Posts Tagged PTSD
Post-Traumatic Stress Disorder (PTSD) is a condition that runs its victims down emotionally and physically. Though most frequently linked to combat veterans and sexual-assault survivors, PTSD can present itself following any traumatic experience, and that includes medical emergencies. Following a stroke and its resulting medical treatment, it is common for patients to feel overwhelmed.
According to a study published in the journal PLoS ONE in June of 2013, almost one quarter of patients who survive a stroke will suffer from PTSD. Unfortunately, it is common for the symptoms of PTSD following a stroke to go unnoticed; due to the intense nature of physical recovery, the psychological hardship associated with it can lead to increased risk for heart disease or another stroke.
What is PTSD?
After experiencing or witnessing a traumatic event, such as a medical emergency, natural disaster, or an assault, it is difficult to adjust to everyday life again. Some people may struggle with relaxing or sleeping, have flashbacks or unsettling memories, or feel constant anxiety.
This psychological reaction is common and very frustrating. The good news is that it typically diminishes, and life returns to normal over the course of weeks or months, depending on the severity of the event. If a patient is experiencing these mental health symptoms for longer than a few weeks or months, whether constant or in waves, it is possible that they may have PTSD.
Symptoms of PTSD After Stroke
It is important to know the signs and symptoms of PTSD so that you can recognize them in a patient or loved one you are caring for after a stroke. Common symptoms of PTSD include experiencing a traumatic event over and over again, having nightmares, or being unable to stop thinking about it. To add to these extremely uncomfortable experiences, victims can also feel general, unyielding anxiety and try to avoid reminders of the event that started their suffering. They can also be tortured with feelings of self-doubt or misplaced guilt after a stroke or other traumatic event, a state of hyperarousal, or feeling overly alert.
If you are worried that a patient or family member is suffering from PTSD, ask them questions such as:
- Are you having nightmares?
- How are you coping?
- How does this make you feel?
These questions can help the patient discuss their symptoms and improve the likelihood of psychological recovery.
TIA and PTSD
Transient Ischemic Attack (TIA), also known as a mini stroke, can increase the likelihood of developing PTSD because the fear of having a stroke may become overwhelming. According to a study published in the American Heart Association journal Stroke, about one third of TIA patients develop signs of PTSD. Approximately 14 percent of TIA patients also experience a drop in physical quality of life, with 6.5 percent of patients experiencing a drop in mental quality of life.
There are ways to relieve the strain of PTSD. Treatment for PTSD may include medication, psychotherapy, or both. Patients experiencing signs of PTSD should see a trained and qualified mental health professional as treatments may vary from patient to patient.
A mental health provider or psychiatrist may prescribe antidepressants to patients struggling with PTSD. Antidepressants have been shown to relieve the symptoms of anger, sadness, and overwhelming worry better than other available medications.
Sometimes referred to as “talk therapy,” psychotherapy can take place in a one-on-one capacity or in a group setting. Talk therapy is the process of speaking with a mental health professional and can encompass the discussion of PTSD symptoms alone or the effect such symptoms may be having on a patient’s life.
PTSD can sometimes wreak havoc on a person’s social, family, or professional life. To help heal the damage, a mental health professional may combine multiple forms of psychotherapy to address any and all issues a patient may be having with the aftermath of a stroke or TIA. Most often, psychotherapy lasts six to twelve weeks, but it is not unusual for it to take longer to address each patient’s symptoms and struggles. Patients are encouraged to involve family and friends in their recovery because having the extra support can improve the speed and efficiency of mental recovery from a stroke.
PTSD can plague individuals who experience or witness a traumatic event. Medical emergencies are often traumatic, so it is common for survivors of stroke to suffer from PTSD; survivors of TIA can develop PTSD because they may be scared of suffering another mini stroke or of having a full-fledged stroke.
Symptoms can be very taxing on survivors and heartbreaking for their families to see. Fortunately, there are effective treatments for PTSD, including antidepressants and talk therapy with a mental health professional. If you are experiencing PTSD, it is important that you communicate how you feel with your doctor, family, and friends, as a strong support system can help you find the relief from psychological pain that you deserve.
What Is PTSD?
Handout: Understanding PTSD and PTSD Treatment (PDF)
PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.
It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. At first, it may be hard to do normal daily activities, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months.
If it’s been longer than a few months and you’re still having symptoms, you may have PTSD. For some people, PTSD symptoms may start later on, or they may come and go over time.
What factors affect who develops PTSD?
PTSD can happen to anyone. It is not a sign of weakness. A number of factors can increase the chance that someone will have PTSD, many of which are not under that person’s control. For example, having a very intense or long-lasting traumatic event or getting injured during the event can make it more likely that a person will develop PTSD. PTSD is also more common after certain types of trauma, like combat and sexual assault.
Personal factors, like previous traumatic exposure, age, and gender, can affect whether or not a person will develop PTSD. What happens after the traumatic event is also important. Stress can make PTSD more likely, while social support can make it less likely.
What are the symptoms of PTSD?
PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD.
- Reliving the event (also called re-experiencing symptoms). You may have bad memories or nightmares. You even may feel like you’re going through the event again. This is called a flashback.
- Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
- Having more negative beliefs and feelings. The way you think about yourself and others may change because of the trauma. You may feel guilt or shame. Or, you may not be interested in activities you used to enjoy. You may feel that the world is dangerous and you can’t trust anyone. You might be numb, or find it hard to feel happy.
- Feeling keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. You might suddenly get angry or irritable, startle easily, or act in unhealthy ways (like smoking, using drugs and alcohol, or driving recklessly.
Can children have PTSD?
Children can have PTSD too. They may have symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children:
- Children under 6 may get upset if their parents are not close by, have trouble sleeping, or act out the trauma through play.
- Children age 7 to 11 may also act out the trauma through play, drawings, or stories. Some have nightmares or become more irritable or aggressive. They may also want to avoid school or have trouble with schoolwork or friends.
- Children age 12 to 18 have symptoms more similar to adults: depression, anxiety, withdrawal, or reckless behavior like substance abuse or running away.
What other problems do people with PTSD experience?
People with PTSD may also have other problems. These include:
- Feelings of hopelessness, shame, or despair
- Depression or anxiety
- Drinking or drug problems
- Physical symptoms or chronic pain
- Employment problems
- Relationship problems, including divorce
In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in treatment can work for PTSD and these related problems.
Will people with PTSD get better?
“Getting better” means different things for different people. There are many different treatment options for PTSD. For many people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense. Your symptoms don’t have to interfere with your everyday activities, work, and relationships.
What treatments are available?
There are two main types of treatment, psychotherapy (sometimes called counseling or talk therapy) and medication. Sometimes people combine psychotherapy and medication.
Psychotherapy for PTSD
Psychotherapy, or counseling, involves meeting with a therapist. There are different types of psychotherapy:
- Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. There are different types of CBT, such as cognitive therapy and exposure therapy.
- One type is Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings. Changing how you think about the trauma can change how you feel.
- Another type is Prolonged Exposure (PE) where you talk about your trauma repeatedly until memories are no longer upsetting. This will help you get more control over your thoughts and feelings about the trauma. You also go to places or do things that are safe, but that you have been staying away from because they remind you of the trauma.
- A similar kind of therapy is called Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements while you talk about the trauma. This helps your brain work through the traumatic memories.
Medications for PTSD
Medications can be effective too. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), which are also used for depression, are effective for PTSD. Another medication called Prazosin has been found to be helpful in decreasing nightmares related to the trauma.
IMPORTANT: Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms and can be addictive.
Most people associate PTSD with veterans of war, but you don’t have to be a soldier to experience this condition.
The NIMH defines PTSD as ‘a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.’ When people experience a traumatic event, it’s common to be impacted by it with a range of emotions. People with PTSD don’t recover from this initial trauma. It doesn’t have to be triggered by a ‘dangerous’ event; many people experience PTSD after the death of a loved one or another emotionally challenging experience.
Risk factors for PTSD will sound familiar to family caregivers. They include:
- Living through dangerous events and traumas
- Seeing another person hurt, or seeing a dead body
- Feeling horror, helplessness, or extreme fear
- Having little or no social support after the event
- Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
You can learn about the symptoms and diagnosis of PTSD on the NIMH website.
If you think you may have PTSD, talk to your family doctor. If you aren’t comfortable seeking treatment, there are still some first steps you can take. Reducing stress through exercise and seeking out comforting situations can help you feel more secure. Get support from your friends and family, especially by letting them know what situations trigger your symptoms. Try to be realistic about what you can do each day, break up projects into small tasks, and accept that you can’t do everything. PTSD doesn’t go away overnight, but it can get better.
Here’s what some of our veteran caregivers have to say about PTSD:
After caring for my husband, for 20 years, I am afraid to answer my phone, open mail, or attend doctor appointments, fearing more bad news. I just want to hide. – Lynn R.
If you sleep with one ear open, you startle easily. Loss of sleep triggered by this startle reflex, will lead to ptsd. People who fail to understand my situation don’t believe me, but thankfully medical professionals do. – Angela M.
After 27 years caring for my very vulnerable son, I can tell you that it is indeed PTSD. For a mother, the fear of something happening to your child is much worse than anything that could happen to yourself. I have an anxiety disorder and have suffered from depression. You live in terror every time you hire a new respite worker, and only trust yourself as a caregiver. Your decisions carry so much weight that some days you feel they will crush you. – Dawn D.
Being part of caring for my MIL definitely has caused PTSD. Its a complete nightmare, and now I am scared of her! She talks about cutting people and watching them bleed! I know its the dementia, but she scares the hell out of me! I have nightmares about all of it! – Vickie B.
Anecdotally, caregivers who take care of a family member who is or has been abusive are more likely to talk about suffering from caregiver PTSD.
I’m the only child in my 50’s. My parents are near 90, refuse all outside care, cashed in their life insurance policy with not enough for burial. Now there is over 12k in medical bills and they won’t call a lawyer or approve forms for Medicaid. They say no one is putting them in a home. Mom has fallen numerous times and in nursing care and Dad signs her out. To stay out of care she shifts blame onto anyone including, and most of all, me. Agencies won’t help. Doctors quit the case. AOA said it’s one of the most difficult cases they have encountered. – Jacqueline A.
I wish my mom would understand that no one wants to help her because she is a mean old spiteful monster who has alienated EVERY one in the family to the point that they don’t even want to call to talk to her anymore. But she blames me for it! – David R.
I used to think that I would ignore my stepfather who abused me, but when it came down to it…I had to treat him better than me. – Jennifer K.
I can relate to caregiver PTSD from taking care of my mother that never took care of me & Granny that raised me! – Chrissy G.
What should you do if you feel you have caregiver PTSD?
The reason you have PTSD is because you love and you care. The key to reducing anxiety is to get out of your own head. Watch your self talk. Be kind to your mind, it does not know the difference between perceived danger and real danger….live in the moment! – Dawn D.
If you are feeling overwhelmed, you may, very well, benefit from talking with a therapist or counselor. I have learned to take time, for myself, once in a while, to spend a few hours, with friends, or even just go for a ride. I feel guilty, for even smiling, sometimes, but we have to take care of ourselves, and find ways to keep our spirits uplifted, while we care for others. For what it’s worth, I would advise you to, whenever you can, do something special, for yourself, even if it is a meal out, a movie, or just something you like. Try to interact, in a positive way, with others, and rejoin the human race. You are entitled to happiness, and, your [loved one] may even want that for you, as well. – Lynn R.
Introduction and Purpose of the Study
After traumatic hand injury, extensive physical and psychological adaptation is required following surgical reconstruction. Recovery from injury can understandably be emotionally challenging, which may result in impaired quality of life and delayed physical recovery. However, the evidence base for identifying high-risk patients is limited.
A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present), PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting psychological outcomes after acute hand trauma. Subsequent review and selection by 2 independent reviewers identified 19 studies for inclusion. These were poor quality level 2 prognostic studies, cross sectional or cohort in design, and varied widely in methodology, sample sizes, diagnostic methods, and cutoff values used to identify psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires used to identify them were extracted and analyzed.
Patients with amputations or a tendency to catastrophize suffered highest pain ratings. Persisting symptom presence at 3 months was the best predictor of chronicity. Many different questionnaires were used for symptom detection, but none had been specifically validated in a hand trauma population of patients. Few studies assessed the ability of selection tools to predict patients at high risk of developing adverse psychological outcomes.
Discussion and Conclusion
Despite a limited evidence base, screening at 3 months may detect post-traumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes.
[ARTICLE] A Virtual Reality Exposure Therapy Application for Iraq War Military Personnel with Post Traumatic Stress Disorder: From Training to Toy to Treatment – Full Text PDF
Post Traumatic Stress Disorder is reported to be caused by traumatic events that are outside the range of usual human experiences including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggests that 1 out of 6 Iraq War veterans are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) exposure treatment has been used in previous treatments of PTSD patients with reports of positive outcomes. The aim of the current paper is to specify the rationale, design and development of a Virtual Iraq PTSD VR application that has been created from the virtual assets that were initially developed for a combat tactical training simulation, which then served as the inspiration for the X-Box game entitled Full Spectrum Warrior.
In 1997, researchers at Georgia Tech released the first version of the Virtual Vietnam VR scenario for use as a graduated exposure therapy treatment for Post Traumatic Stress Disorder (PTSD) with Vietnam veterans. This occurred over 20 years following the end of the Vietnam War. During that interval, in spite of valiant efforts to develop and apply traditional psychotherapeutic approaches to PTSD, the progression of the disorder in some veterans severely impaired their functional abilities and quality of life, as well as that of their family members and friends. The tragic nature of this disorder also had significant ramifications for the U.S. Veteranes Administration healthcare delivery system often leading to designations of lifelong service connected disability status. In mid-2004, the first systematic study of mental health problems due to the Iraq conflict revealed that ?@The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent)T (Hoge et al., 2004). With this history in mind, the USC Institute for Creative Technologies (ICT) has initiated a project that is creating an immersive virtual environment system for the treatment of Iraq War veterans diagnosed with combat-related PTSD. This project has now been funded as part of a larger multi-year effort by the U.S. Office of Naval Research that brings together the technical, clinical and creative forces of ICT, Virtually Better, Inc. and the Virtual Reality Medical Center. The VR treatment environment is based on a cost effective approach to recycling virtual graphic assets that were initially built for a combat tactical simulation scenario entitled Full Spectrum Command, which later inspired the creation of the commercially successful X-Box game, Full Spectrum Warrior. This paper will present the vision, rationale, technical specifications, clinical interface design, and development status of the Full Spectrum PTSD treatment system that is currently in progress at the ICT.
More than 20 percent of Americans regularly consume prescribed drugs related to mental health issues, earning contemporary America the nickname, “the Prozac Generation.” However, developing safe, targeted, and effective drugs for mental illnesses has increasingly become a struggle for the pharmaceutical industry.
As a result, there’s been a gradual withdrawal of research dollars from this area, despite the fact that globally, the mental health pharmaceutical market is worth more than $80 billion.
According to the National Institute for Mental Health (NIMH), more than 57 million people, or 26 percent of the U.S. population suffer from some form of mental health problem. But despite the ongoing need, one can legitimately claim that research has not produced a novel neurological drug in the past 30 years. Additionally, many drugs currently on the market have been increasingly identified with negative side effects and limited efficacy.
Until recently, most mood disorders were attributed to an imbalance in a single neurochemical, such as serotonin. Increasingly, scientists have come to acknowledge that this is an oversimplification that can lead to counterproductive treatment.
Due to the complexity of brain networks, these pharmaceutical compounds may work to alleviate some symptoms, but they may exacerbate others. They may even contribute to new problems, such as cognitive impairment, suicide, or diabetes. Because the diagnosis of many conditions is a highly subjective process based on patient self-reporting, identifying the appropriate course of treatment is frequently an exercise in trial and error.
High cost, negative press, and the lack of an efficacy model have resulted in the drying up of the drug pipeline for pharmaceutical treatment of mental illness.
Are we moving into a post-pharmaceutical age in the treatment of neurological and psychiatric illness? If the flurry of wearable sensors, brain-computer interfaces, and non-invasive brain stimulation research are any measure, then the answer is “yes.”
Brain training can be used to treat problems related to cognition, behavior, and emotion. (Image Source: Evoke Neuroscience)
New technology and an increased focus on traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), have led to a greater understanding of the complexity of the brain. Instead of focusing on single chemical neurotransmitters affecting cognition and behavior, mental health research has evolved to address neurological “functions” through models of neural circuits known as “neural networks.”
Continue –> Brain Training And The End Of The Prozac Generation.
Brain injury and emotions
A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems.
Difficulty controlling emotions or “mood swings”
Some people may experience emotions very quickly and intensely but with very little lasting effect. For example, they may get angry easily but get over it quickly. Or they may seem to be “on an emotional roller coaster” in which they are happy one moment, sad the next and then angry. This is called emotional lability.
What causes this problem?
- Mood swings and emotional lability are often caused by damage to the part of the brain that controls emotions and behavior.
- Often there is no specific event that triggers a sudden emotional response. This may be confusing for family members who may think they accidently did something that upset the injured person.
- In some cases the brain injury can cause sudden episodes of crying or laughing. These emotional expressions or outbursts may not have any relationship to the way the persons feels (in other words, they may cry without feeling sad or laugh without feeling happy). In some cases the emotional expression may not match the situation (such as laughing at a sad story). Usually the person cannot control these expressions of emotion.
What can be done about it?
- Fortunately, this situation often improves in the first few months after injury, and people often return to a more normal emotional balance and expression.
- If you are having problems controlling your emotions, it is important to talk to a physician or psychologist to find out the cause and get help with treatment.
- Counseling for the family can be reassuring and allow them to cope better on a daily basis.
- Several medications may help improve or stabilize mood. You should consult a physician familiar with the emotional problems caused by brain injury.
What family members and others can do:
- Remain calm if an emotional outburst occurs, and avoid reacting emotionally yourself.
- Take the person to a quiet area to help him or her calm down and regain control.
- Acknowledge feelings and give the person a chance to talk about feelings.
- Provide feedback gently and supportively after the person gains control.
- Gently redirect attention to a different topic or activity.