POST TRAUMATIC STRESS DISORDER (PTSD) IN WAR VETERANS TIMOTHY DEMASON AND CHRISTIAN EDINGER
Dec 31, 2015
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: SOCIOCULTURAL FACTORS• Discrimination• Oppression• Roysircar (2000)• Societal Expectations
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