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| =====Presentation Slides===== | =====Presentation Slides===== | ||
| + | {{ :group_3-ptsd_presentation_with_audio_final_1_.pptx }} | ||
| =====Post-Traumatic Stress Disorder (PTSD)===== | =====Post-Traumatic Stress Disorder (PTSD)===== | ||
| - | <box 25% round center|> {{ :ptsdbrain.png?250 |}} </box| Figure x. PTSD Terms (Essig, 2015)> | + | <box 25% round center|> {{ :ptsdbrain.png?250 |}} </box| Figure 1. PTSD Terms (Essig, 2015)> |
| =====Introduction===== | =====Introduction===== | ||
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| The diagnostic criteria for PTSD has been modified recently, with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. This criterion involves a set of 20 questions that assesses an individual’s response to a stressful previous experience, also abbreviated as PCL-5 with PCL referring to the PTSD Checklist. This questionnaire asks about how much an individual is bothered by changes in their psychological thinking in the past month, as symptoms of PTSD can occur within a month after the experience. The scale for the responses to the questions is from 0-4, with 5 options being “not at all,” “a little bit,” moderately,” “quite a bit,” or “extremely” (Weathers et al., 2013). The 20 questions from the PCL-5 are asked about the stressful experience in the following condensed manner: | The diagnostic criteria for PTSD has been modified recently, with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. This criterion involves a set of 20 questions that assesses an individual’s response to a stressful previous experience, also abbreviated as PCL-5 with PCL referring to the PTSD Checklist. This questionnaire asks about how much an individual is bothered by changes in their psychological thinking in the past month, as symptoms of PTSD can occur within a month after the experience. The scale for the responses to the questions is from 0-4, with 5 options being “not at all,” “a little bit,” moderately,” “quite a bit,” or “extremely” (Weathers et al., 2013). The 20 questions from the PCL-5 are asked about the stressful experience in the following condensed manner: | ||
| - | <box 45% round right|> {{ :ptsd_diagnosis.png?450 |}} </box| Figure x. PTSD Diagnosis Criteria (Tull, 2019)> | + | <box 45% round right|> {{ :ptsd_diagnosis.png?450 |}} </box| Figure 2. PTSD Diagnosis Criteria (Tull, 2019)> |
| - Repeated memories | - Repeated memories | ||
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| Hyperarousal symptoms are constant after the traumatic event and involve a feeling stressed and angry. This also includes being easier to startle, being easier to anger, increased irritability, trouble sleeping, and trouble concentrating. Cognition and mood symptoms include ongoing and distorted beliefs about oneself or others, ongoing fear, horror, anger, guilt or shame, much less interest in activities previously enjoyed, and feeling detached from others (NIMH, n.d.; American Psychiatric Association, 2013). | Hyperarousal symptoms are constant after the traumatic event and involve a feeling stressed and angry. This also includes being easier to startle, being easier to anger, increased irritability, trouble sleeping, and trouble concentrating. Cognition and mood symptoms include ongoing and distorted beliefs about oneself or others, ongoing fear, horror, anger, guilt or shame, much less interest in activities previously enjoyed, and feeling detached from others (NIMH, n.d.; American Psychiatric Association, 2013). | ||
| - | <box 20% round center|> {{ :symptoms.png?200 |}} </box| Figure x. PTSD Symptoms (Tull, 2020)> | + | <box 25% round center|> {{ :symptoms.png?250 |}} </box| Figure 3. PTSD Symptoms (Tull, 2020)> |
| =====Risk Factors===== | =====Risk Factors===== | ||
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| Another risk factor is having a job that increases one’s risk of being reminded of the traumatic events (e.g. One has a traumatic experience in the war and now has a job as military personnel and first responders). Another risk factor is when an individual has other mental disorders such as anxiety or depression or has a family background of mental illness. The individual may also have problems with bad coping mechanisms or substance misuse, such as excess drinking or drug use. The individual may also lack a good support system of family and friends. This is critical because PTSD suffers must have a strong, positive support system to overcome their trauma. | Another risk factor is having a job that increases one’s risk of being reminded of the traumatic events (e.g. One has a traumatic experience in the war and now has a job as military personnel and first responders). Another risk factor is when an individual has other mental disorders such as anxiety or depression or has a family background of mental illness. The individual may also have problems with bad coping mechanisms or substance misuse, such as excess drinking or drug use. The individual may also lack a good support system of family and friends. This is critical because PTSD suffers must have a strong, positive support system to overcome their trauma. | ||
| - | <box 45% round center|> {{ :risk.png?450 |}} </box| Figure x. PTSD Risk Factors (need citation)> | + | <box 45% round center|> {{ :risk.png?450 |}} </box| Figure 4. PTSD Risk Factors (Tull, 2019)> |
| =====Trauma===== | =====Trauma===== | ||
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| The hypothalamic-pituitary-adrenal (HPA) axis is the body's major response system for stress. The hypothalamus secretes corticotropin-releasing hormone (CRH), which binds to receptors on pituitary cells. Pituitary cells then produce adrenocorticotropin (ACTH), which is transported to the adrenal gland where Cortisol is released. The release of Cortisol activates sympathetic nervous pathways and generates negative feedback to both the hypothalamus and the anterior pituitary (Sherin & Nemeroff, 2011). This negative feedback system appears to be compromised in patients with PTSD, as a lower level Cortisol is observed (Yehuda, Mcfarlane, & Shalev, 1998). The decreased availability of Cortisol results in abnormal regulation of HPA axis, which may promote abnormal stress reactivity and fear processing (Sherin & Nemeroff, 2011). | The hypothalamic-pituitary-adrenal (HPA) axis is the body's major response system for stress. The hypothalamus secretes corticotropin-releasing hormone (CRH), which binds to receptors on pituitary cells. Pituitary cells then produce adrenocorticotropin (ACTH), which is transported to the adrenal gland where Cortisol is released. The release of Cortisol activates sympathetic nervous pathways and generates negative feedback to both the hypothalamus and the anterior pituitary (Sherin & Nemeroff, 2011). This negative feedback system appears to be compromised in patients with PTSD, as a lower level Cortisol is observed (Yehuda, Mcfarlane, & Shalev, 1998). The decreased availability of Cortisol results in abnormal regulation of HPA axis, which may promote abnormal stress reactivity and fear processing (Sherin & Nemeroff, 2011). | ||
| - | <box 35% round center|> {{: HPA_axis.jpg?350|}} </box| Figure x. HPA axis (Sherin & Nemeroff, 2011)> | + | <box 35% round center|> {{: HPA_axis.jpg?350|}} </box| Figure 5. HPA axis (Sherin & Nemeroff, 2011)> |
| ===Neurochemical Factors=== | ===Neurochemical Factors=== | ||
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| Stress Inoculation Training (SIT) can be done alone or in a group and is more focused on how to deal with the stress that has arisen from the event. It incorporates massages and breathing techniques to stop negative thoughts through the relaxation of the body. After 3 months of therapy, you will develop the skills needed to deal with the added stresses of life (WebMD, n.d.). | Stress Inoculation Training (SIT) can be done alone or in a group and is more focused on how to deal with the stress that has arisen from the event. It incorporates massages and breathing techniques to stop negative thoughts through the relaxation of the body. After 3 months of therapy, you will develop the skills needed to deal with the added stresses of life (WebMD, n.d.). | ||
| - | <box 25% round center|> {{ :treatmentt.png?250 |}} </box| Figure x. PTSD Treatment (Dr. Diane, n.d.)> | + | <box 25% round center|> {{ :treatmentt.png?250 |}} </box| Figure 6. PTSD Treatment (Dr. Diane, n.d.)> |
| ===Prevention=== | ===Prevention=== | ||
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| The brains of individuals with PTSD process “threats” differently because of imbalances in neurotransmitters. The “fight or flight” response in these individuals is easily triggered which makes them jumpy and on-edge. Medications help to stop thinking and reacting to what happened and help to have a more positive outlook on life. Several drugs can help the brain deal with fear and anxiety. Medications that affect norepinephrine and serotonin levels include: Fluoxetine, Paroxetine, Sertraline, and Venlafaxine (WebMD, n.d.). These drugs have been FDA approved to treat PTSD; however, not everyone’s PTSD is the same and not everyone responds to medication the same. Some off label medications include: antidepressants, MAOIs, SGAs, beta-blockers, benzodiazepines (WebMD, n.d.). | The brains of individuals with PTSD process “threats” differently because of imbalances in neurotransmitters. The “fight or flight” response in these individuals is easily triggered which makes them jumpy and on-edge. Medications help to stop thinking and reacting to what happened and help to have a more positive outlook on life. Several drugs can help the brain deal with fear and anxiety. Medications that affect norepinephrine and serotonin levels include: Fluoxetine, Paroxetine, Sertraline, and Venlafaxine (WebMD, n.d.). These drugs have been FDA approved to treat PTSD; however, not everyone’s PTSD is the same and not everyone responds to medication the same. Some off label medications include: antidepressants, MAOIs, SGAs, beta-blockers, benzodiazepines (WebMD, n.d.). | ||
| - | <box 20% round center|> {{ :medicationn.png?200 |}} </box| Figure x. Illustration of medications (Drugs.com, n.d.)> | + | <box 20% round center|> {{ :medicationn.png?200 |}} </box| Figure 7. Illustration of medications (Drugs.com, n.d.)> |
| =====Case Study: War Veteran in the Iraq War===== | =====Case Study: War Veteran in the Iraq War===== | ||
| Tom is a 23-year-old, white male who served in the Iraq war for a year (Barlow, 2014). Prior to serving in the military army, Tom had a precursed exposure to trauma. During his adolescence, Tom has witnessed his best friend kill himself by a gunshot in the head. This has caused him to be more vulnerable and preceptive to violence-related trauma. At 21 years of age, Tom witnessed suicide bombers, and many of his fellow soldiers get injured and killed. Without knowing that he would see his fellow soldiers for the last time, he developed intense grief and fear. | Tom is a 23-year-old, white male who served in the Iraq war for a year (Barlow, 2014). Prior to serving in the military army, Tom had a precursed exposure to trauma. During his adolescence, Tom has witnessed his best friend kill himself by a gunshot in the head. This has caused him to be more vulnerable and preceptive to violence-related trauma. At 21 years of age, Tom witnessed suicide bombers, and many of his fellow soldiers get injured and killed. Without knowing that he would see his fellow soldiers for the last time, he developed intense grief and fear. | ||
| - | <box 25% round center|> {{ :casee.png?250 |}} </box| Figure x. Image of a soldier (Lamplugh, 2017)> | + | <box 25% round center|> {{ :casee.png?250 |}} </box| Figure 8. Image of a soldier (Lamplugh, 2017)> |
| Tom describes his most distressing event as having to kill a pregnant woman with a child. He confessed that if he knew he had to kill a pregnant woman, he would have never joined the army. During his interview, Tom states: “I killed an innocent family. The family of someone who loves. I am a murderer.” From this event, Tom has night terrors (which are a more severe form of nightmares), insomnia, anxiety, and flashbacks (i.e. recurring episodes) of the war. He developed a severe drinking problem, in which case he began drinking to suppress his memories. | Tom describes his most distressing event as having to kill a pregnant woman with a child. He confessed that if he knew he had to kill a pregnant woman, he would have never joined the army. During his interview, Tom states: “I killed an innocent family. The family of someone who loves. I am a murderer.” From this event, Tom has night terrors (which are a more severe form of nightmares), insomnia, anxiety, and flashbacks (i.e. recurring episodes) of the war. He developed a severe drinking problem, in which case he began drinking to suppress his memories. | ||
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| Khan Academy. (n.d.). What is post traumatic stress disorder? Retrieved March 24, 2020, from https://www.khanacademy.org/science/health-and-medicine/mental-health/anxiety/a/post-traumatic-stress-disorder-article | Khan Academy. (n.d.). What is post traumatic stress disorder? Retrieved March 24, 2020, from https://www.khanacademy.org/science/health-and-medicine/mental-health/anxiety/a/post-traumatic-stress-disorder-article | ||
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| + | Lamplugh, M.W. (2017). The Veteran Firefighter and Post Traumatic Stress Disorder. Retrieved from https://community.fireengineering.com/profiles/blog/show?id=1219672%3ABlogPost%3A635541 | ||
| Lewis, L.L. (2018). When PTSD Accompanies a Concussion. Retrieved from https://www.everydayhealth.com/concussion/get-facts-about-concussion-ptsd/ | Lewis, L.L. (2018). When PTSD Accompanies a Concussion. Retrieved from https://www.everydayhealth.com/concussion/get-facts-about-concussion-ptsd/ | ||
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| Tull, M. (2019). Symptoms and Diagnosis of PTSD. Verywell Mind. Retrieved from https://www.verywellmind.com/requirements-for-ptsd-diagnosis-2797637 | Tull, M. (2019). Symptoms and Diagnosis of PTSD. Verywell Mind. Retrieved from https://www.verywellmind.com/requirements-for-ptsd-diagnosis-2797637 | ||
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| + | Tull, M. (2020). What Is Post-Traumatic Stress Disorder (PTSD)? Verywell Mind. Retrieved March 25, 2020, from https://www.verywellmind.com/an-overview-of-ptsd-2797638 | ||
| Vermetten, E., & Bremner, J. D. (2002). Circuits and systems in stress. II. Applications to neurobiology and treatment in posttraumatic stress disorder. Depression and Anxiety, 16(1), 14–38. doi: 10.1002/da.10017 | Vermetten, E., & Bremner, J. D. (2002). Circuits and systems in stress. II. Applications to neurobiology and treatment in posttraumatic stress disorder. Depression and Anxiety, 16(1), 14–38. doi: 10.1002/da.10017 | ||
