Transcript Document

“The Reintegration of Veterans with PTSD Back into Their
Communities Through the Use of Public Health Initiatives”
A Brief History of PTSD
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1980 PTSD was codified as a
disorder in the (DSM) Diagnostic
and Statistical Manual of Mental
Disorders.
Between 1 & 5 or 1 & 6 people
who undergo a traumatic event in
there lifetime will develop PTSD.
Over the last 60 years great strides
have been made in the diagnosis
and treatment of PTSD.
Past names referring to PTSD are
as follows.
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Nervous Shock
Shell Shock
Traumatic Neurosis
Rape related fear and anxiety
PTSD can happen to anyone that is
exposed to a traumatic event.
Symptoms of chronic PTSD can
affect an individual even after 25
years or more after the traumatic
event.
Of the approximate 1 in 5 veterans that suffer from PTSD only
½ take the steps to seek treatment.
Of those that seek help to manage their PTSD, only ½ of those
actually receive adequate treatment in managing their PTSD
symptoms.
Reasoning behind use of Epidemiology
and Biostatistics for PTSD tracking.
• Over 4 billion dollars are annually spent in compensation
and disability claims to veterans with PTSD.
• After 13 years of war; an estimated 100,000 – 300,000
OIF/OEF veterans are at significant risk of developing
chronic PTSD.
• Nearly ½ of the soldiers in the military have experienced
multiple deployments & chances of developing PTSD
increases with each deployment.
• All Americans will bare the cost of treating these veterans
through financial or community obligations.
• Forming better treatments takes a better understanding of
the illnesses and its symptoms. Hence the reasoning
behind tracking PTSD to formulate these treatments.
Factors of (PTSS) Post Traumatic Stress
Symptoms
Stressors
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Age
Gender
Marital Status
Education Level
Rank
Employment Status
Ethnicity
Parental Status
Pre-disposition to stressors or
existing PTSD
• Combat Exposure
• Other Variables
Classifications of home front
stressors
• No home front stressors before or
after the new deployment (No
stressors).
• Home front stressors after but
not before the new deployment
(New stressors).
• Home front stressors before but
not after the new deployment
(Relieved stressors).
• Home front stressors both before
and after the new deployment
(Chronic stressors).
Study Results
• This study revealed that
the occurrence of home
front stressors increased
the risks of PTSS and that
soldiers were more likely
to develop precursors to
PTSD if PTSS was present
before and after the
deployment.
• Overall, the issues that
pertain to the lifestyle or
family of individuals
deployed are relevant to
the mental health of the
individual.
Biological & Molecular effects of PTSD
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There are many things that can trigger a traumatic event activating a person’s fight-or-flight response
which is the body’s instinctual reflex to possible trauma & works as a survival mechanism normally
by increasing the biological output of molecular responses such as the increase of hormones such as
adrenaline or body systems such as arterial blood pressure, oxygen exchange in the lungs & many
other effects.
This natural response has given man many advantages over the course of evolution.
There are instances though that this natural mechanism displays a dysfunction which happens when
a functional impairment causes an individual to become psychologically traumatized creating PTSD
within the individual because their normal defense mechanisms against trauma has failed to operate
& process the information in a manner that is traditionally in line with the body’s normal
functioning.
These individuals are among the population that is biologically susceptible to the pathophysiology
that causes PTSD.
These pathological features found in patients with PTSD overlap similarly in patients with traumatic
brain injury paralleling the shared signs & symptoms of these syndromes in clinical studies.
The signs & symptoms of PTSD appear to reflect a persistent & abnormal adaptation of
neurobiological systems to the stress of a witnessed traumatic event.
The neurobiological systems that regulate stress responses include certain endocrine &
neurotransmitter pathways as well the network of brain regions known to regulate fear & behavior
at both conscious & unconscious levels.
Biological & Molecular Effects of PTSD
Changes in the Endocrine system
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Hormone production levels will either
increase or decrease based on the
symptoms experienced and the severity
of the physiological symptoms.
These endocrine changes will either be
protein based or lipid based and can
affect cardiovascular output, blood
pressure, fluid retention/renal use,
sexual arousal and various other
systems controlled by the endocrine
system.
Changes in the endocrine system can
have short term or long lasting effects
and prolonged symptoms.
Changes in the Nervous system
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This is a result of the brain releasing
chemicals triggering responses to the
chemical stimuli.
This can result in phantom sensations
or reliving the experiences causing the
endocrine system to release hormones
as a result of the nervous system
thinking it is responding to a crisis.
Elevated respiratory output & cardio
vascular output are just examples.
Flashbacks or mental visions of reliving
the experiences are extreme but are
seen in severe cases and during therapy
& Treatment.
The hippocampus is a biological component of a
portion of the human brain affected by PTSD
Biological & Molecular effects of PTSD
The Hippocampus
• One of the areas that is affected on a molecular level is
the hippocampus.
– The hippocampus is a seahorse shaped portion of the
brain. Its exact function is unknown but it is believed to be
responsible for playing a role in long term memory among
other theories.
– In studies on animals, exposure to severe stress can
damage the hippocampus.
– Similar studies in humans suggests a link between the
amount of blood volume in the hippocampus correlates
with vulnerability to psychological trauma.
– Smaller hippocampal volume constitutes a higher risk &
susceptibility to PTSD than those with higher volume.
Biological and Molecular effects of
PTSD
A study of the Serotonergic & Noradrenergic
markers of PTSD & Depression has shown that
research on the biological pathophysiology of
PTSD found evidence of the roles of
catecholamine & serotonin (5-HT). This finding
on the increases of the catecholaminergic or
sympathetic nervous system (SNS) activity in
PTSD patients is fairly consistent across studies.
Biological Pathophysiology of PTSD
Serotonergic & Noradrenergic markers of PTSD & Depression effects related
to the Sympathetic Nervous System (SNS)
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Combat veterans with PTSD have shown
significantly higher 24-hour urinary
excretion with plasma concentrations of
catecholamine, noradrenaline (NE),
adrenaline, & dopamine, versus the
normal control group, other psychiatric
patients, or combat veterans without
PTSD.
Combat veterans have shown significantly
higher rise in plasma (NE) & peripheral
(SNS) activity than normal volunteers
following acute stressors within the
laboratory with stimuli reminiscent of the
trauma linked to their PTSD
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PTSD patients also have significantly
decreased platelet counts suggesting
down-regulation of α2-adrenoceptors (α2ARs) on platelets within the bloodstream
Laboratory trials with yohimbine, a α2-AR
antagonist that blocks the presynaptic α2AR auto-receptor resulted in significantly
higher plasma levels of 3-methoxy-4hydroxyphenylglycol (MHPG), the major
NE metabolite. This was more prominent
in PTSD veterans than in control groups.
These results suggest that central
presynaptic α2-ARs are sub-sensitive in
PTSD patients
Biological and Molecular effects of
PTSD and Pharmacology
• Other studies have tried to identify the implications & relationships
between trauma memory for pharmacological treatments which have
been proposed for the prevention of PTSD & the idea of reprocessing
trauma memories to bring about recovery through treatments such as
invasive exposure therapy.
• Psychological accounts of PTSD & the biological concept for
reconsolidation of active memories suggest that physiological arousal
enhances the reprocessing of traumatic memories.
• Use of drugs that influence arousal through chemical means may then
have effects after the trauma & depend on the psychosocial context that
they are used in, thus in theory helping to prevent the development of
PTSD in some trauma victims, but impeding recovery in others who would
do well without such treatments.
• This would mean that you would have to be preemptively treating
someone with drug related therapies before they were exposed to the
traumatic event in order to use some of these treatments successfully.
Psychosocial & Behavioral Health
Factors Influenced by PTSD
• Public Health is concerned with
the psychosocial and behavioral
health factors of the community
at large.
• Public health can gauge these
concerns using the ecological
model of health behaviors which
are identified as the five following
factors.
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1) Intrapersonal factors
2) Interpersonal relations
3) Institutional factors
4) Community factors
5) Public policy
• Specific symptom clusters of
PTSD are atypical across
experiences and are displayed in
the following forms in some
degree or another.
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1) Hyper-arousal
2) Re-experiencing
3) Numbing
4) Avoidance
• These symptom clusters of PTSD
cause significant interference in
the daily activities related to
functioning within the ecological
model of health behaviors.
Psychosocial Behaviors and PTSD
• With over 1.5 million soldiers deployed into the theater of
operations and an estimate as high as 10-20% of these
veterans experiencing some type or form of PTSD
symptoms, it is of particular interest to better understand
how PTSD can be displayed or induce other forms of mental
health disorders such as OCD or anxiety disorders.
• These disorders and the symptoms of PTSD are presenting
with different clinical outcomes compared to other
instances of PTSD and will thus complicate the treatment
process and possibly creates a concern for the public health
in how to best address the treatment of this increasing
population and return them into active members of the
community.
Conclusion
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The reintegration of veterans with PTSD back into the community through public
health initiatives is a lengthy and time consuming process.
It is not something that happens over the course of a night, through 1 meeting, or
the application & use of medications. There is no cure all or instant fix solutions.
It is not completed with just a shot in the arm, a pill to pop, or the duration of a
course of a prescription drug. It is a life-long process with success being measured
in varying degrees.
The public’s health has been sustained in part through the contributions and
sacrifices of the veteran community allowing for the continuation of the American
lifestyle.
PTSD is perhaps the most painful mental disorder to have treatment for and it can
be a life-long process of treatment through either therapy or medication to
manage and control the symptoms.
The reintegration of these veterans into being active and participating members of
society is paramount to the overall success of the community.
They have valuable skills and experience that contribute to the success of a
sustainable economy and in order for the structure of society to remain intact, the
public health community needs to accommodate planning and strategies to
address how to best help reintegrate these individuals into the home front.
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