Transcript Chapter 39 Militaryx

Chapter 39: The Military
and Their Families
Introduction
• For veterans of wars in Iraq and Afghanistan, the incidence of
mental health issues has become one of the leading health
problems, second only to orthopedic issues.
• Deployment can adversely affect one’s health and psychological
well-being
• The most pervasive and disabling experiences to military troops,
families, and survivors are threats to psychological health and
well-being.
Medical Disorders of Veterans
Vietnam War
• Military personnel are exposed to conditions that make them
vulnerable to developing a variety of medical conditions
• Vietnam War 1961-1975 PTSD, Agent Orange, Birth defects,
Hepatitis B & C, HIV & Aids, Substance Abuse, Military sexual
trauma
Persian Gulf War
• Persian Gulf War 1990 – not determined: PTSD, Gulf War illnesses,
Leishmaniasis, ALS, exposure to chemical smoke, biological agents
& depleted uranium, immunizations, substance abuse and military
sexual trauma.
Global War on Terror
• Global War on Terror 2001 to present: PTSD, TBI, Multidrug
resistant Acinetobacter, Leishmaniasis, Vision loss, hearing loss,
tinnitus, traumatic amputation, exposure to depleted uranium,
substance abuse and military sexual trauma.
Traumatic Brain Injury
TBI is a complex injury with a broad spectrum of symptoms and
disabilities that can adversely impact quality of life.
Classifications based on intensity: Primary blast injuries (direct
injury from atmospheric pressure), Secondary injuries (shrapnel or
missiles), Tertiary injuries (propelled by the blast and hit
something), Quaternary (sequelae of the blast such as burns, PTSD)
Posttraumatic Stress Disorder
• PTSD: anxiety disorder that arises when a person has been
exposed to a life-threatening traumatic event that provokes
terror, horror, and helplessness such as combat experiences.
• Results from excessive activity of the sympathetic nervous system.
The exaggerated effect of the fight or flight response is
responsible for physiological symptoms associated with
hyperarousal and re-experiencing phenomena. This response also
stimulates the limbic system and fear circuitry of the brain which
in turn triggers abnormal emotional and behavioral responses.
Three Groups of PTSD Symptoms
Re-experiencing symptoms (1 or more): recurrent intrusive
thoughts, disturbing dreams, flashbacks, emotional distress from
reminders, and physical reaction from reminders.
Avoidance symptoms (3 or more): avoids thoughts or feelings
reminding them of trauma, avoids people, places or things
reminding them of trauma, traumatic events blocked from memory,
decreased interest in activities, Feeling detached/aloof, blunted
affect and sense of foreshortened future.
Hyperarousal symptoms (2 or more): sleep disturbance, increased
anger/irritability, decreased concentration, hypervigilance, and
hyperactive startle.
Pharmacological Treatment of PTSD
• SSRIs are considered the first line of pharmacological treatment for
individuals diagnosed with PTSD. This med helps with depression,
irritability, anxiety and intrusive thoughts
• SNRI, venlafaxine, also helpful.
• Atypical antipsychotics used alone or in combination with
antidepressants
• Benzodiazepines may be helpful in anxiety, insomnia, and hyperarousal
but use with caution d/t abuse.
• The alpha-blocker Minipress has been effective in managing hyperarousal
and re-experiencing symptoms by decreasing nightmares and normalizing
sleep.
• Mood stabilizers have not been demonstrated to be helpful.
Nonpharmacological Treatment of PTSD
Cognitive behavioral therapy (CBT)
• Be nonjudgmental and supportive
• Assure client that his or her feelings and behaviors are normal reactions
• Encourage client to express feelings; provide individual therapy that addresses loss of control
or anger issues
• Assist client to develop adaptive coping mechanisms and to use relaxation techniques
• Encourage support groups
Prolonged exposure (PE) Interventions include:
• Facilitate a progressive review of the trauma experience
• Encourage client to establish and reestablish relationships.
• Inform client that hypnotherapy or systematic desensitization may be used as a form of
treatment.
Other Psych Disorders
• Suicide: It has been estimated that as many as 20% of all suicides in this
country are documented among veterans. In the first half of 2009, more
American soldiers committed suicide than died in combat.
• Substance Use Disorders: It is estimated that one in four deaths among
veterans is attributable to use of alcohol, tobacco, or hallucinogens and
that more than 7% of veterans meet criteria for substance abuse
problem.
• Military Sexual Trauma: Approximately 1:5 women and 1:100 men
seeking treatment from the VA respond “yes” when screened for MST.
Survivors of MST may be reluctant to report abuse.
• Women are more likely to be victims of physical and domestic abuse and
10x more likely than their male counterparts of being victims of MST.
Challenges to Care
• The five challenges to care are psychological health, access to services
and support, communication challenges, deployment, and frequent
relocation.
• Education, debriefing, and supportive therapy are essential to ensure
smooth reintegration for these veterans.
• Although the rates of those suffering physical and psychological injuries
may be fairly high, the percentage who actually seek treatment is
disproportionately low.
• Efforts must be increased to change the culture and educate veterans
about the potential benefits of services including mental health services
to make it more likely that these services will be utilized.
Impact on Families and Clinicians
• Deployment for military families can produce many issues and hardships
• Creating avenues and opportunities for family members to cope with
deployment and healthy reintegration in routines prior to deployment is
a key supportive intervention for the psychiatric nurse.
• Mental health providers working with PTSD may become vulnerable to
the effects of trauma by proxy called vicarious traumatization.
• Compassion fatigue and burnout are very high in health care workers.
• It is critical that providers working with survivors of trauma be aware of
their personal feelings and vulnerabilities to provide quality clinical
care.
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