Traumatic Brain Injury and Post Traumatic Stress Disorder in Soldiers from Afghanistan and Iraq - Research Paper Example

Connections between Traumatic Brain Injury and Post Traumatic Stress Disorder in Returning Soldiers from Afghanistan and Iraq The problem of mild brain trauma injury has emerged as one that is related to 21st-century warfare. The use of small, contained blasts on a frequent basis has created an epidemic of brain trauma in soldiers who are returning from Afghanistan and Iraq. Reports of depression and post-traumatic stress disorder are frequently associated with those who suffered from mild brain trauma injury. The following study examines the issue of MTBI as it is associated with PTSD as comorbidity. This association has some support through neurological studies that have been conducted, but conclusions have yet to be drawn as to whether or not there is a causal relationship between MTBI and PTSD. Further study into this topic is needed through both neurological and psychological evaluations in order to come to definitive conclusions about relationships between these two conditions. The potential benefit to both military and civilian applications is unlimited as the development of an understanding of how the brain works in terms of psychological development and benefit human health. Connections between Traumatic Brain Injury and Post Traumatic Stress Disorder in Returning Soldiers from Afghanistan and Iraq Experiences in battleground hospitals have shown that there is likely a connection between traumatic brain injury, or TBI and posttraumatic stress disorder or PTSD. Soldiers who have dramatic brain injury often end up exhibiting posttraumatic stress disorder symptoms which can lead to an assumption that there is a connection between these two experiences. The following literature review studies the issue of a connection between traumatic brain injury and posttraumatic stress disorder in soldiers between the ages of 18 and 35. Soldiers who have returned from Iraq or Afghanistan are increasingly showing evidence of a connection between PTSD and MTBI. The objectives of this study are to examine traumatic brain injury, post-dramatic stress disorder, and to discover if there is a connection between these two experiences in soldiers who have been in Afghanistan and Iraq. Background War does not end when a soldier comes home. More than 17,530 US troops in 2009 were hospitalized for mental disorders. Traumatic brain injury is the most prominent injury that occurs in war with more than 50% of all combat related casualties a result of brain injury. With the advances in treatment and evacuation, however, more wounded soldiers are surviving than they did just a few years ago. However, hundreds of thousands are coming home and suffering from posttraumatic stress disorder with a significant percentage of those who are suffering not realizing they have condition (Lawhorn & Philpott, 2010). Good treatment centers now exist that can help wounded warriors with traumatic brain injury and the consequential PTSD. Until recently, the consequences of PTSD were not fully understood. There is the perception that its is something experienced and then it goes away. Many soldiers come home exhibiting a wide range of symptoms but do not realize that what they are experiencing is PTSD. Both traumatic brain injury and posttraumatic stress disorder have a number of symptoms that may not seem relevant, but will affect the quality of life of an individual who is suffering. Many of the psychological disorders that soldiers suffer, including PTSD, may come from physical injuries they have endured (Lawhorn & Philpott, 2010). Vasterling, Bryant & Keane (2012) discuss the need to increase research and attention on stress-related psychological disorders due to the wars in both Afghanistan and Iraq. There is a strong belief that there is an intersection that occurs between traumatic brain injury and PTSD. Both of these problems are often considered invisible injuries because they are not easily observed in those who suffer. TBI and PTSD often occur simultaneously. It is essential to understand how these two conditions run concomitantly present. This has a great deal of impact on both military and civilian health issues. In general terms, PTSD runs in about 7 to 8% of the population in the United States. This is much higher in some groups such as those who have been victims of violence and of course those serving in the military. As well, TBI occurs in about 1.1 million people who end up in emergency rooms across the United States. Shockingly, this may actually be a low estimate as many people with traumatic brain injury that occurs at a milder level have few symptoms and do not seek care. Some people lose consciousness over only brief periods of time and do not feel the need to seek care. However, the estimated amount of TBI and PTSD in soldiers who were in Operation Enduring Freedom and Operation Iraqi Freedom is estimated to be between 13.8% and 19.5% assigned to each. It is difficult to have exact figures and is also difficult to determine numbers due to the variations in how PTSD and TBI are defined. It is critical that definitions be made so that practitioners can address the issues with understanding and comprehension (Vasterling, Bryant & Keane, 2012). One of the biggest problems in addressing this issue has been that hospital policy concerning TBI and PTSD has been to assign this solely as a psychiatric problem. There are three main issues that create barriers to continuing quality of life in those first suffer from TBI and PTSD. The first is that they struggle with social anxiety; the second is that they have cognitive impairments especially concerning attention and memory, and the third is that they have anxiety about returning to college or getting additional training because of the injuries they suffered. Developing treatments for people who have concurrent TBI and PTSD would help soldiers and citizens in being able to get back to a more meaningful life because the issues that they are facing have been addressed. However, because of bias that exists about mental issues, some patients do not even seek treatment even though they know that something is not quite right within their psyches. Following research questions have been used to frame the inquiry and to limit the scope so that the intentions of the research can be focused: 1. What is the overall effect of traumatic brain injury on soldiers as they return from recent wars? 2. What is the overall effect of posttraumatic stress disorder on soldiers who have returned from wars? 3. Can a connection be drawn between traumatic brain injury and posttraumatic stress disorder? 4. If a connection is drawn between these two types of effects, what does this mean in terms of treatment and prognosis? These questions frame the issue and support the idea that if the premise is correct, then treatment needs to be tailored to understand that both issues of TBI and PTSD are involved. Methods This study uses secondary research in order to make connections between ideas and concepts that can illuminate the topic. Through search of databases and online book resources, the development of a rich foundation of resources can help to explore the subject matter. Using keywords to define the search, the literature can be used in order to determine how connections can be made between PTSD and TBI. Once the literature was accumulated and reviewed, the information from those works was put into context with the research questions and concepts were developed by creating connections between those works. Findings The effects of war are often hotly baited, some factions wanting to downplay those effects in order to support your efforts and others wanting to inflate them in order to support peace. There is a disagreement in terms of persistent post concussive symptoms that are reported by Iraq combat veteran who have had repeated episodes of mild traumatic brain injury from being in close proximity to explosive blasts. This represents functional and structural brain damage and may also present with epiphenomenon of comorbid posttraumatic stress disorder (Sayer, 2012). Peskind et al (2011) conducted a study with 12 veterans from the Iraqi war who had experience one or more exposures to blasts and use a control group of 12 community volunteers. The veterans showed signs of decreased cerebral metabolic rates of glucose within the vermis, pons, cerebellum and medial temporal lobe. There were also impairments, although slight, in terms of cognitive processes, attention, verbal fluency, and working memory. This is very similar to the effects of cerebellar lesions. Brain imaging also found that there was chronic post concussive symptoms and the Iraqi veterans. There is some evidence to suggest that delayed onset of PTSD can follow an incident of mild TBI. After an event of mild TBI, a longitudinal study on civilians found that 40% could recall the details of the injury two years after it occurred, where one month after the memory was not available to them. Biscuits just that for service members who suffer delayed PTSD the reason is because of the mild brain trauma that allowed for the manifestation of PTSD. Delayed onset of PTSD is considered to be more common the military then civilian settings and the reconstruction of the dramatic experiences can contribute to the delayed nature of the stress. There is speculation that trauma memory reconstruction in a post-deployment time is a contributing factor the development of delayed PTSD (Bryant, Castro & Iverson, 2012: Carlson et al, 2010). Taylor et al (2012) has determined that genetic brain injury is a ‘signature injury’ that is symbolic of the Afghanistan and Iraq wars. Observations of patients with combat related traumatic brain injury shows that there are high rates of psychiatric pain and disturbances that accompany this type of injury. In 2009 there were approximately 327,388 veterans from these two conflicts and 6.7% of them had been diagnosed as having received a mild TBI. Of those diagnosed with a mild TBI, 89% were co-diagnosed with a psychiatric disturbance. Of that 89%, 73% were diagnosed with PTSD. Another 70% of the veterans had back, head, and neck pain. The longitudinal effect on veterans of the Iraqi and Afghanistan conflicts in terms of brain injury and posttraumatic stress disorder are yet unknown. In a study done by Polusny et al (2011) 950 National Guard soldiers were studied in order to assess the effects of MTBI and he TSD in terms of physical symptoms, depression, alcohol use, quality of life issues and overall social function. The results showed that soldiers who had concussion or NTBI were more likely to report postemployment symptoms and poor psychosocial outcomes. The conclusions of the study determined that combat related PTSD was associated with post concussive symptoms and consequential psychosocial outcomes with a long-term negative impact for outcomes related PTSD. The outcomes reported by Polusny et al (2011) might be explained by some of the discoveries by Petrie et al (2014) where relationships were studied between the cerebral glucose metabolism in veterans with blast injuries and comorbidities with both depression or post back stress order. Participants exhibited abnormalities in the structure of their brain which is congruent with evidence that is being compiled about the neuropathological issues that accompany chronic brain injury in these types of veterans. This is consistent with work done by Pham et al (2014) which showed that disposing rats to a shockwave pressure of different intensities led to increase prion protein in the plasma and was potentially responsible for the comorbidity of psychiatric issues. Because visual symptoms such as lesions are not usually found when imaging MTBI, researchers depend on a great deal on histories of behavioral symptoms which are endemic of posttraumatic stress disorder and depression. In a study conducted in order to determine physical markers for neurological diagnoses of issues related to MTBI, high angular resolution diffusion imaging showed that white matter “whole-brain voxelwise analysis of crossing fibers provided separate partial volume fractions reflecting the integrity of primary fibers and secondary (crossing) fibers” (Morey et al, 2012, p. ). Losses to primary fibers in the white matter was specifically associated chronic mild TBI where distribution patterns of major fiber bundles and each smaller tracts in the peripheral, which included the corpus callosum and a number of other aspects correlated with MTBI that not with PTSD or depressants. However, impact related MTBI was associated with inflammatory and neurochemical events in the participants (p. 2986). Therefore there is some dispute whether or not comorbidity reflects a relationship between mild brain trauma and posttraumatic stress disorder. Discussion Most studies show that there is comorbidity between MTBI and PTSD. However, finding a causal relationship has yet to be proven. In a study conducted by Carlson et al (2011) where evidence was collected along studies published between 1980 and 2009 the outcome was that across 34 studies no accurate treatments or diagnosis was possible in terms of connecting MTBI and PTSD. The however, in the 5 to 7% of the veterans who returned from Iraq and Afghanistan reported both MTBI, there was a prevalence of PTSD in 33 to 39% of the cases. This suggests that there is a distinct possibility of discovering a connection between these two issues. The changes that have been observed in brain structure would indicate that some effect is likely to have occurred. The presence of more traumatic brain injury in the recent worse than reported in previous wars suggests that this issue is of great importance to soldiers returning home. The development of more concentrated blasts that occur more frequently has made this issue one of 21st century warfare more than any other time (Ling, 2013). While PTSD has been part of warfare throughout history, the development of PTSD as a condition of MTBI may either be a modern warfare manifestation or the development of signs of knowledge on the topic. Men who are returning home to face social normalcy after being in the theater of war often become either depressed or manifests PTSD. Delayed onset of PTSD is more common in soldiers than it is in civilians. In addition, stress disorder such as PTSD are becoming more commonly understood and recognize, leading to an understanding that these issues are far more prevalent than in soldiers returning from war. The resilience of the human mind to withstand the effects of stress has often shielded researchers from being able to draw conclusions, but emerging neuroscience research has capacity to begin to understand physical aspects of brain trauma and associated psychological effects (National Research Council (U.S.), 2009). Through continued research on this topic the potential for changing the nature of modern warfare exists in order to protect soldiers from the effects of mild brain trauma as well as PTSD. The study was limited in terms of scope and length which meant that conclusions cannot be drawn in terms of neurological studies without a much longer and more in-depth examination. Further research can be conducted on this topic based on the findings that report comorbidities exist between MTBI and PTSD. Understanding that neurological effects of blasts have an effect on psychiatric conditions can provide context for understanding the experiences of soldiers. Further research should be conducted examining the brain after mild brain trauma and the delayed emergence of PTSD. Conclusion Warfare is always going to have casualties. However, understanding the effects of a variety of different tactics is going to increase the ability of the military to protect their men from the hazards of war. The connection between posttraumatic stress disorder and mild shamanic brain injury has not clearly been established, but enough evidence exists to suggest that further inquiry might provide answers to the neurological questions concerning the comorbidity of these two effects. Developing a better understanding of the brain and the effects of mild brain trauma will help researchers to be able to better assess high frequencies of comorbidity between PTSD and mild brain trauma. Further research can be beneficial to the topic matter in terms of deeper neurological study as well as behavioral understanding of the effects that are experienced by soldiers when they come home. References Bryant, R. A., Castro, C. A., & Iverson, G. A. (2012). Implications for service delivery in the military. (235-250) In Vasterling, J. J., Bryant, R. A., & Keane, T. M. (Eds.) PTSD and mild traumatic brain injury. New York: Guilford Press. Carlson, K. F., Kehle, S. M., Meis, L. A., Greer, N., MacDonald, R., Rutks, I., & Wilt, T. J. (2011). Prevalence, assessment, and treatment of mild traumatic brain injury and posttraumatic stress disorder: A systematic review of the evidence. The Journal of head trauma rehabilitation, 26(2), 103-115. Carlson, K. F., Nelson, D., Orazem, R. J., Nugent, S., Cifu, D. X., & Sayer, N. A. (2010). Psychiatric diagnoses among Iraq and Afghanistan war veterans screened for deployment‐related traumatic brain injury. Journal of traumatic stress, 23(1), 17-24. Driscoll, P. P., Straus, C., & Armed Forces Foundation (U.S.). (2009). Hidden battles on unseen fronts: Stories of American soldiers with traumatic brain injury and PTSD. Drexel Hill, PA: Casemate. Lawhorne, S. C., & Philpott, D. (2010). Combat-related traumatic brain injury and PTSD: A resource and recovery guide. Lanham: Government Institutes. Ling, G. S., Hawley, J., Grimes, J., Macedonia, C., Hancock, J., Jaffee, M., ... & Ecklund, J. M. (2013, May). Traumatic brain injury in modern war. In SPIE Defense, Security, and Sensing (pp. 87230K-87230K). International Society for Optics and Photonics. Morey, R. A., Haswell, C. C., Selgrade, E. S., Massoglia, D., Liu, C., Weiner, J., & McCarthy, G. (2013). Effects of chronic mild traumatic brain injury on white matter integrity in Iraq and Afghanistan war veterans. Human brain mapping, 34(11), 2986-2999. National Research Council (U.S.). (2009). Opportunities in neuroscience for future army applications. Washington, D.C: National Academies Press. Peskind, E. R., Petrie, E. C., Cross, D. J., Pagulayan, K., McCraw, K., Hoff, D., & Minoshima, S. (2011). Cerebrocerebellar hypometabolism associated with repetitive blast exposure mild traumatic brain injury in 12 Iraq war Veterans with persistent post-concussive symptoms. Neuroimage, 54, S76-S82. Petrie, E. C., Cross, D. J., Yarnykh, V. L., Richards, T., Martin, N. M., Pagulayan, K., & Peskind, E. R. (2014). Neuroimaging, behavioral, and psychological sequelae of repetitive combined blast/impact mild traumatic brain injury in Iraq and Afghanistan war veterans. Journal of neurotrauma, 31(5), 425-436. Pham, N., Sawyer, T., Wang, Y., Rastgar Jazii, F., Vair, C., & Taghibiglou, C. (2014). Primary blast-induced traumatic brain injury in rats leads to increased prion protein in plasma: a potential biomarker for blast-induced traumatic brain injury. Journal of Neurotrauma. Polusny, M. A., Kehle, S. M., Nelson, N. W., Erbes, C. R., Arbisi, P. A., & Thuras, P. (2011). Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Archives of general psychiatry, 68(1), 79-89. Sayer, N. A. (2012). Traumatic Brain Injury and Its Neuropsychiatric Sequelae in War Veterans. Annual review of medicine, 63, 405-419. Taylor, B. C., Hagel, E. M., Carlson, K. F., Cifu, D. X., Cutting, A., Bidelspach, D. E., & Sayer, N. A. (2012). Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq War Veteran VA users. Medical care, 50(4), 342-346. Vasterling, J. J., Bryant, R. A., & Keane, T. M. (2012). PTSD and mild traumatic brain injury. New York: Guilford Press. Read More