PTSD and Brain Injury- The Perfect Storm Part I

Transcription

1 PTSD and Brain Injury- The Perfect Storm Part I Lori Wardlow, LMSW VA Nebraska Western Iowa Health Care System Peggy Reisher, MSW Brain Injury Alliance of Nebraska 2016 Invisible Wounds of War 19% of personnel returning from Iraq and Afghanistan report possible BI 20% report PTSD Number of serious BIs identified is 5 times greater than the number of amputations A study of individuals seen at Walter Reed Army Medical Center showed that 56% of BIs were moderate or severe Rand Report

2 Three Types Of Stress Injuries Observed In Theater DR. (CPT) BILL NASH, USN COMBAT / OPERATIONAL STRESS TRAUMA FATIGUE GRIEF An impact injury Due to events involving terror or horror A wear-and-tear injury Due to the accumulation of stress over time A loss injury Due to the loss of people important to you Operational Stress Injuries May Persist as DSM-IV Diagnoses COMBAT / OPERATIONAL STRESS TRAUMA FATIGUE GRIEF ASD Adj D/O GAD V62.82 MDD PTSD MDD Panic 2

3 What is (PTSD) Post Traumatic Stress Disorder Post-traumatic Stress Disorder is a type of Trauma Disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death. Causes, incidence, and risk factors PTSD can occur at any age. It can follow a natural disaster such as a flood or fire, or events such as: Assault Domestic abuse Rape Terrorism War Normal reactions to abnormally stressful events ETIOLOGY OF MILITARY RELATED PTSD 94% of Soldiers in Iraq Reported Receiving Small Arms Fire 86% of Soldiers in Iraq Reported Knowing Someone Who Was Seriously Injured or KIA 68% Reported Seeing Dead or Seriously Injured Americans 77% of Soldiers Deployed to Iraq Reported Shooting or Directing Fire at the Enemy 3

4 PTSD Symptoms RE-EXPERIENCING HYPER-AROUSAL AVOIDANCE NEGATIVE THOUGHTS RE-EXPERIENCING Intrusive Thoughts/Memories Nightmares/Dreams Flashbacks 4

5 Flash back video 2min &chapterid=1 HYPER-AROUSAL Sleep Problems Irritability/Anger Outbursts Difficulty Concentrating Hyper Vigilant 5

6 AVOIDANCE Avoiding thoughts or feelings Avoiding Activities, Places or People That Remind Veteran of the Stressful Experience(s) NEGATIVE THOUGHTS Exaggerated negative beliefs or expectations no one can be trusted Blaming self Loss of Interest in Activities Emotionally Numb, Feeling Distant or Cut Off from Others 6

7 Treatment Evidence Based therapies have been shown to decrease symptoms, Examples are: Cognitive Processing Therapy (CPT) Prolonged Exposure (PE) Eye Movement Desensitization and Reprocessing (EMDR) Overlap of PTSD &TBI Symptoms PTSD TBI Flashbacks Nightmares Hypervigilance Increased startle response Cognition Depression Anxiety Insomnia Fatigue Substance use Headache Nausea Vertigo Vision problems Sensitivity to light or noise Source: David E. Ross, M.D., Director, Virginia Institute of Neuropsychiatry, Clinical Assistant Professor, Virginia Commonwealth University 7

8 What is a Brain Injury Brain Injury is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a BI. The severity of a BI may range from Mild Severe a brief change in mental status or consciousness an extended period of unconsciousness or amnesia after the injury. What this Might Look Like 8

9 Mild BI, Not so Mild A concussion which results from a blow to the head and causes the brain to strike the skull No structural damage to the brain Occurs with or without loss of consciousness Closed head injury may be missed when more visible injuries require immediate attention. Physical Effects of BI Balance and walking problems because of dizziness. Weakness/fatigue Seizure disorders Spasticity and tremors Fine/gross motor coordination problems Motor speech problems Sensory loss (taste, touch, hearing, smell) 9

10 Cognitive Effects of BI Attention and concentration problems Perseveration/rigidity Learning and memory problems Executive Function problems Processing problems Planning Insight and Awareness Sequencing Social-emotional Effects of BI Change in personal relationships Impulsivity Inability to read nonverbal cues Low frustration tolerance Denial/lack of awareness Dependent behaviors Fluctuating emotions Lack of motivation Irritability Aggression Depression Lack of inhibition Self centeredness Social isolation 10

11 Post- Concussion Syndrome Concussion symptoms fail to resolve and linger for up to ten years after the injury. Growing body of evidence indicates a high number of concussions can cause: Long term memory impairment Emotional instability Erratic behavior Depression Impulse control Early onset of neurodegenerative diseases Video 11

12 Obstacles to Treatment of BI and PTSD Over 40% of those experiencing mental health problems associated with combat refuse treatment due to the fear that treatment will: hurt their image ruin their military careers/promotions negative perception from peers, family and leadership limit civilian career opportunities Attention, Concentration, & Focus Simplify environment Control noise and light Provide clear visual prompts for environment Provide clear structure and predictable routine Remove any surprising/startling stimuli Check-in for comprehension Break larger tasks down Make paperwork as simple as possible Large font Soft colored paper Give breaks Give few problems at one time Shorten instructions Provide quiet room to complete tasks 12

13 Visual Processing Assist in completing paperwork Sunglasses inside Provide soft lighting and a quiet place for relaxation Assist with computer usage Learning and Memory Adjustments Write things down Provide way for individuals to record information Provide memory supports in the environment Written and posted schedule/instructions; label cabinets/drawers/rooms Shorten instructions Present in with words and pictures Model tasks Check in for comprehension 13

14 Processing Speed & Fluency Adjustments Complete paperwork in quiet, distraction-free room Don t put on the spot Provide cues for time sensitive tasks Create an environment that is conducive to asking for help and acknowledging any cognitive or emotional difficulties Emotional/interpersonal difficulty Communication should be direct, not subtle Nonjudgement, noncritical, supportive feedback Remain calm to reduce others agitation Recognition that self-awareness and/or awareness of deficits may be low or nonexistent 14

15 Brain Injury Management PCP Profession Neuropsychologist Physical Therapist Occupational Therapist Speech- Language Pathologist Audiologist Psychologist Neurologist Expertise health history; basic medicine cognitive function; brain/behavior relationship, behavioral treatment below the waist"; motor systems; balance "above the waist" adaptive behavior; functional assessment speech and language assessment; language rehab including cognition related to language vestibular system; auditory inputs Therapy, sleep hygiene, anxiety management brain structure and function; diagnose disease Contact us Lori Wardlow, LMSW VA Neb/Western Iowa Health Care System Peggy Reisher, MSW Brain Injury Alliance of Nebraska

16 References and Resources tml 16