In addition, there is also the case of trying to persistently avoiding the situation or thought that are related to the accident. That can be seen through the patient refusing to drive like in Dean’s case where the girlfriend drives him to work. Meanwhile Dean also feels disappointed that he cannot drive himself and may be if he was a good driver the accident might have not happened on that day (Wrenger M, 2015). The other form of symptoms is that most of these patients will always isolate themselves from the rest. They develop a sense of uneasiness. In most cases they also feel agitated with cases of insomnia not forgetting disturbed sleep.

Discussion and Prognosis

According to a lot of research conducted in the same field it has been concluded that there is usually 25-30% cases of post motor vehicle accident traumas for at least a period of 30 days after the accident. The patients are usually affected with mood disturbances. That is what makes Dean disagree with the parents. Most of the time he lectures the parents. Dean’s symptoms tend to move hand in hand with the findings of national comorbidity survey which examine post-traumatic stress related cases. Even though not revealed in the case study it is confirmed that survivors of post traumatic disorders are 5 more times likely to engage in alcohol abuse in men. In women the chances are few and only 1.3 times possibility in engaging in drug and substance abuse (Koren D, 2015).

Most of the post traumatic survivors always associated with litigation. However, there is very little evidence that litigation reduces the chances and symptoms of the disorders. It is therefore necessary and important to screen and treat post traumatic patients. One of the ways through which screening can be done is through the administration of self-reports which if exceeds the limit then possible treatment measures can be started. A clinician Administered PSTD Scale can be used in diagnosis of the disorder. Some of the questions within the scale involve the level and frequency of the traumas at a range of 0-5 (Bryant R, 2012). The scale also goes ahead and test the social life of the patients to determining their functioning. Probes are usually added in order to confirm if all the symptoms provided are related to the post traumatic event or basically associated with the pain. For example, difficulty in sleeping may be due to pain from the accident and not the horrifying traumas.

Several kinds of therapy can be recommended to Dean. However, it is always better to provided clinical counselling sessions 30 minutes after the accident. The counselling sessions usually help the patients to relax and speak more about what they feel. It also allows them to understand some of the strategies they can use to prevent the traumas from happening. Seemingly, that did not happen to Dean and hence the reason why he is experiencing recurrent traumatic stress. In most cases the psychological debriefing has been proved to help reduce the cases of post traumatic traumas. However, that is not to say that such survivors will fully recover from their traumas since one counselling session is not enough to wipe out such anxiety (Lensvelt-Mulders G, 2013).

The first interaction between the physician and the patient is very important in helping provide therapy to such patients. The history of the patient should be well obtained since this will determine how the patient will react to the incident. Police reports are also necessary and might also provides some light on what actually happened. That is because the clinicians are able to fully comprehend the range at which there was physical injuries and engage in discussions with the patient to help them alleviate the psychological impact. In any case there is an indication of head trauma there is need for further investigation and evaluation since head injuries if assumed can be explosive and lead to death. During the analysis of the impact of stress it is recommended that physicians treat any affirmative answer as a likelihood of increased post-traumatic stress levels. For example, if Dean affirms to the clinician that he is having flashbacks and nightmares so frequently it can be concluded that he is encountering a severe post-traumatic stress. In addition, if the thoughts are intrusive and unwanted then it reveals that the level of stress is high. The second probable question that may affirm that the level of stress is acute is if the patients affirms that they have had problems driving or being driven in vehicles since the day of the accident. It can further be diagnosed if the patient has developed ritualistic behaviors while driving or while on the road. Affirming to such experiences helps in confirming that the patients are suffering from acute post-traumatic stress levels. Finding out if the patient may want to take legal action against the other parties involved in an accident is also an important psychological question that if affirmed may help determine if the stress levels are high or not.

Intervention

Most of the interventions are always aimed at ensuring that the patient has established a good equilibrium between the past and current behavior. Through education and discussions it can be easier to convince Dean that the incident may never happen again especially if he is the driver. That will give confidence to the patient and will give reassurance that what happened was just a mistake and may not happen again especially if they are in control. In most cases the therapies if repeated subsequently helps in reducing the stress levels and increases confidence levels to the patients. The physicians should also ensure that they inform the patients about their trauma. It is important to notify them that whatever is happening is just a normal mirror reflection and depends on the attitude and the type of reflection and projection they may want to have in future. Change of perception and image is usually very important and benefiting to the patients. Clinicians should also provide the patients with the probable expectations at the end of the therapy. That may give the patients a good timeline upon which they can recover. In most cases the survivors of the car accidents are not usually informed or educated regarding the symptoms and treatment procedures that are involved. Discussing such information with the patients is very important since it helps the patient to understand that what they are really experiencing is normal and has been researched on and documented. During this time it is important that the clinician highlight on some of the delayed symptoms. In most cases the symptoms may not be seen or experienced up to a certain time or stage. That may help prevent the patient from overreacting and hence they will be able to take control of their life. Symptoms reviews are highly discouraged since they have been perceived to be increasing stress levels to the patients. For example, most of the reviews are usually of war veterans from Vietnam War and the rest. Such incidences usually create negative impact to the patients and it is suspected that it may increase their stress levels. Relaxation techniques can also be shared with the patients to help them overcome the belief that they can overcome the traumas. Techniques such as physical exercise can help relieve hyper-arousal symptoms and also degrade the flashbacks and dreams. In most cases medication has always been used in treatment of such conditions. If necessary medications should be started at an early stage and should be recommended at a consistent level to prevent chronicity. Benzodiazepines have always been recommended since they play a huge role of creating sedation symptoms to the patients. In addition the drug has also been associated with short term memory loss. However, they should be used with a lot of caution due to their side effects. In case of consistent symptoms of re-experiencing it is suggested that beta blockers can be used. At certain moments the antipsychotic medications may also be used as a means of treatment. It may not be so easy to prevent car accidents or recurrent of such devastating occurrences. However, proper education can be encouraged. That will help reduce road carnage especially in relation to the patients. It is recommended that patients be always informed to wear seat belts all the time while in a car.

Conclusion

The purpose of the paper was to identify the psychopathological procedures that can be used in the treatment of post traumatic stressing disorders from the car accident patients. Dean was suffering from a post traumatic disorder that faces many people who engage in car accidents. Dean was showing symptoms that indicate that he is suffering acute levels of post-traumatic stress. That is because Dean was having flashbacks and dreams regarding the car accident he was involved. He was also showing withdrawal symptoms. He was unable to drive himself. Dean was also showing signs of revenge. Dean was also experiencing some symptoms that are related to the cues in the environment. For example, he complained that loud sounds affected him and in most cases took him back to the bad memories of the car accident. Dean was also seen to be so easily irritated and hence argued with the parents. It can be conclude that the best treatment method for this case was to engage a therapist. Upon asking three questions confirmed that the patient is suffering from acute stress levels from the accident. The best method of treatment however varied depending on the condition of the patient and his response to therapy. In case of recurrence the patient will be subjected to drugs like beta blockers and Benzodiazepines. However, this was considered as a last resort since the best way of treatment is usually through psychological counselling.

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