Posttraumatic Stress Disorder

Posttraumatic stress disorder is a condition that is caused by experiencing of a traumatic event that involves the threat of injury or death. It usually develops as a result of a terrible or frightening experience. It may also be caused by a highly unsafe or horrific experience (Kinchin, 2004). This event may involve a threat to an individual or to someone else that overwhelms the individual’s ability to cope.

Physical changes in the brain

PTSD may alter three parts of the brain. They include; prefrontal cortex, amygdale and hippocampus. PTSD affects the autonomic and central nervous systems. The hippocampus decreases in mass, and the amygdale becomes overactive. Memory is an essential aspect of PTSD and traumatic experience is relived through memory. Both the hippocampus and amygdale are key to human memory. The amygdala conditioned to initiate the connection between fear, producing experience in the past and pair them with stimulus in the present that may be neutral (Kinchin, 2004). The hippocampus plays a vital role in learning and memory. It works by creating expectations in instances by basing them on memory and past experience. As a result of hippocampus damage, among those with PTSD, it may be hard for the brain to learn new experiences for situations after the event of trauma.

Symptoms and reactions of PTSD

Symptoms of posttraumatic stress disorder can rise gradually, suddenly or come and go over time a time period. Sometimes they appear out of the blue or are started by something that reminds person with PTSD about the trauma with something like image, noise, smell or certain word.

Re-experiencing the traumatic event

One of the major symptoms of PTSD is the re-experiencing of the trauma experience that caused the stress. For example, one can have troublesome memories due to flashbacks caused by reminders of a traumatic event. These flashbacks normally seem real and events seem to be happening again and again. Recurring nightmares of the experience that occur in the same way is also a common symptom. Dissociative reliving of the trauma without knowledge is another symptom. This relieving of events disturbs the day to day activity.  People affected by PTSD also have strong uncomfortable reactions to situations that remind them of the trauma. There may also be intense physical reactions to the reminders of the event including muscle tension, rapid breathing, pounding heart, nausea, and sweating.

Avoiding reminders of trauma

Avoidance to the point of having phobias of places, people and experiences that may cause memory of trauma or a general numbing of emotional responsiveness is also a reaction of people with PTSD.  This avoidance is also characterized by feeling detached to reality, inability to remember crucial parts of trauma, having less interest in normal activities, becoming less moody and  feeling a blank future because the traumatic experience already ended your life.

Emotional arousal and increased anxiety

Long term  physical signs of hyper arousal, including difficulty falling asleep or staying asleep, trouble concentrating, irritability, anger, blackouts, difficulty in memorizing, increased reaction to being startled are all symptoms and reactions of PTSD.  This arousal is also characterized by feeling more aware of normal situations and having exaggerated responses to such situations.

Other common symptoms and reactions of PTSD include shame or self-blame, guilt, depression, substance abuse and feelings of mistrust, hopelessness, suicidal thoughts and feelings of betrayal and physical aches and pains.

The emotional numbing of PTSD may present a lack of interest in activities that one used to enjoy, emotional deadness distancing oneself from people or a sense of foreshortened future. At least, a re-experiencing symptom, numbing symptoms and two hyper arousal symptoms must be there for at least a month and cause significant difficulty or functional impairment in for diagnosis of PTSD to be made.

Psychological changes

Following trauma or a repeat of trauma, people react in different ways, producing a range of emotional reactions.  These responses mostly are normal reactions to abnormal events. They include; confusion, anxiety, fear, mood swings, withdrawal from others, hopelessness, denial and feeling disconnected or numb.

Treatment of PTSD

Treatment for   PTSD usually includes psychological and medical interventions. One could provide information on illness and help the individual directly by talking to him/her. One could also teach the person ways of managing symptoms of PTSD and exploring ways to manage it. Modification of inaccurate ways is also a means of managing symptoms associated with PTSD. These techniques are used in psychotherapy for this illness (Friedman, Keane, 2010). Specific types of treatment for PTSD are:

Trauma- focused cognitive –behavioral therapy

This involves the careful and slow exposure to oneself thoughts, experiences and emotions that remind one of trauma incidence. Therapy involves identification of upsetting thoughts about a traumatic incidence. This particularly is for distorted and irrational thoughts. These are then replaced by more balanced thoughts. While, at cognitive behavioral theory, people with PTSD are taught on practical approaches that cope with what can be extremely disturbing and intense symptoms. Sufferers are also taught on how to learn and manage their anxiety and anger, improving their communication skills and use of breath control and other relaxation techniques (Friedman, Foa and Keane, 2010).  Cognitive behavioral psychotherapy can also help people with PTSD recognize relationships between thoughts and feelings, hence adjust to trauma related thoughts. Help them develop alternative interpretations by practicing new ways of observing situations. Practicing learned techniques also becomes involved with this treatment.

Eye Movement Desensitization and Reprocessing.(EMDR)

This form of cognitive therapy involves the practitioner guiding the patient to talk about the trauma experienced and any negating factors associated with the experience. This is done while focusing on the professional’s rapidly moving finger. It borrows elements from cognitive behavioral therapy in addition to eye movement, and other forms of rhythmic stimulation such as sounds or hand taps. These movements are believed to work through unfreezing the human mind’s information processing system.

Family therapy

Families of patient and the patient may benefit through family counseling. Family members may also provide relevant history about their loved ones, for example, sleeping habits, emotions and behavior and socialization that people with the illness are unwilling or unable to share. Family therapy can also help the family understand what the patient is going through. This may assist in communication within the family and solve relationship problems caused by PTSD symptoms.

Medication

Medications used in helping PTSD patients include antidepressants like fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (paxil). Medicine that can help decrease physical symptoms like prazosin (Minipress), clonidine (Catapres), guanfacine (Tenex) and propranolol can also be used. SSRIs tend to help the patients in modifying information taken from the environment. Mood stabilizers like lamotrigine can also be used for those that suffer from symptoms such as agitation, dissociation, hyper vigilance, paranoia or brief breaks. These are mostly prescribed to assist patients relieve secondary symptoms of depression or anxiety (Vasterling, 2005).

Directly addressing sleep problems that are part of PTSD has been found helpful in alleviating symptoms related to the illness. Specifically rehearsing adaptive ways of coping with nightmares, training in relaxation methods, positive self-talk as well as screening for sleep problems have been found helpful in decreasing the sleep problems associated with PTSD.

Understanding combat posttraumatic stress disorder

Combat PTSD is a range of behaviors that result in stress of battle, which decreases the fighter’s efficiency. In World War I, this kind of stress disorder was regarded a psychiatric illness as a result of nerve damage during battles. It was initially called shell shock because of the belief that it was caused by waves generated from artillery shells, which damaged nerves. Initially, it was not acceptable to come forward and accept that one had this disorder because one would be considered a weakling. Therefore, soldiers were forced to suppress the symptoms and cope with the disorder as they knew best. The major cause of this combat disorder was traumatic brain injury that occurred during war or experiences that the soldiers went through during the war, which resulted in posttraumatic stress disorder.

Traumatic brain injury

Traumatic brain injury is a complicated injury. It has a wide spectrum of symptoms and disabilities. It is a form of brain injury caused by a sudden trauma that results in damage to the brain (Ashley, 2009). It can occur when the head is violently hit by an object or when an object pieces enter the brain tissue.  It refers to brain damage caused by mechanical injury.

Symptoms and reactions of traumatic brain injury

Symptoms depend on the type of TBI and part of the brain affected. Unconsciousness lasts longer for those injured towards the left of the brain compared to those with injuries to the right side. Symptoms rely on the severity of the injury. With mild TBI, patients may lose consciousness for a few minutes. Symptoms can, therefore, be classified as severe, mild or moderate depending on the extent of the brain damage.

Mild symptoms of TBI

These symptoms may not be noticed or present at the time of injury. Symptoms may be delayed for days or weeks before they appear. They include fatigue, headaches, visual disturbances, memory loss, poor attention, sleep disturbances, confusion, dizziness, feelings of depression and seizures (Ashley, 2009). Other symptoms may include nausea, loss of smell, and sensitivity to light or sounds,   ringing in the ears, mood changes, unpleasant taste in the mouth, fatigue, getting lost and slowness in thinking.

Moderate to severe symptoms of TBI

This may result in loss of consciousness from twenty minutes to six hours and even more if it is a severe case of TBI.  The impact of the moderate to severe brain damage depends on; severity of initial injury, completeness of physical recovery, functions affected and areas of function not affected by TBI (Ashley, 2009).

The impact of moderate to severe brain injury can include cognitive deficits, including difficulties with; attention, distractibility, memory, concentration, language processing, speed of processing and impulsiveness.  It can also lead to deficits in speech and language which may include; slurred speech, problems with writing, difficulty speaking and being understood, not understanding the spoken word and problems reading. It can interfere with vision, leading to partial or total loss of vision, intolerance of light, problem withs judging distance, involuntary eye movements and double vision (Marion, 1999).  It can interfere with hearing leading to; decrease or loss of hearing, increased sensitivity to sounds and ringing in the ears. It is also characterized by physical changes including; paralysis, sleep disorders, loss of stamina, chronic pain, appetite changes, regulation of body temperature, control of bowel and bladder and menstrual difficulties. Moderate to severe TBI also has socio-emotional symptoms, which include; denial or lack of awareness, irritability, aggression and depression, lack of motivation, disinhibition and dependent behavior. Moderate to severe TBI patients can also experience headaches that get worse or don’t go away, convulsions or seizures, difficulty in awakening from sleep, repeated vomiting or nausea, dilation of pupil/s and numbness in the extremities.

Treatment of Traumatic Brain Injury

Mild TBI usually requires no treatment. It just needs a lot of rest and painkillers to relieve or treat the headache. A person with mild traumatic brain injury must, however, be closely monitored for any persistent or new symptoms (Jay, 2010).

Anyone with signs of moderate-severe TBI requires immediate medical attention. Little can be employed to reverse initial brain damage resulting from trauma, and the first thing medical personnel must do is to prevent further injury. There are different kinds of treatment available for patients of traumatic brain injury.

Initial treatment

This stabilizes the individual following a traumatic brain injury. This is the first treatment that a person with TBI receives. The trauma medical team performs resuscitation procedures, monitoring vital body functions, reacting to life threatening instances and communicate care with other hospital personnel.

Rehabilitative care center treatment

This helps restore the patient's daily life. This is where the patient is normally referred after the initial treatment. Here, specialists stabilize medical issues related to brain injury. The patients are engaged in therapy that helps them deal with functions that have been distorted following the brain injury. Neuropsychologists can help assure patients and their families through counseling and education (High, 2005). A lot of occupational therapies at the centre is provided to help the patients regain important skills that they might have lost. Occupational therapists assess the functions and possible complications that are related to the movement of the daily living skills, upper extremities, cognition, perception and vision. Patients may require relearning basic activities such as talking and walking. Nurse specialists also educate the families about the condition and the recovery process.

Acute treatment of a traumatic brain injury

This is aimed at minimizing secondary injury. Mechanical ventilations are used to maintain low pressure in the brain. To minimize secondary injury and agitation, a patient may be provided with medication that allows sedation and drug induced coma. Medications used in controlling spasticity can be used as the patient recovers functions. Anti-seizure   drugs may also be provided in the first week to aid in reducing additional brain damage that may cause a seizure.

Surgical treatment

It is offered to help prevent secondary injury. Surgery helps maintain oxygen and blood flow towards the brain. Bleeding in the skull cavity can be surgically drained or removed. Bleeding vessels or tissue may require repair.

Causes of Traumatic Brain injury

Traumatic brain injury can be caused by injury to head. Events that may cause traumatic brain injury include:

Explosive blasts or combat injuries. These are common causes for TBI during active duty in the military. The pressures of the waves through the brain disrupt the brain function. It may also result from severe blows to the head with debris, penetrating wounds, and bodily collisions with objects through a blast.  Vehicle related collisions or motorcycles are also a cause of TBI. Falls such as slipping in the bath, falling out of bed or down steps are common causes for traumatic brain injury.

Causes of posttraumatic stress disorder

One can develop PTSD when experiencing an event that causes horror, intense fear or helplessness. Such events may include experiencing or witnessing a severe accident, receiving a life-threatening medical diagnosis, physical injury, being a victim of torture or kidnapping, exposure  to a natural disaster or to war combat, being a victim of rape, robbery, mugging or assault, sexual, enduring physical or emotional abuse.

Inherited mental health risks such as an increased risk of anxiety and depression, inherited aspects of personality like temperaments or the way one’s brain regulates chemicals and hormones your body releases in response to stress may also cause posttraumatic stress disorder.

War or combats are also leading causes of PTSD. This is because the experience during war leaves a long lasting effect on those present during the war. Many soldiers after the war still find themselves hearing the sounds of war or even associating smells with certain things during the war. Many, who actively participate in wars, like soldiers, contact posttraumatic stress afterwards.

Statistics

Posttraumatic stress disorder can affect anyone at any age. Millions of Americans contact PTSD every year. The National Co-morbidity Survey Replication estimated prevalence of PTSD at 6.8% among adult Americans. Plenty of war veterans have contracted posttraumatic stress disorder. This is mainly because the war places them in a context where daily activities are risk factors for depression and may lead to symptoms related to posttraumatic stress disorder. Women also tend to get posttraumatic stress disorder more often compared to men. This is because men can cope better with stress and have better ways of suppressing their feelings than women (Kimerling, 2002). Women also deal with many situations, which may ultimately lead to depression or immense stress. Children who have parents who suffer from PTSD are also at risk of experiencing posttraumatic stress disorder. Prevalence of PTSD cannot be analyzed according to race. Every race that faces a lot of traumatic experiences is at a risk of PTSD. Each year in the United States, 2 million people suffer TBI. Between 70,000 and 90,000 of these are left with irreversible impairments. Males between the ages of 15 and 34 are most likely to suffer traumatic brain injury. Many suffer TBI from sporting events or motor vehicle accidents. People over the age of 75 also comprise a large number of patients with TBI, mostly as a result of falls. TBI is a leading cause of disability among children and young adults who are in their most active years. Many veterans of war suffer traumatic brain injury during the war caused by blasts and gunshots.

Posttraumatic stress disorder and traumatic brain injury are, therefore, two main disorders that are affecting the majority of population and should be given extra attention so that intervention and treatment administered can be done early enough.