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group_4_presentation_1_-_post-traumatic_stress_disorder [2017/10/01 23:27]
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group_4_presentation_1_-_post-traumatic_stress_disorder [2018/01/25 15:18] (current)
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 ===== Origin & Background ===== ===== Origin & Background =====
-The concept of post-traumatic stress is not a new one. War veterans returning from battle have been reporting symptoms of flashbacks, hyper-arousal,​ anxiety and depression, for hundreds of years (Malia, 2014). When Civil war veterans were first diagnosed, physicians referred to it as “Soldier’s Heart”, “Shell Shock” or “Combat Fatigue”. It wasn’t until 1980, that the American Psychiatric Association (APA) added Post-Traumatic Stress Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). ​+The concept of post-traumatic stress is not a new one. War veterans returning from battle have been reporting symptoms of flashbacks, hyper-arousal,​ anxiety and depression, for hundreds of years (Malia, 2014). When Civil war veterans were first diagnosed, physicians referred to their symptoms ​as “Soldier’s Heart”, “Shell Shock” or “Combat Fatigue”. It wasn’t until 1980, that the American Psychiatric Association (APA) added Post-Traumatic Stress Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). ​
  
 PTSD is broadly characterized by an extreme reaction to trauma that changes how a person thinks, feels and behaves (Malia, 2014). This can present in a variety of different ways, of varying severity, and causes considerable distress to the individual, usually affecting their ability to function normally. An individual who develops PTSD hasn't necessarily gone through a traumatic event, but may experience symptoms of traumatic stress indirectly from a trauma affecting close friends or family (Post-Traumatic Stress Disorder, 2016). The proximity, duration and severity of trauma exposure can affect whether or not you develop symptoms. For example, you are more likely to develop symptoms if you personally experience chronic, severe trauma such as childhood abuse, rather than an individual who witnesses one-time experience, such as a robbery (American Psychiatric Association,​ 2013).  ​ PTSD is broadly characterized by an extreme reaction to trauma that changes how a person thinks, feels and behaves (Malia, 2014). This can present in a variety of different ways, of varying severity, and causes considerable distress to the individual, usually affecting their ability to function normally. An individual who develops PTSD hasn't necessarily gone through a traumatic event, but may experience symptoms of traumatic stress indirectly from a trauma affecting close friends or family (Post-Traumatic Stress Disorder, 2016). The proximity, duration and severity of trauma exposure can affect whether or not you develop symptoms. For example, you are more likely to develop symptoms if you personally experience chronic, severe trauma such as childhood abuse, rather than an individual who witnesses one-time experience, such as a robbery (American Psychiatric Association,​ 2013).  ​
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 {{:​ptsd.png|}} {{:​ptsd.png|}}
  
-**Figure 1**: This image depicts the six main components of post-traumatic stress disorder (American Psychiatric Association2013). +**Figure 1**: This image depicts the six main components of post-traumatic stress disorder (Sadock & Ruiz2015). 
    
 === Normal Stress Reaction === === Normal Stress Reaction ===
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 {{:​brainjt.png|}} {{:​brainjt.png|}}
  
-**Figure 2**: This image shows how brain structures respond differently in an individual experience post-traumatic stress disorder (American Psychiatric Association2013). +**Figure 2**: This image shows how brain structures respond differently in an individual experience post-traumatic stress disorder (Sadock & Ruiz2015). 
  
 ===== Symptoms ===== ===== Symptoms =====
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 {{ :​dsm-5_3d.jpg?​100|}} {{ :​dsm-5_3d.jpg?​100|}}
-DSM5 is the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (APA, 2013). It is used by clinicians and researchers to diagnose and classify mental disorders. The aim of this diagnostic tool is to provide concise and explicit criteria to facilitate objective assessments of symptom presentations in a variety of clinical settings. The settings may include inpatient, outpatient, consultation,​ clinical, private practice and primary care (APA, 2013). The diagnostic criteria for Post-Traumatic Stress Disorder, as listed in the DSM-5, is provided below: ​+DSM5 is the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). It is used by clinicians and researchers to diagnose and classify mental disorders. The aim of this diagnostic tool is to provide concise and explicit criteria to facilitate objective assessments of symptom presentations in a variety of clinical settings. The settings may include inpatient, outpatient, consultation,​ clinical, private practice and primary care (American Psychiatric Association, 2013). The diagnostic criteria for Post-Traumatic Stress Disorder, as listed in the DSM-5, is provided below: ​
  
  
  
-**Figure 2**: An image of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.+**Figure 2**: An image of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition ​(American Psychiatric Association,​ 2013)
  
 **Criterion A (one required)**:​ The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): **Criterion A (one required)**:​ The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
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 ===== Etiology ===== ===== Etiology =====
  
-PTSD can develop in war veterans, children, and victims of natural disasters, sexual or physical abuse, family violence, and torture (The National Institute of Mental Health, 2016). If a person directly experiences the traumatic event and there is bodily harm involved, the risk of PTSD is significantly higher (Ford et al., 2015). If a person witnesses the traumatic event taking place, and the event is on a large scale like instances of war and genocide, this can lead to a greater likelihood of developing PTSD. Repeated exposure to traumatic stressors, known as “retraumatization”,​ has proven to increase PTSD risk in individuals. This is still being debated as the criteria for what should be considered retraumatization has not been defined. PTSD is not triggered exclusively by traumatic experiences. Approximately 80-90% of people exposed to traumatic events do not develop PTSD. If the traumatic event occurs during one’s developmental years, the risk of developing PTSD is greater by 75% or more (Ford et al., 2015).+PTSD can develop in war veterans, children, and victims of natural disasters, sexual or physical abuse, family violence, and torture (National Institute of Mental Health, 2016). If a person directly experiences the traumatic event and there is bodily harm involved, the risk of PTSD is significantly higher (Ford et al., 2015). If a person witnesses the traumatic event taking place, and the event is on a large scale like instances of war and genocide, this can lead to a greater likelihood of developing PTSD. Repeated exposure to traumatic stressors, known as “retraumatization”,​ has proven to increase PTSD risk in individuals. This is still being debated as the criteria for what should be considered retraumatization has not been defined. PTSD is not triggered exclusively by traumatic experiences. Approximately 80-90% of people exposed to traumatic events do not develop PTSD. If the traumatic event occurs during one’s developmental years, the risk of developing PTSD is greater by 75% or more (Ford et al., 2015).
  
-PTSD can develop at any age however, adolescents and young to midlife adults have a greater risk compared to children and elderly populations(Ford et al., 2015). Females and ethnic-racial minorities are also more susceptible to developing PTSD, the latter being a result of social and economic factors like racial stigma, discrimination,​ and poverty (Ford et al., 2015). Additional determinants that increase one’s likelihood of developing PTSD are childhood trauma, poverty, living through dangerous events, dealing with physical injuries and having a history of mental illness or substance abuse (The National Institute of Mental Health, 2016). The type of response that follow these traumatic events are also risk factors, known as “peritraumatic” risk factors (Ford et al., 2015). Some of the main peritraumatic risk factors include high levels of initial distress characterized by increases in blood pressure, as well as dissociation and disorientation (Ford et al., 2015).+PTSD can develop at any age however, adolescents and young to midlife adults have a greater risk compared to children and elderly populations(Ford et al., 2015). Females and ethnic-racial minorities are also more susceptible to developing PTSD, the latter being a result of social and economic factors like racial stigma, discrimination,​ and poverty (Ford et al., 2015). Additional determinants that increase one’s likelihood of developing PTSD are childhood trauma, poverty, living through dangerous events, dealing with physical injuries and having a history of mental illness or substance abuse (National Institute of Mental Health, 2016). The type of response that follow these traumatic events are also risk factors, known as “peritraumatic” risk factors (Ford et al., 2015). Some of the main peritraumatic risk factors include high levels of initial distress characterized by increases in blood pressure, as well as dissociation and disorientation (Ford et al., 2015).
  
  
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 === Cognitive activation studies === === Cognitive activation studies ===
-Cognitive activation studies have shown increased amygdalar activity and decreased medial prefrontal cortical responses to threat in PTSD groups (Taber and Hurley, 2009). Reduced responses in the rostral anterior cingulate cortex to emotional stimuli have also been observed(Taber and Hurley, 2009).+Cognitive activation studies have shown increased amygdalar activity and decreased medial prefrontal cortical responses to threat in PTSD groups (Taber and Hurley, 2009). Reduced responses in the rostral anterior cingulate cortex to emotional stimuli have also been observed (Taber and Hurley, 2009).
  
 === Morphometric studies === === Morphometric studies ===
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 === Neurobiology of Serotonin ===  === Neurobiology of Serotonin === 
-In the brain, specifically in the brainstem medical and dorsal raphe nuclei, serotonin cell bodies (5-HT) regulate important functions (Kelmendi et al., 2016). Some vital roles that the 5-HT regulates include sleep, motor function, cognition and aggression (Sherin & Nemeroff, 2011). Previous research indicated that 5-HT is involved in stress response in patients with PTSD since the 5-HT neurons mediate anxiety producing effects on individuals through the 5-HT2 receptors (Sherin & Nemeroff, 2011). On the other hand, the 5-HT1A receptors regulate anti-anxiety producing effects from the median raphe. ​The5-HT1A  and 5-HT1B ​ receptors have been associated with disorders including PTSD (Bailey et al., 2013). Any changes in the functional 5-HT pathway may contribute to intrusive memories and impulsivity that is associated with PTSD symptoms ​PTSD (Bailey et al., 2013). Furthermore,​ Sari identifies ​the 5-HT1B receptor to be associated with PTSD. In the study, when there was a reduced amount of 5-HT1B receptor ​in the brain, the animals showed anxiety like behaviour (Sari, 2004). ​+In the brain, specifically in the brainstem medical and dorsal raphe nuclei, serotonin cell bodies (5-HT) regulate important functions (Kelmendi et al., 2016). Some vital roles that the 5-HT regulates include sleep, motor function, cognition and aggression (Sherin & Nemeroff, 2011). Previous research indicated that 5-HT is involved in stress response in patients with PTSD since the 5-HT neurons mediate anxiety producing effects on individuals through the 5-HT2 receptors (Sherin & Nemeroff, 2011). On the other hand, the 5-HT1A receptors regulate anti-anxiety producing effects from the median raphe. ​The 5-HT1A  and 5-HT1B ​ receptors have been associated with disorders including PTSD (Bailey et al., 2013). Any changes in the functional 5-HT pathway may contribute to intrusive memories and impulsivity that is associated with PTSD symptoms(Bailey et al., 2013). Furthermore,​ Sari identified that the 5-HT1B receptor to be associated with PTSD, when there was a reduced amount of 5-HT1B receptor, the animals showed anxiety like behaviour (Sari, 2004). ​
  
 {{ :​serotonin_melatonin_2017_.jpg?​300 |}} {{ :​serotonin_melatonin_2017_.jpg?​300 |}}
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 {{:​ptsd_association_of_canada.jpeg?​200|}}{{:​veterans_transition_network.png?​200|}}{{:​cmha_logo_.jpg?​300|}}{{:​camh_logo.jpg?​200|}} ​ {{:​casp-blue-logo.png?​100|}} {{:​ptsd_association_of_canada.jpeg?​200|}}{{:​veterans_transition_network.png?​200|}}{{:​cmha_logo_.jpg?​300|}}{{:​camh_logo.jpg?​200|}} ​ {{:​casp-blue-logo.png?​100|}}
  
-These are a lot of mental health resources that are related to people struggling with PTSD. Although some of these organizations don’t specialize specifically in PTSD, there are treatments or programs that they may provide. A lot of these organizations work together as opposed to separate and different organizations may handle different illnesses depending on the community that they are located in. If some can’t find what they are looking for at one of these organizations they will have connections to others that do. These five organizations are not the only five that deal with PTSD. There are a variety of them out there, the common ones were selected that were located in Canada. ​+There are a lot of mental health resources that are related to people struggling with PTSD. Although some of these organizations don’t specialize specifically in PTSD, there are treatments or programs that they may provide. A lot of these organizations work together as opposed to separate and different organizations may handle different illnesses depending on the community that they are located in. If some can’t find what they are looking for at one of these organizations they will have connections to others that do. These five organizations are not the only five that deal with PTSD. There are a variety of them out there, the common ones were selected that were located in Canada. ​
  
 ==Post-traumatic Stress Disorder Association of Canada (PTSDAC)== ==Post-traumatic Stress Disorder Association of Canada (PTSDAC)==
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 +===== PTSD Powerpoint Presentation ===== 
 +{{:​group_4_ptsd_slides.pptx|}}
 ===== References ===== ===== References =====
  
-1. Shubina, I. (2015). Cognitive-behavioral Therapy ​of Patients with Ptsd: Literature ReviewProcedia - Social And Behavioral Sciences165, 208-216. http://​dx.doi.org/​10.1016/​j.sbspro.2014.12.624 +1. American Psychiatric Association. (2013). Diagnostic and statistical manual ​of mental disorders (5th ed.). ArlingtonVAAmerican Psychiatric Publishing
  
-2. Cognitive Behavioral Therapy ​(CBTfor Treatment of PTSD. (2017). http://www.apa.org. Retrieved 16 September 2017, from http://www.apa.org/ptsd-guideline/​treatments/​cognitive-behavioral-therapy.aspx+2. Asnis, G., Kohn, S., Henderson, M., & Brown, N. (2004). SSRIs versus Non-SSRIs in Post-traumatic Stress Disorder. Drugs, 64(4), 383-404. http://dx.doi.org/10.2165/00003495-200464040-00004 
  
-3. Post-traumatic stress disorder (PTSD) - Treatment - NHS Choices(2015)Nhs.ukRetrieved 26 September 2017from http://www.nhs.uk/​Conditions/​Post-traumatic-stress-disorder/​Pages/​Treatment.aspx +3. Bailey, CR., Cordell, E., Sobin, SM., & Neumeister, A(2013)Recent progress in understanding the pathophysiology of post-traumatic stress disorder. ​CNS drugs, 27(3), 221-232. ​
  
-4. Eye Movement Desensitization and Reprocessing Therapy | Psychology Today. (2017). Psychologytoday.com. Retrieved 27 September 2017from https://www.psychologytoday.com/therapy-types/eye-movement-desensitization-and-reprocessing-therapy+4. Brady, K., Pearlstein, T., Asnis, G., Baker, D., Rothbaum, B., Sikes, C., & Farfel, G. (2000). Efficacy and Safety of Sertraline Treatment of Posttraumatic Stress DisorderJAMA283(14), 1837. http://dx.doi.org/10.1001/jama.283.14.1837 ​
  
-5. Wilson, K. (2012). Equine- Assisted Psychotherapy as an Effective Therapy in Comparison to or in Conjunction with Traditional Therapies (Undergraduate)University of Central Florida+5. Canadian Association for Suicide Prevention. (2016). Need Help?: CASP Retrieved September 22, 2017, from CASP Web site: https://​suicideprevention.ca/​need-help/​
  
-6.Masters, N. (2010). Equine Assisted Psychotherapy for Combat Veterans with PTSD (Masters of Nursing)WASHINGTON STATE UNIVERSITY+6. Canadian Mental Health Association. (2017). Mental Health: CMHA Ontario. Retrieved September 22, 2017, from CMHA Ontario Web site: http://​ontario.cmha.ca/
  
-7. Equine Therapy ​for (PTSD) Post Traumatic Stress Disorder. (2017). Calico Junction New Beginnings Ranch, Inc.. Retrieved ​26 September 2017, from http://www.calicojunctionnewbeginningsranch.org/ptsd.html+7. Centre ​for Addiction and Mental Health. (2012). Who We Are: CAMH. Retrieved September ​22, 2017, from CAMH Web site: http://www.camh.ca/​en/​hospital/​about_camh/​who_we_are/​Pages/who_we_are.aspx 
  
-8. Pharmacogenetics And Genomics, 19(11), 907-909. http://dx.doi.org/10.1097/fpc.0b013e32833132cb ​+8. Cognitive Behavioral Therapy ​(CBT) for Treatment of PTSD. (2017). http://www.apa.org. Retrieved 16 September 2017, from http://www.apa.org/ptsd-guideline/​treatments/​cognitive-behavioral-therapy.aspx
  
-9. AsnisG., KohnS., HendersonM., & BrownN. (2004). SSRIs versus Non-SSRIs ​in Post-traumatic ​Stress Disorder. ​Drugs64(4), 383-404. http://​dx.doi.org/​10.2165/00003495-200464040-00004 ​+9. DavidsonJ., PearlsteinT., LondborgP., Brady, K., Rothbaum, B., & BellJ. et al. (2003). Efficacy of Sertraline ​in Preventing Relapse of Posttraumatic ​Stress Disorder. ​FOCUS1(3), 273-281. http://​dx.doi.org/​10.1176/foc.1.3.273
  
-10. BradyK., Pearlstein, T., Asnis, G., Baker, D., Rothbaum, B., Sikes, C., & Farfel, G. (2000). Efficacy and Safety of Sertraline Treatment of Posttraumatic Stress Disorder. ​JAMA283(14)1837. http://dx.doi.org/10.1001/jama.283.14.1837 +10. Dryden-EdwardsMR(n.d.). Posttraumatic Stress Disorder: Read Up on PTSD SymptomsRetrieved September 272017from http://www.medicinenet.com/posttraumatic_stress_disorder/article.htm
  
-11. Davidson, J., Pearlstein, T., Londborg, P., Brady, K., Rothbaum, B., & Bell, J. et al. (2003). Efficacy of Sertraline in Preventing Relapse of Posttraumatic Stress DisorderFOCUS1(3), 273-281. http://dx.doi.org/10.1176/foc.1.3.273+11. Eye Movement Desensitization and Reprocessing Therapy | Psychology Today. (2017). Psychologytoday.com. Retrieved 27 September 2017from https://www.psychologytoday.com/therapy-types/eye-movement-desensitization-and-reprocessing-therapy
  
-12. Three Types of Medications Used to Treat PTSD – DH Information. (2011). Dhinfo.org. Retrieved ​25 September 2017, from https://www.dhinfo.org/2011/​02/​three-types-of-medications-used-to-treat-ptsd+12. Equine Therapy for (PTSD) Post Traumatic Stress Disorder. (2017). Calico Junction New Beginnings Ranch, Inc. Retrieved ​26 September 2017, from http://www.calicojunctionnewbeginningsranch.org/ptsd.html
  
-13. PTSD Medications - Posttraumatic Stress Disorder (PTSD) - HealthCommunities.com. (2015). ​Healthcommunities.com. Retrieved ​24 September 2017, from http://www.healthcommunities.com/posttraumatic-stress-disorder-ptsd/medications-ptsd-treatment.shtml +13. Ford, JD., Grasso, D. J., Elhai, J. D., & Courtois, C. A. (2015). ​Posttraumatic stress disorder: scientific and professional dimensionsAmsterdam: Academic Press. Retrieved September ​23, 2017, from http://scitechconnect.elsevier.com/wp-content/uploads/​2016/​05/​PTSD.pdf
  
-14.  ​SouthwickS. M., Yehuda, R., Giller Jr, EL., & CharneyDS(1994). Use of tricyclics and monoamine oxidase inhibitors in the treatment of PTSD: a quantitative reviewCatecholamine function in post-traumatic stress disorder: Emerging concepts, 293-305.)+14. Friedman, M. J(2007January 31)PTSD: National Center for PTSDRetrieved September 272017from https://www.ptsd.va.gov/​professional/​ptsd-overview/​ptsd-overview.asp
  
-15. KelmendiB., Adams, T., YarnellS., Southwick, S., AbdallahC., & Krystal, J. (2016). PTSD: from neurobiology to pharmacological treatmentsEuropean Journal Of Psychotraumatology7(1)31858. http://dx.doi.org/10.3402/ejpt.v7.31858 ​+15. HayesJP., VanElzakkerMB., & ShinLM. (2012). Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studiesFrontiers in Integrative Neuroscience. Retrieved September 272017from https://www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3466464/
  
-16.SherinJE., & Nemeroff, C. B. (2011). Post-traumatic stress disorderthe neurobiological impact of psychological traumaDialogues in clinical neuroscience13(3), 263.+16. KelmendiB., Adams, T., Yarnell, S., Southwick, S., Abdallah, C., & Krystal, J. (2016). PTSDfrom neurobiology to pharmacological treatmentsEuropean Journal Of Psychotraumatology7(1), 31858. http://​dx.doi.org/​10.3402/​ejpt.v7.31858 
  
-17.BaileyCR., Cordell, E., Sobin, SM., & NeumeisterA(2013)Recent progress in understanding ​the pathophysiology ​of post-traumatic stress disorder. CNS drugs, 27(3), 221-232. ​+17. MaliaSThe Chemistry of Post Traumatic Stress Disorder (PTSD)(n.d.)Retrieved September 272017from http://www.chemistryislife.com/the-chemistry-of-post-traumatic-stress-disorder ​
  
-18. SariY. (2004). Serotonin 1B receptors: from protein to physiological function and behavior. Neuroscience & Biobehavioral Reviews, 28(6), 565-582.+18. MastersN. (2010). Equine Assisted Psychotherapy for Combat Veterans with PTSD (Masters of Nursing). WASHINGTON STATE UNIVERSITY
  
-19. +19. National Institute of Mental Health. (2016). Post-Traumatic Stress Disorder. Retrieved September 24, 2017, from https://​www.nimh.nih.gov/​health/​topics/​post-traumatic-stress-disorder-ptsd/​index.shtml#​part_145372
  
-20. +20. Pharmacogenetics And Genomics, 19(11), 907-909. http://​dx.doi.org/​10.1097/​fpc.0b013e32833132cb ​
  
-21.+21. Post-Traumatic Stress Disorder. (n.d.). Retrieved September 27, 2017, from https://​www.nimh.nih.gov/​health/​topics/​post-traumatic-stress-disorder-ptsd/​index.shtml
  
-22. National Institute of Mental Health. (2016). Post-Traumatic Stress Disorder. Retrieved September ​24, 2017, from https://www.nimh.nih.gov/health/​topics/​post-traumatic-stress-disorder-ptsd/index.shtml#​part_145372+22. Post-traumatic stress disorder (PTSD) - Symptoms and causes. (2017). Mayo Clinic. Retrieved ​23 September 2017, from http://www.mayoclinic.org/diseases-conditions/​post-traumatic-stress-disorder/symptoms-causes/dxc-20308550
  
-23. Ford, J. D., Grasso, D. J., Elhai, J. D., & Courtois, C. A. (2015). ​Posttraumatic stress disorder: scientific and professional dimensionsAmsterdam: Academic Press. Retrieved September ​23, 2017, from http://scitechconnect.elsevier.com/wp-content/uploads/2016/​05/​PTSD.pdf+23. Post-traumatic stress disorder (PTSD) - Treatment - NHS Choices. (2015). ​Nhs.uk. Retrieved ​26 September 2017, from http://www.nhs.uk/Conditions/​Post-traumatic-stress-disorder/Pages/Treatment.aspx 
  
-24. Sareen J. (2017Posttraumatic stress disorder in adultsEpidemiology,​ pathophysiology,​ clinical manifestations,​ course, assessment, and diagnosis  +24. PTSD Association of Canada. (2016). HomePTSD Association of Canada. ​Retrieved September ​22, 2017, from PTSD Association of Canada Website: http://www.ptsdassociation.com/
-Retrieved September ​23, 2017, from https://www.uptodate.com/contents/​posttraumatic-stress-disorder-in-adults-epidemiology-pathophysiology-clinical-manifestations-course-assessment-and-diagnosis#​H9+
  
-25. ViewegW.,  ​JuliusD.,  Fernandez, ​A.,  Brooks, M., Hettema, J., & PandurangiA. (2006). Posttraumatic stress disorder: clinical ​features, pathophysiology,​ and treatmentThe American Journal of Medicine. Retrieved September 222017, from http://​www.amjmed.com/​article/​S0002-9343(05)00871-5/​fulltext#​section.0050+25. SadockB.J., SadockV.A., & RuizP. (2015). Kaplan & Sadock’s synopsis of psychiatryBehavioral sciences/clinical ​psychiatryPhiladelphiaPAWolters Kluwer
  
-26. Taber, K., & HurleyR., (2009PTSD and combat-related injuries: functional neuroanatomyThe Journal of Neuropsychiatry and Clinical Neurosciences. Retrieved September ​27, 2017, from http://neuro.psychiatryonline.org/doi/full/​10.1176/​jnp.2009.21.1.iv+26. PTSD Medications - Posttraumatic Stress Disorder (PTSD) - HealthCommunities.com. (2015). Healthcommunities.com. Retrieved ​24 September 2017, from http://www.healthcommunities.com/posttraumatic-stress-disorder-ptsd/medications-ptsd-treatment.shtml 
  
-27. Hayes, ​J. P.VanElzakkerM. B.& ShinL. M. (2012). Emotion ​and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies. Frontiers in Integrative Neuroscience. Retrieved September ​27, 2017, from https://​www.ncbi.nlm.nih.gov/pmc/​articles/​PMC3466464/+27. Sareen ​J. (2017) Posttraumatic stress disorder in adults: Epidemiologypathophysiologyclinical manifestations,​ courseassessment, and diagnosis. Retrieved September ​23, 2017, from https://​www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-epidemiology-pathophysiology-clinical-manifestations-course-assessment-and-diagnosis#​H9
  
-28. Post-traumatic stress disorder ​(PTSD- Symptoms ​and causes. (2017). Mayo Clinic. Retrieved 23 September 2017from http://www.mayoclinic.org/​diseases-conditions/​post-traumatic-stress-disorder/​symptoms-causes/​dxc-20308550+28. Sari, Y. (2004). Serotonin 1B receptors: from protein to physiological function ​and behaviorNeuroscience & Biobehavioral Reviews, 28(6), 565-582.
  
-29. American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders(5th ed.). WashingtonDCAuthor+29. Schuster, S. (2017January 28). 19 People Describe What It's Like To Have PTSD. Retrieved September 282017, from The Mighty Web sitehttps://​themighty.com/ 
 +(Schuster, 2017) - this is for the slide with quotes at the beginning ​
  
 +30. Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in clinical neuroscience,​ 13(3), 263.
  
 +31. Shubina, I. (2015). Cognitive-behavioral Therapy of Patients with Ptsd: Literature Review. Procedia - Social and Behavioral Sciences, 165, 208-216. http://​dx.doi.org/​10.1016/​j.sbspro.2014.12.624 ​
  
 +32. Southwick, S. M., Yehuda, R., Giller Jr, E. L., & Charney, D. S. (1994). Use of tricyclics and monoamine oxidase inhibitors in the treatment of PTSD: a quantitative review. Catecholamine function in post-traumatic stress disorder: Emerging concepts, 293-305.)
  
 +33. Taber, K., & Hurley. R., (2009) PTSD and combat-related injuries: functional neuroanatomy. The Journal of Neuropsychiatry and Clinical Neurosciences. Retrieved September 27, 2017, from http://​neuro.psychiatryonline.org/​doi/​full/​10.1176/​jnp.2009.21.1.iv
  
 +34. Three Types of Medications Used to Treat PTSD – DH Information. (2011). Dhinfo.org. Retrieved 25 September 2017, from https://​www.dhinfo.org/​2011/​02/​three-types-of-medications-used-to-treat-ptsd/ ​
  
 +35. Veterans Transition Network. (2017). About Us: VTN Canada. Retrieved September 22, 2017, from VTN Canada Web sit: https://​vtncanada.org/​
  
 +36. Vieweg, W.,  Julius, D.,  Fernandez,​ A.,  Brooks, M., Hettema, J., & Pandurangi, A. (2006). Posttraumatic stress disorder: clinical features, pathophysiology,​ and treatment. The American Journal of Medicine. Retrieved September 22, 2017, from http://​www.amjmed.com/​article/​S0002-9343(05)00871-5/​fulltext#​section.0050
  
 +37. Wilker, S., Pfeiffer, A., Kolassa, S., Elbert, T., Lingenfelder,​ B., Ovuga, E., Papassotiropoulos,​ A., de Quervain, D., Kolassa, I. (2014). The role of FKBP5 genotype in moderating long-term effectiveness of exposure-based psychotherapy for posttraumatic stress disorder. Translational Psychiatry. Retrieved September 30, 2017, from http://​www.nature.com/​tp/​journal/​v4/​n6/​full/​tp201449a.html
  
 +38. Wilson, K. (2012). Equine- Assisted Psychotherapy as an Effective Therapy in Comparison to or in Conjunction with Traditional Therapies (Undergraduate). University of Central Florida. ​
  
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