Caring for Military Combat Veterans with Post-Traumatic Stress Disorder (PTSD)
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1 Caring for Military Combat Veterans with Post-Traumatic Stress Disorder (PTSD) Tanya M. Benjamin-Wilson, DHSc, MPH, MSN, CHES, RN, APHN-BC Sigma Theta Tau International (STTI) 28 th International Nursing Research Congress Dublin, Ireland July
2 Introduction
3 Military Veterans Service in Armed Forces: Active Duty National Guard Reservists Retirees
4 Military Veterans (continued) Permanently stationed Temporarily deployed Hazardous duty combat areas Increased risk for severe mental health disorders
5 Nature of PTSD Known as shell shock or combat stress Traumatic or lifethreatening experience(s) Induces stress-related responses Impaired functioning
6 Nature of PTSD (continued) Consequences of non-treatment: Homelessness Substance abuse Domestic violence/relationship breakdown Criminality
7 Understanding PTSD
8 PTSD Incidence & Prevalence Rare disorder Increasing incidence among combat veterans Psychiatric casualty Caused by stress & trauma
9 PTSD Incidence & Prevalence (continued) Increased risk Young veterans Predisposing factors Poor SES Immaturity
10 PTSD Signs/Symptoms Acute or Chronic: Sleep disturbances Difficulty with memory/concentration Night Sweats Fatigue
11 PTSD Signs/Symptoms (Continued) Impairs Functioning: Professional Social Physical Interpersonal
12 PTSD Signs/Symptoms (Continued) Occur in 4 main Clusters (DSM-V): Intrusion (re-experiencing) Avoidance Negative Alteration (Cognition/Mood) Increased Arousal
13 PTSD Treatment Interventions
14 Pre-deployment Strategies Pre-deployment risk screen: Impractical Infeasible Inadequate
15 Post-deployment Strategies Pharmacotherapy Psychotherapy Exposure therapy
16 Pharmacological Therapy SSRIs 1 st Line Pharmacological treatment
17 Selective Serotonin Reuptake Inhibitors (SSRIs) Sertraline (Zoloft) or Paroxetine (Paxil) Treats anxiety & comorbid depression 6 week therapeutic blood level Drawback
18 Pharmacological Therapy (Additional Options) Mood Stabilizers Atypical Antipsychotics Prazosin/Tricyclics/ MAOIs BZDs/Beta Blockers
19 Cognitive Behavioral Therapy (CBT) Aids PTSD symptom management Boosts quality of life Focuses on interpreting trauma Encourages coping strategies
20 Virtual Reality Exposure Therapy (VRE) Connects emotion to fear activation Uses computer-generated technology Simulates trauma events
21 VRE (continued) Reduces combat-related anxiety Helps overcome stigma Favored over talk therapy
22 Factors Interfering with PTSD Treatment
23 Barriers to Care (Initial Tx) Lengthy periods without treatment Lack of PTSD Knowledge Feelings of invalidation Personal values/beliefs
24 Barriers to Care (Pharmacology) Fear of side effects & addiction Medication crutch Improper usage/dosing self-medication (substance use)
25 Treatment Retention Iraq & Afghanistan veterans: Less likely to seek psychiatric treatment Less likely to remain in treatment Significant factors: Age Comorbidity
26 Comorbidities Makes PTSD treatment difficult Overshadow PTSD symptoms Same signs/symptoms as other psychiatric disorders
27 Medication Adherence and Relapse Medication Misuse Missed appointments Treatment noncompliance Re-hospitalization
28 Access to Care Issues
29 Diagnosis and Treatment Discrepancies Low % of diagnosis documentation Misdiagnosis Patients in treatment < 50% Patient reporting of symptoms
30 Recommendations
31 Recommendations Seek advanced PTSD knowledge Conduct research Research technologybased therapies
32 Recommendations (Continued) Culture change Encourage PTSD treatment Policies & Procedures Review, revise, update, or implement
33 Contact Information Dr. Tanya Marie Benjamin-Wilson Georgia Southern University College of Health & Human Sciences School of Nursing
34 Any Questions
35 References Alexander, W. (2012). Pharmacotherapy for posttraumatic stress disorder in combat veterans: focus on antidepressants and atypical atipsychotic agents. P&T: Journal for Formulary Management, 37(1), Bastien, D. (2010). Pharmacological treatment of combat-induced PTSD: a literature review. British Journal of Nursing, 19(5), Dadić-Hero, E., Torić, I., Ruzić, K., Medved, P., & Graovac, M. (2009). Comorbidity - a troublesome factor in PTSD treatment. Psychiatria Danubina, 21(3),
36 References (Continued) Das, K., Malick, S., & Khan, K. (2008). Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part one. Journal of the Royal Society of Medicine, 101(10), doi: /jrsm Garske, G. (2011). Military-related PTSD: a focus on the symptomatology and treatment approaches. Journal of Rehabilitation, 77(4),
37 References (Continued) Harpaz-Rotem, I., & Rosenheck, R. (2011). Serving those who served: retention of newly returning veterans from Iraq and Afghanistan in mental health treatment. Psychiatric Services, 62(1), doi: /appi.ps Hourani, L. L., Council, C. L., Hubal, R. C., & Strange, L. B. (2011). Approaches to the primary prevention of posttraumatic stress disorder in the military: A review of the stress control literature. Military Medicine, 176(7),
38 References (Continued) Jeffreys, M. (2017). Clinician s Guide to Medications for PTSD. PTSD: National Center for PTSD. Retrieved from treatment/overview/clinicians-guide-tomedications-for-ptsd.asp
39 References (Continued) Lockwood, A., Steinke, D., & Botts, S. (2009). Medication adherence and its effect on relapse among patients discharged from a Veterans Affairs posttraumatic stress disorder treatment program. The Annals of Pharmacotherapy, 43(7), doi: /aph.1m017 Meltzer, E., Averbuch, T., Samet, J., Saitz, R., Jabbar, K., Lloyd-Travaglini, C., & Liebschutz, J. (2012). Discrepancy in diagnosis and treatment of posttraumatic stress disorder (PTSD): Treatment for the wrong reason. Journal of Behavioral Health Services & Research, 39(2), doi: /s x
40 References (Continued) Reger, G., & Gahm, G. (2008). Virtual reality exposure therapy for active duty soldiers. Journal of Clinical Psychology, 64(8), doi: /jclp Sayer, N. A., Friedemann-Sanchez, G., Spoont, M., Murdoch, M., Parker, L. E., Chiros, C., & Rosenheck, R. (2009). A qualitative study of determinants of PTSD treatment initiation in veterans. Psychiatry: Interpersonal & Biological Processes, 72(3),
41 References (Continued) Stewart, C., & Wrobel, T. (2009). Evaluation of the efficacy of pharmacotherapy and psychotherapy in treatment of combat-related post-traumatic stress disorder: a meta-analytic review of outcome studies. Military Medicine, 174(5), U.S. Department of Veteran s Affairs. (2012, June 5). PTSD Overview. In National Center for PTSD. Retrieved from pages/fslist-ptsd-overview.asp
42 References (Continued) Walker, S. (2010). Assessing the mental health consequences of military combat in Iraq and Afghanistan: A literature review. Journal of Psychiatric and Mental Health Nursing, 17, doi: /j x
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