COMBAT PTSD Recognition and Treatment

1
COMBAT PTSDRecognition and Treatment

• Harry Croft, M.D.
• Texas Association of Osteopathic Physicians
• San Antonio,
• June, 2012

2
Research and Speaking Honoraria
Astra Zeneca Boehringer-Ingelheim BMS Eli
Lilly Forest Pharmaceuticals GSK Otsuka Pfizer Tak
eda
3
Learning Objectives

• 1. Learn usual presenting symptoms to civilian
  pcp of combat related PTSD.
• 2. Understand the importance of treating combat
  related ptsd in addition to relieving obvious
  presenting symptoms.
• 3. Become familiar with common misconceptions as
  well as facts regarding ptsd.
• 4. Know current evidence based treatments for
  ptsd.

3
4
(No Transcript)
5
WWW.MYBACKTOTHEWALL.COM

• RECOGNIZING When PTSD is in Your Life
• EDUCATING Yourself About PTSD
• CONNECTING Biology With Your Psychology
• ORGANIZING a Comprehensive Care Plan
• VIEWING Your Issues in a New Light
• EMPOWERING Yourself Through Strong Systems of
  Support
• REDEFINING the Meaning of Your lIfe Post
• Traumatic Growth
• T

5
6
Why Civilian Physicians Should Care

• PTSD in general population
• Returning Veterans
• 20 of 5 million
• Vietnam
• Middle East
• But what about the VA?
• Dont THEY take care of vets
• Not eligible
• No desire to go

7
Recognition of PTSDProblems for Patients and
Families

• Failure to Recognize Symptoms for what they Are
• Incorrectly Ascribe Cause
• Myths and Misconception About PTSD
• Stigma Surrounding PTSD

8
Myths and Misconceptions about PTSD

• 1. Only a soldiers problem
• 2. Only a mans problem (men acting badly)
• 3. A Psychiatric condition (denoting cowardice or
  craziness or weakness
• 4. Only affects those in direct combat
• 5. Almost everyone deployed to combat zone comes
  back with PTSD
• PTSD is an all or none disorder

9
PTSD IS.....

• Not just caused by Combat Related Trauma
• Not Just a Mans Problem
• Not Just Psychiatric Disorder
• Not all deployed to combat area
• Not all or none
• A Psycho-neuro-immunological problem

10
Recognizing PTSD Problems for Physicians -
Pr

• Patient reports only certain symptoms
• Failure to report traumatic experience/ vet
• Visit by patient not self motivated

11
Risks to Military Members More than Just Combat

• Combat
• Non-predictable Threats - to even
  non-combatants
• Repeated Deployments
• Repeated Separations
• Dwell time
• Unemployment / finances

12
Impacts Many Life Areas

• Relationships
• Marital, Family, Friends
• EMPLOYMENT/ EDUCATION
• Legal Problems
• Physical Health
• Risk Taking
• DESPAIR / SUICIDE

13
DIAGNOSIS

• STRESSOR
• RE-EXPERIENCING
• AVOIDANCE
• AROUSAL
• EMOTIONAL DISTRESS OR LIFE INTERFERENCE

DSM IV
14
Assessment of PTSD

• PC-PTSD Primary Care PTSD Screen
• 4 items (2 or more diagnostic)
• PCL PTSD Checklist (C M)
• 19 items (0-4) cutoff gt50

15
CO-OCCURRING CONDITIONS

• DEPRESSION
• ANXIETY DISORDERS
• Generalized, Panic, Social Phobia
• SUBSTANCE ABUSE DISORDERS
• OCD VARIANTS

16
Foundations of Treatment

• Recognition of Need for Treatment
• Decision to Get Help
• Finding a Place even if..
• Trust and Rapport
• Someone who understands
• Someone who will not judge
• Someone who will not be horrified
• BUT RAPPORT ALONE IS NOT ENOUGH

17
PSYCHOTHERAPY

• COGNITIVE-BEHAVIORAL THERAPY
• Prolonged Exposure
• Cognitive Processing Therapy
• SUPPORTIVE
• EMDR
• OTHER

18
MEDICATIONS

• ANTI-ADRENERGIC
• SSRI and SNRI
• MEDS TO AID WITH SLEEP
• Other antidepressants
• ATYPICAL Antipsychotics
• ANTI-EPILEPTICS
• Avoid BENZODIAZEPINES IF POSSIBLE

19
NEW MEDICATIONS

• CRF Antagonists
• Neuropeptide Y Agonists
• Antiadrenergic Drugs
• Selective Opiod agents
• Substance P Antagonists
• D-Cycloserine
• NMDA
• Anticonvulsants
• BDNF promoters

PTSD.VA.GOV PTSD 101
20
OTHER THERAPIES

• Meditation
• Exercise
• Yoga
• Accupuncture
• Animal Therapy
• Art and Writing

21
SUPPORT SYSTEMS

• FAMILY
• FRIENDS
• OTHER VETERANS
• ORGANIZATIONS
• HELPING OTHERS
• SPIRITUALITY

22
VIEWING ISSUES IN NEW LIGHT

• Viewing TRIGGERS as Manageable Events
• Need for Speed and other Risky Behaviors
• Viewing Relationships in a New Light
• Intimacy
• Children

23
REDEFINING LIFE AFTER PTSDPOST PTSD GROWTH

• Recognizing how others survive
• Who you are vs. what you do..or did
• Importance of lifelong growth and learning

24
Co-occurring Disorders

• Treat both disorders
• Assumption that dealing with one cures the
  other is not valid
• Need for support in sobriety
• One day at a time
• Medications

25
Suicide Risk Factors

• Person sees no way out and fears things will get
  worse
• Predominant emotions are hopelessness and
  helplessness
• Person is anxious, agitated and has insomnia
• Thinking is constricted with a tendency to
  persieve situation as all bad
• Judgement is impaired by use of alcohol or other
  substances
• Lack of future orientation
• Weapons are easily accessible

26
FOR MORE INFORMATION

• www.va.ptsd.gov
• www.medscape.com
• www.ptsd.va.gov/professional/pages/assessments/ncp
  tsd-instrument-request-form.asp
• TO DOWNLOAD PCL-M AND PCP PCL
• www.mybacktothewall.com