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POST TRAUMATIC STRESS DISORDER (PTSD)

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War may be hell but home ain t exactly heaven, either. When a Soldier comes home from war, he finds it hard Operation Enduring Freedom (OEF) Operation Iraqi ... – PowerPoint PPT presentation

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Title: POST TRAUMATIC STRESS DISORDER (PTSD)


1
War may be hell but home aint exactly heaven,
either.
When a Soldier comes home from war, he finds
it hard
2
to listen to his son whine about being bored.
3
to keep a straight face when people complain
about potholes.
4
to be tolerant of people who complain about the
hassle of getting ready for work
5
to be understanding when a co-worker complains
about a bad nights sleep
6
to control his panic when his wife tells him he
needs to drive slower
7
to be grateful that he fights for the freedom of
speech.
8
to be silent when people pray to God for a new
car.
9
to be compassionate when a businessman expresses
a fear of flying.
10
to not laugh when anxious parents say theyre
afraid to send their kids off to summer camp.
11
to not ridicule someone who complains about hot
weather.
12
to control his rage when a colleague gripes
about his coffee being cold.
13
to remain calm when his daughter complains about
having to walk the dog.
14
to be civil to people who complain about their
jobs.
15
to just walk away when someone says they only
get two weeks of vacation a year.
16
to be happy for a friends new hot tub
17
to be forgiving when someone says how hard it is
to have a new baby in the house.
18
to not punch a wall when someone says we should
pull out immediately.
19
The only thing harder than being a Soldier
By Danielle A Proud Army Wife
20
is loving one.
21
A gentle reminder to keep your life in
perspective. And when you meet one of our
returning Soldiers, please remember what hes
been through and show him compassion and
tolerance.
Thank you. CPT Alison L. Crane, RN,
MS Mental Health Nurse Observer-Trainer 7302nd
Medical Training Support Battalion
22
POST TRAUMATIC STRESS DISORDER(PTSD)
  • Beth Jeffries, PhD
  • PCT Supervisor
  • Jack C Montgomery Veterans Hospital
  • Muskogee, OK

23
What Well Cover
  • Post Traumatic Stress Disorder (PTSD)
  • Traumatic Brain Injury (TBI)
  • Social Implications
  • Academic Implications
  • Occupational Implications

24
PTSD
25
Brief Overview
  • Experience of being exposed to an extreme
    traumatic stressor falling outside of the typical
    human experience or expectation
  • Response to this event involves intense fear,
    helplessness or horror
  • Evidence of persistent re-experiencing of the
    event
  • Evidence of persistent avoidance behaviors
    related to the trauma and generalized numbing of
    responsiveness
  • Increased arousal
  • These symptoms must be present for more than 1
    month
  • Create dysfunction in social, occupational, and
    other important areas of functioning

26
Extreme Stressors
  • Some examples
  • Military combat
  • Violent personal assault
  • Terrorist attack
  • Kidnapping
  • Natural or Manmade disasters
  • Diagnosed with life threatening illness or injury

27
Personal Response
  • How the person responds is important
  • Amount of control the person feels in the
    situation appears to be very important for
    outcome
  • Social support, or lack of, impacts symptoms
  • Avoidance is NOT helpful

28
Symptoms of PTSD
  • Associated with Re-experiencing
  • Intrusive thoughts of the event
  • Nightmares and sleep disturbance
  • Flashbacks
  • Intense psychological and physiological distress
    when reminded of the event

29
Symptoms continued
  • Associated with Avoidance and Numbing
  • Efforts to avoid reminders
  • Inability to recall important aspects of the
    event
  • Withdrawal from favored activities and interests
  • Strong feelings of detachment and/or estrangement
    from others
  • Restricted range of affect (poker face)

30
Symptoms continued
  • Associated with Arousal
  • Irritability and outbursts of anger
  • Difficulty concentrating/often confused with
    memory loss
  • Hypervigilance
  • Exaggerated startle response

31
Suicide
  • Feelings of hopelessness
  • Feelings of isolation/detachment
  • Depression and Loss
  • Guilt
  • Substance Abuse/Excessive Use
  • Coming home to family changes such as divorce,
    loss of money, or deaths in the family
  • Physical changes/disabilities resulting from
    wartime experience

32
Suicide What to look for
  • Isolation
  • Substance abuse/excessive use
  • Depression
  • Giving possessions away
  • Threats of suicide/past attempts
  • Talking about lack of future/hopelessness
  • Family history should be considered
  • Lack of social support

33
Suicide National Hotline
  • It Takes the Courage and Strength of a Warrior to
    Ask For Help
  • 1-800-273-TALK (8255)
  • Press 1 for Veterans
  • www.suicidepreventiononlifeline.org

34
PTSD Prevalence and Etiology
  • Estimated that 8 of total population meets
    criteria as set forth by the Diagnostic and
    Statistical Manual-IV (DSM-IV)
  • Research indicates 30-40 of persons exposed to
    trauma go on to develop PTSD
  • Number may be higher in real world

35
Prevalence and Etiology cont
  • No one group impacted more than another
  • Childhood traumas may prime individuals to
    develop PTSD after subsequent traumas
  • Not considered an illness, but rather a stress
    reaction
  • Long term, adrenal system impacted and other
    physiological problems

36
Symptom Presentation
  • Withdrawal from family and friends
  • Inability to get along with others
  • Alcohol and substance abuse
  • Poor performance in home activities, school and
    work
  • Personality changes, behavior changes

37
Prognosis
  • Typically considered chronic, but
    recovery/management realistic goal
  • Up and down pattern of symptoms likely over a
    lifetime
  • Anxiety and depression features are medication
    responsive
  • Early, intense cognitive behavioral therapies are
    effective

38
Medications
  • SSRIs
  • TCAs
  • Sometimes, anti psychotics
  • Alpha blockers
  • Discourage use of sleep agents and benzos
    consistently found to be ineffective, at best,
    and possibly, more harmful

39
Behavioral Treatments
  • Group Therapy Therapy of Choice
  • Individual Therapy
  • Supportive Therapy
  • Cognitive Behavioral Therapy (CBT)
  • Cognitive Processing Therapy (CPT)
  • Prolonged Exposure Therapy (PET)
  • Family/Marriage Counseling
  • Support and Peer Groups

40
Evidence Based Psychotherapy
  • Cognitive Processing Therapy (CPT)
  • Prolonged Exposure (PE)
  • Cognitive Behavioral Therapy (CBT)

41
PHYSICAL INJURIESTraumatic Brain Injury
42
Significant Issues
  • Physical Injuries
  • Loss of eyesight
  • Loss of limbs
  • Burns
  • Traumatic Brain Injury (TBI)
  • Soldiers are surviving injuries on the
    battlefield that would have been fatal in the
    past!

43
Traumatic Brain Injury (TBI)
  • Closed or Open Wound
  • Loss of consciousness
  • Dizzy
  • Headache
  • Memory loss
  • Nausea
  • Suicidal risk

44
TBI, cont.
  • Can be difficult to distinguish from PTSD, many
    symptoms are similar
  • Behavioral changes
  • Attention deficits, Concentration problems
  • Impulsive behaviors/Acting out
  • Nervous energy
  • Depression, withdrawal, suicidal ideations
  • Not always visually apparent

45
TBI Treatment
  • Psychological Testing from a trained
    Neuropsychologist is recommended
  • Medical tests such as CAT scans and MRIs may be
    warranted
  • Assessment of pre-morbid functioning is
    recommended

46
TBI, cont
  • Head injuries may impede a persons ability to
    function in all spheres, including academic
  • Ability to concentrate
  • Socialize appropriately
  • Focus of attention
  • Memory
  • Retention
  • Personality changes
  • Impulsivity

47
  • HOW DO ALL THESE INJURIES IMPACT THE RETURNING
    SOLDIER IN HIS LIFE
  • AND
  • HOW DO THEY IMPACT THE
  • REST OF US

48
Social Functioning
49
Big Changes
  • Withdrawal / Isolation
  • Impulsive
  • Aggressive / Acting out
  • Short Attention Span
  • Self Focused / Selfish / Childlike
  • Regression
  • Angry
  • Controlling

50
Family and Friends
  • Isolates from others, even at home
  • May be uninvolved
  • May be overly involved
  • Detachment
  • Clingy-ness
  • Routines are disrupted
  • Roles are altered

51
What Might Help
  • Give self and family time to adjust
  • Create a routine
  • Communicate, communicate, communicate
  • Set aside alone time
  • Set aside family time
  • Monitor and minimize substance use
  • Seek VA (or other) services to assist with
    adjustment issues
  • Understand that both of you have changed in some
    ways

52
Academic
53
Big Changes
  • Loss of Concentration / Distractable
  • Inability to sit still
  • Speaks out in class
  • Disorganized
  • Easily Frustrated / Slow to learn

54
What Might Help
  • Set aside study times that are brief and
    consistent/daily
  • Consider testing in separate room and/or extended
    time
  • Use a study partner
  • Practice going outside your comfort zone in
    simple, small ways to start

55
Occupational
56
Big Changes
  • Not Dependable or Reliable
  • Frustrates Easily
  • Loss of Concentration
  • Difficulty Getting Along with Supervisors and
    Co-workers
  • Frequent Mistakes
  • Over Controlling -or- Appears to not care

57
What Might Help
  • Consider employment options carefully
  • Practice going outside your comfort zone in small
    ways
  • Use relaxation and visualization techniques
  • Improve surroundings in small but meaningful ways

58
Where and How to Get Help
59
Veterans Administration (VA)Services
  • DoD and VA collaboration to inform veterans about
    our services
  • Orientations and PTSD Screen in Primary Care
  • Easy access and flexible hours
  • Outpatient/Inpatient/Crisis services

60
PTSD Clinical Team (PCT)
  • Specialized team focused on treatment and care of
    veterans with PTSD
  • Psychiatrists, psychologists, social workers and
    administrative personnel available for
    comprehensive, team approach

61
Group Therapy
  • Treatment of Choice
  • 3 Stage Program
  • Core group 3 months/education focus
  • Action group 3 month/process focus
  • Maintenance group 1 yr/support focus
  • Intense focus groups
  • CPT groups

62
Individual Therapy
  • Supportive and Cognitive
  • CPT
  • PET
  • Marriage/Crisis/Family
  • Importance of family involvement is stressed

63
Who Needs a Referral?
  • Identifying the need is the biggest step
  • The individual may avoid the problem by
  • Self medicating with substances
  • Withdrawing from activities and life
  • Using anger
  • Performance may suffer

64
Who can and should be referred to VA?
  • Any member of the National Guard or Reserves, or
    other affiliation with our Armed Forces
  • Any veteran of our Armed Forces
  • Of the above, anyone who requests a referral

65
Who Do I Call for Assistance?
  • Contact the business office at
  • Jack C Montgomery VA Hospital
  • Muskogee, OK
  • (918) 577-3000 / (888) 397-8387
  • Contact the Behavioral Medicine Clinic
  • Muskogee 918-577-3699
  • Tulsa 918-610-2000
  • Beth Jeffries, PhD Program Director/Supervisor
    PCT
  • 918-610-2000 Ernest C Childress VA Tulsa
  • 918-577-3699 Jack C Montgomery VA Muskogee

66
Operation Enduring Freedom (OEF)Operation Iraqi
Freedom (OIF)
  • Nanette Waller, MSW
  • OEF/OIF Program Director
  • Jack C Montgomery VA Hospital
  • Muskogee, OK 74401
  • 918-577-4150

67
Oklahoma City Area VA
  • For admissions in person, go to the 2nd floor of
    Building 3 and request an information packet.
  • For telephone information, or to have a packet
    sent to your home, please contact Cheryl Bays,
    LCSW at
  • (405) 270-0501, extension 5367
  • A copy of your DD214 is required.

68
Operation Enduring Freedom (OEF)Operation Iraqi
Freedom (OIF)
  • Steven Scruggs, PhD
  • OEF/OIF Program Director
  • Veterans Administration Hospital
  • Oklahoma City, OK
  • (405) 270-0501

69
  • QUESTIONS???

70
  • THANK
  • YOU
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