POST TRAUMATIC STRESS DISORDER

(PTSD) IN WAR VETERANS

TIMOTHY DEMASON AND CHRISTIAN EDINGER

VIDEOS OF PTSD

• YouTube: http://www.youtube.com/watch?v=azWNpCap_Ww

• CBS NEWS: http://www.cbsnews.com/news/the-war-within-treating-ptsd/

ETIOLOGY: BIOLOGICAL FACTORS

• Noradrenaline• Stathmin• GRP (gastrin-releasing peptide)• Hyperresponsive Amygdala and Prefrontal Cortex• Shin et al. (2001)

ETIOLOGY: COGNITIVE FACTORS

• Appraisal• Lower Intelligence•McNally and Shin (1995)

ETIOLOGY: SOCIOCULTURAL FACTORS• Discrimination• Oppression• Roysircar (2000)• Societal Expectations

SYMPTOMS

• Re-experiencing • Avoidance • Hyper arousal

PREVALENCE

• 2-17% point prevalence of combat related PTSD in US military veterans

CULTURAL FACTORS

• 3% Prevalence rate • Around 0-3% Globally

GENDER VARIATIONS

•Higher in women than men

TREATMENT APPROACHES1. Psychotherapy

• Cognitive Therapy (CT)

o Cognitive Behavioral Therapy, Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT)

• Eye Movement Desensitization and Reprocessing (EMDR)

• Stress Inoculation Training

• Interpersonal Psychotherapy (IPT)

• Group Therapy

• Family Therapy

• Psychodynamic Therapy

2.Medication

3.Other• Exercise and other physical activities

RELATIONSHIP BETWEEN ETIOLOGY AND THERAPEUTIC APPROACH

• Disclaimer: 1. No 1 treatment works for everyone

2. Identifying a specific cause is reductionist

3. Can one truly treat symptoms when the “causes” are unknown

4. Primary therapeutic approach aimed to reduce greatest risk factor

5. Culture affects beliefs about causes and treatments

6. Gender

7. Desire to locate causes is a highly western phenomenon

8. Eclectic approach works well

RELATIONSHIP BETWEEN ETIOLOGY AND THERAPEUTIC APPROACH CONT’D• Low levels of Serotonin are present in PTSD victims

• Use of SSRIs to help Serotonin stay in the synapse longer would be one way etiology would cause a therapeutic approach

• Low education about PTSD and an inability to cope with the traumatic event

• Use of Prolonged Exposure (PE) to educate patient and then enhance their ability to face the traumatic event so that they can move on with daily life

• Low levels of cortisol are also present

• Glucocorticoid provides a dose of corticosterone to boost cortisol levles and has worked in rats

• There are many different relationships that exist and since PTSD is complex and relatively new. Researchers have not found an optimal treatment for PTSD, AND SYMPTOMS ARE

WHAT ARE ULTIMTELY REDUCED RATHER THAN THE MENTAL ILLNES ITSELF

Traumatic event

Biological Factor:Genetic Predisposition(True et al., 1993)

Cognitive factor: Coping ability(Foa & Kozak, 1986)

Sociocultural factors: Societal expectations(Nayback, 2008)

Pathophysiology• Neuroendocrinology

• Over-reactive adrenaline response• Hypocortisolism• High norepinephrine

• Neuroanatomy• HPA Axis• Hippocampus and flashbacks =

suppression(Skelton et al., 2011)(Heim, Elhert, and Hellhammer, 2000)

PTSD