Overview of PTSD/TBI

1. Overview of PTSD/TBI Rodgers M. Wilson, M.D. Acting Chief Medical Officer Arizona Department of Behavioral Health Services

2. PTSD: Definition • Posttraumatic Stress disorder (PTSD) is an anxiety disorder that can occur after you have been through a event. A traumatic event is something horrible and scary. During the event , an individual believes that his/her life or the lives of others are at risk.

3. What types of events may cause PTSD? Combat or military exposure Childhood sexual or physical abuse Terrorists attacks Sexual or physical assaults Serious accidents, such as a car wreck Natural Disasters, such as a fire, tornado, flood or earthquake

4. Blast-related Injuries • The recent RAND Center for Military Health Policy Research “Invisible Wounds of War - Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery” report on OIF/OIE veterans, discussed that of the1.64 million service members who have been deployed for OIF/OIE as of October 2007, they estimate that 300,000 individuals currently suffer from PTSD or major depression and that 320,000 individuals experienced a probable TBI during deployment.

5. Disorders and Returning Veterans Rand Study: • 69.3% have no diagnosis • 11.2% PTSD or depression • 7.3% have PTSD/Dep/TBI • 12.2% have TBI only

6. Prevalence of PTSD • Estimated prevalence of lifetime PTSD to be 7.8% in the general population. • Women are twice as more likely to than man to develop PTSD at some point in their lives. • Men are more likely to experience a trauma. ( National Center for PTSD)

7. Who is likely to develop PTSD? 1.Had an earlier life-threatening event or trauma, such as being abused as a child 2.Poorly educated 3.Younger age 4.Having another mental health problem 5.Family with mental health problems 6.Limited support from friends and family 7.Recent loss of a loved one 8.Recent stressful life changes 9.Alcohol abuse 10.Female

8. How would you know if an individual has PTSD? • Bad dreams • Flashbacks • Scary thoughts • Staying way from places and things that remind you of what happened • Feeling worried, guilty, or sad • Feeling alone • Trouble sleeping • Feeling on the edge • Angry outbursts • Thoughts of hurting yourself or others

9. How would an individual know if a child had PTSD? Regression: behaving like they did when they were younger Somatic preoccupations Behavioral Disruptions Poor School performance Refusing to play or play with friends.

10. TBI: Definition A traumatic brain injury is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Not all blows or jolts to the head result in a TBI. Degree of Injury: Injuries may range from mild( brief changes in mental status) to severe (extended periods of unconsciousness or amnesia after the injury. TBI can result in short or long-term problems with independent functioning (CDC,2006)

11. TBI Data Centers for Disease Control and Prevention. “Traumatic Brain Injury in the United States: A Report to Congress.” (January 16, 2001). Traumatic brain injury is classified as a public health epidemic in America.

12. Who is a risk for TBI? 1. Military personnel 2. Males are about 1.5 times more likely than females to sustain TBI Cost: Direct medical cost and indirect cost such as the loss of productivity of TBI totaled $60 billion in the U.S. in 2000 (Finkelstein,2006)

13. 1.4 million injured 50,000 die from a TBI 235,000 are hospitalized 1.1 million treated and released from ED 5.3 million, approximately 2% of the U.S. population, currently have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI. Centers for Disease Control and Prevention Annual

14. TBI Data • The number reported with TBI underestimates the magnitude of the problem because the following are not included in those estimates: • Those treated by private physicians. • Those treated in private clinics, urgent cares. • Individuals who did not seek medical care.

15. TBI Data The leading causes of TBI are: • Falls • Motor vehicle-traffic crashes • Struck by/against events • Assaults • (Defense and Veterans Brain Injury Center,2005)

16. Family Violence In intimate partner violence, the head and face are targeted half the time. In non-intimate assaults against women, nearly 60% of the assaults are to the head and face. Greenfield, L. Et al, Violence by Intimates, NCJ-167237, US Department of Justice, Bureau of Justice Statistics, March 1998

17. Family Violence Many children have neurological deficits caused by repeated blows to the head and face and/or by the chemical reaction to prolonged stress of witnessing and living in a violent home.

18. TBI Data and ResearchFamily Violence …Physical, sexual and psychological trauma in childhood are now being connected to mental health difficulties, that show up in childhood, adolescence, or adulthood.

19. Blast-related Injuries • The report further discussed that • Of those reporting a probable TBI, 57 per cent had not been evaluated by a physician for brain injury • Some specific groups that were understudied (e.g. Reserve Components, those who left military service) may be at higher risk for suffering from these conditions.

20. What are the signs/symptoms of TBI? • Mild TBI: headaches, confusion, lightheadedness, dizziness, blurred vision, ringing in ears, bad taste in mouth, fatigue, sleep disturbance, mood changes, decrease memory, difficulty with concentration, attention or thinking. The injury may or may not result in a brief period of unconsciousness (TBI Recovery Center,2006)

21. What are the signs/symptoms of TBI? • Moderate or Severe TBI: symptoms may be similar to mild but they may also include a headache that gets worst and never goes away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the arms or legs, loss of coordination, increased confusion, restlessness, or agitation. ( TBI Recovery Center,2006)

22. Long-term consequence of TBI • 5.3 million Americans have long-term or lifelong need for help to perform daily living(Thurman,1999) • 40% of those hospitalized for TBI had at least one unmet need for services. The most frequent unmet needs: a. Improving memory and problem solving b. Managing stress and emotional upsets c. Controlling one’s temper d. Improving one’s job skills (Corrigan,2004)

23. Interruption of Brain Behavior Relationships There is a potential for symptoms to be dismissed, rejected, misdiagnosed, or misunderstood due to a delay in the manifestations of some of the symptoms and the similarities to mental illness. Individuals may be presenting with possible psychiatric illnesses where brain injury is really the underlying cause or driving the illness. Cognitive changes following brain injury may impair the individual’s ability to access and use cognitive behavioral strategies.

24. TBI and PTSD: Similarities in Symptoms TBI • Increased anger/irritability • Rage • Depression • Memory impairment • Sleep disturbance • Headaches • Avoidance of crowds/social isolation • Substance Abuse • Suspicion/paranoia • Anxiety PTSD • Increased anger/irritability • Rage • Depression • Memory impairment • Sleep disturbance • Headaches • Avoidance of crowds/social isolation • Substance Abuse • Suspicion/paranoia • Anxiety (Brain Injury Association of Arizona)

25. TBI and PTSD: Non-Similarities in Symptoms TBI • Impaired decision making • Work retrieval problems • Low frustration problems • Low frustration tolerance • Impulsive behavior • Noise Sensitivity • Easily confused PTSD • Easily Startled • Hyper-vigilant of surroundings • Strong reaction to flashbacks • Nightmares • Intrusive thoughts • Guilt (Brain Injury Association of Arizona)

26. Interruption of Brain Behavior Relationships • Cognitive, emotional, and/or behavioral challenges after brain injury can result in referrals to systems and services that do not have adequate knowledge, understanding, training, and/or experience working with individuals with brain injury and their families. • This may result in: • inappropriate evaluations, assessments and treatment; • inaccurate assessment of response to treatment; • exacerbation of symptoms; • Inappropriate medications or overmedication; • Substance abuse.

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