Post Traumatic Stress Disorder vs Mild Traumatic Brain Injury - Coursework Example

The two disorders mostly experienced by victims of war or who had previously experienced traumatic events are post traumatic stress disorder and mildtraumatic brain injury. There has been confusion between the two disorders because they have similar symptoms. Additionally, studies show that a person having mild traumatic brain injury is likely to develop post traumatic stress disorder. The two disorders have had significant attention previously because of the increasing number of veterans and civilians experiencing the disorders. Veterans previously deployed in Afghanistan and Iraq have experienced traumatic events because of injuries sustained during the war. Trauma has two different meanings that can explain the disparity existing between Post traumatic stress disorders (PTSD) and mild traumatic brain injury (mTBI). Trauma can be explained as the physical injury of the brain or stressful emotions. Physical injury to the brain can cause traumatic brain injury while stressful events are the main cause of PTSD. However, research shows that the two disorders can occur simultaneously. For example, in warzones where soldiers engage in serious gunfights with the enemy, physical injuries are likely to occur. At the same time, the soldiers might become vulnerable and afraid. This means that both disorders are likely to occur. Despite the chances of the two disorders occurring at the same time, they both have different clinical features. Nevertheless, research shows that one of the disorders is likely to increase the chances of another disease occurring. For example, it has been noted that mild traumatic brain injury increases the chance of development of post traumatic stress disorder (Pitman, 2010). Traumatic brain injury mainly occurs when the brain is damaged by an external force. There are different injuries that can contribute to brain injuries. Some of them are brain lacerations, intracranial hematoma, contusion, hypoxia, intracranial hypertension, hydrocephalus, and metabolic anomalies. The description of TBI is based on the mode of the disorder such as mild, moderate or severe. There are various aspects that can give a clear definition of mild traumatic brain disorder. It can be defined as a brain damage caused by an external force, loss of conciseness for less or half an hour, confusion or disorientation. Secondly, the disorders can be defined on the Glasgow scale as ranging from 13 to 15. Thirdly it can be defined as post-traumatic amnesia that can happen for less than 24 hours (Ribbers, 2010). PTSD is described according to the time the trauma is likely to occur. According to Bryant (2011), the difference between immediate and longer post traumatic stress disorder is quite significant. This is because severe stress reactions occur most of the time in many patients but for a shorter time. Therefore, there is a need to differentiate from less relenting PTSD. The main definition of PTSD is based on the American Psychiatric Associations DSM-IV. The definition provided by the DSM-IV indicates that the disorder has five significant conditions. According to DSM-IV, the disorder is likely to occur on exposure of a person to a traumatic event, when a person responds to horrific event that makehim or her vulnerable. Secondly, one must show that he or she is experiencing continuous symptoms such as nightmares, disturbing memories and traumatic events when the victim is reminded of the painful incident. The third description is avoidance symptoms such as feelings, traumatic events, avoidance of other people, or emotional signs. The fourth description is that the person with the disorder must present signs such as marked hyper arousal, insomnia, lack of concentration, starlet response, hyper vigilance and irritability. PTSD is diagnosed at most after 1 month of the traumatic event. However, between the time of the shocking event and the diagnosis of PTSD, there is acute stress disorder. Acute dress disorder is describing the initial stage of trauma. Additionally, it was availed to fill the gap between the initial occurrence of trauma and PTSD. Traumatic Brain Injury and Mild Traumatic Brain Injury Mild traumatic disorder can be described as a concussion because it is not the same as brain injury that might have been caused by anything that has penetrated to the brain. The disorder happens when there is a hard blow to the brain that can causes the brain to shake. In combat zones, this is common when there is a blast or blow from IED explosions. Mild traumatic brain injury does not show any physical injuries, but it can interfere with the brain’s functions. Loss of consciousness, loss of memory for a short time and confusion are common signs of mild traumatic disorder. At times, mild traumatic stress disorder may not shows signs of loss of consciousness. However, there are times at which the symptoms vary from one person to another. Symptoms may take several minutes, days, weeks, months or more than that. Stoler (1998) explains that snapping of the brain rapidly makes it move in different directions. This movement ends up tearing the nerve cells on the brain, therefore brain injuries are likely to occur. As explained above, the symptoms can take more or less time. According to Stoler (1998), brain functionalities can be interrupted for a short time hence difficulties that had been caused disappear after a short time probably a week. This is because the brain and nerve cells heals or form new pathways replacing the damaged cells. The author explains further that the healing process happen only in a small percentage on individuals. Approximately 60% of individuals will still have problems of mild traumatic disorder three months after the accident that caused the disorder. Brain injuries cause traumatic brain injury. However, it depends on the result of the force applied or force of impact. The nature of TBI is determined by the speed and type of force on the brain. Additionally, intracranial haemorrhag, hypotension, and hypoxemia are other difficulties that determine the nature of TBI and the time at which the disorder is likely to occur. This is because the complications mentioned above are likely to prolong the trauma to hours or days after the injury. The level of consciousness and neurologic functionalities are the determinants of the level of TBI. Hence the disorder is regarded as a mild, moderate or severe TBI. The classification is performed using the Glasgow Coma Scale (GCS). The level of the disorder is shown by Glasgow Coma Scale (GCS) is between 3 and 15 of the EMV score. It is referred as the EMV because the analysis is done on an eye opening represented by E, motor response represented by M, and the verbal response represented V. Based on the Glasgow Coma Scale, mild traumatic brain disorder shows GCS of 13-15, moderate shows 9-12, while severe TBI shows 3-8 of GCS. The classification of traumatic brain disorder (TBI) within the three levels; mild, moderate and severe can also be done by evaluating the extent of loss of consciousness. For example, loss of consciousness for close to 30 minutes shows that an individual has mild traumatic brain injury, more than 30 minutes to 24 hours is considered as moderate TBI. While severe TBI, can go on for more than 24 hours. However, the extent of post traumatic amnesia can also determine the level of TBI. Post traumatic amnesia for a day is considered as mild traumatic brain injury (Frey et al., 2007). Prevalence Traumatic brain injuries are the main sources of deaths in the warzones especially places such as Iraq, Vietnam, and Afghanistan. Explosions or blast in the warzones are the main causes of the brain injuries. There have been difficulties in the determination of the prevalence rate of TBI among the veterans of war. Different aspects that have lead to difficulties in the determination of prevalence rate. Estimation of the rate of TBI among the veterans is not reliable because some cases are reported biased. This has been a significant problem during the developmental stages of the disorder or at a mild level. Because, the victim will not get medical attention or the problem will not be recognized. The secondly, analysis of the level of the disorder has been different. Lastly, the study of the TBI has been done with the help of the available statistics of the disorder leaving other information because of different geographical locations of combat zones. However, prevalence rate of TBI is high among the individuals that have sustained injuries during explosions or fire tragedies. This is because such incidents are documented. Despite the fact that there have been difficulties in the estimation of a number of TBI victims among the veterans, research shows that the veterans that have shown positive results of TBI are more likely to develop post traumatic stress disorder (Vasterling et al., 2012). Warden (2006) explains that the rate of TBI among the female veterans is high in comparison with the female civilians. In war time, the rate of TBI among the soldier is high based on the fact there are high cases of injuries among the soldiers. The author argues that the rate of TBI is high in the current wars as compared to wars that were fought previously. However, the rate of mortality has decreased in the current wars. There are several factors that have determined the high rate of TBI in the current wars and the low mortality rates. According to the author, improvement of technology is one of the factors that determine the prevailing rate of TBI. The military personnel have advanced body armour that has made it difficult for them to sustain bullet or blast injuries that can kill them. However, they can still sustain injuries on their head and necks. Another factor is the increase in the number of explosions or blasts in the warzone; this is attributed to the high number of IEDs that military personnel encounter. According to Warden (2006), approximately 88 percent of the reported injuries during the war are contributed highly by blast. Additionally, the author points out that, two thirds of the evacuations during the war are caused by blast or explosions. Arciniegas et al. (2005) points out that approximately 1.1 million people in USA experience TBI, among this number, it is estimated that close to 235000 people experience serious TBI that require medical attention while others are treated and released from hospitals. Post concussive symptoms There is a difference between post concussive symptoms and mild traumatic brain injury. Clinical referents of mild traumatic brain injury are not the same with post concussive symptoms. However, mild traumatic brain injury gives the descriptions of brain injury while the post concussive symptoms is a description of difficulties faced by patients of mild traumatic brain injury. Post concussive symptoms are developed by persons that had previously experienced mild traumatic brain injury and it is described by the following symptoms; dizziness, fatigue, headaches, poor attention cognitive and other physical symptoms (Vasterling et al., 2012). Arciniegas et al. (2005) shows that post concussive symptoms are developed after the traumatic brain injury of any level such as mild, moderate, or severe TBI. Post concussive symptoms developed from TBI are categorised into three groups; they are cognitive, physical and emotional symptoms. Description of post concussive symptoms is quite problematic because most of the causes are similar with the causes of PTSD. Most of the individuals reporting cases of post concussive symptoms do not complain of difficulties similar to patients with brain injury. Research shows that individuals involved in court cases have shown common signs of post concussive symptoms. However, they approximately 50% of them have no background cases of trauma or head injuries. Post traumatic stress disorder According to Sbordone et al. (2005), post traumatic stress disorder develops when an individual is exposed to traumatic or physical events such as wars, disastrous events, floods, massacre, and other painful incidents. According to the Diagnostic and Statistical Manual and Mental Disorders fourth edition (DSM-IV), an individual diagnosed with PTSD must have encountered an event that might have threatened her life, caused serious injury, or threatened his or her integrity or integrity of other people. Which in the end it threatens a person’s feelings, terrorises or leaving them in a vulnerable situation. Vasterling et al. (2009), explains that diagnosis of PTSD is based on Diagnostic and Statistical Manual for Mental Disorders, 4th Edition (DSM-IV-TR). The manual shows that a person must have been exposed to events mentioned above. Additionally, the symptoms on a person must have been there for close to one month and must have caused emotional distress or interfere with memory functions. Sbordone et al. (2005), explains that development of PTSD for close to one month after exposure to a traumatic event is regarded as acute PTSD. However, according to DSM-IV acute PTSD is regarded as Acute Stress Disorder. Research shows that, close to 40% of the individuals that have previously been diagnosed of acute PTSD do not develop chronic PTSD. Definition of PTSD has changed for since 1980 because of changes made on the DSM by American psychiatric association. Consider the definition of presented on the DSM-III, it states that PTSD is when a person is exposed to a traumatic event beyond the range of human experience for example rape, combat and natural disasters. However, the definitions presented on the DSM-III do not include the common stressful events such as divorce, financial meltdown or sickness. DSM-IV was revised to show that an individual develops PTSD when confronted, experienced or witnessed an event that is life-threatening. Prevalence (war) Epidemiological study of PTSD shows that close to half of the American adults have been exposed to traumatic events. Research shows that the number of men and women exposed to traumatic events, one in ten women and one in twenty men develop PTSD. Traumatic events reported shows that 36% men and 14.5% of women have witnessed traumatic events such as deaths or severe injuries. Others have been in life threatening situation, approximately 25 % of men and 14 % of women. The above situations are the most prevailing traumatic events that contribute highly to PTSD. However, other traumatic events less prevalent but an individual who had suffered such trauma is at greater risk of developing PTSD. For example, rape, child abuse, and battering (Bryant 2011). Prevalence rate PTSD among the veterans and the military personnel has been high. However, the statistic presented for study has not been uniform. This is because of inconsistency of sampling, disparity in measurement, and biases in presentation or reporting of figures relating to PTSD. Study on the US veterans and military personnel show that the prevalence rate ranges from 2% to 17%. However, their lifetime prevalence rate ranges from 6% to 31%. The study of wars that US military has engaged such as Vietnam, Gulf War and the recent Iraq and Afghanistan war shows different prevalence rate. Vietnam War reported 2.2% to 15.2%, the analysis on the Gulf war showed a prevalence rate of 1.9% to 13.2% while the Iraq and Afghanistan show a prevalence rate of 4% to 17.1% (Richardson et al. 2010). Comparison of prevalence rate of veterans and the US civilians shows that, the prevalence rate among the veterans is high than the civilians. According to Richardson et al. (2010), samples conducted on US adults showed that the prevalence rate ranges from 5% to 6%. However, the lifetime prevalence rate if approximately 7.8%. Study of the prevalence in other countries apart from US shows a low percentage. For example, survey conducted by Canadian clinic showed that the prevalence rate among the Canadian forces was 2.7%. However, there lifetime prevalence rate of PTSD is estimated at 7.2%. Study on the Australian Defence Forces shows that the prevalence rate among the Vietnam veterans is 21%. However, the current prevalence rate is at 12% among the Vietnam veterans. Study conducted on 53% of the UK veterans that had served in the Iraq war showed that only 2.5% had post traumatic stress disorders. However, study of US and UK veterans using the same measures shows that 2.5% to 6% UK veterans had symptoms of PTSD. Conversely, analysis of the US veterans shows that 17.1% had PTSD. The difference is attributed to the duration of military personnel in the warzones, the nature of combat, and the frequency of war (Richardson et al. 2010). Symptoms (DSM-V) The definition presented on DSV-V states that development of PTSD occurs when an individual is exposed to life threatening situation such as death, must have suffered or witnessed serious injuries, and exposed to sexual violence or threatened with such a situation. However, according to DSM-V, exposure to situations mentioned above can be either directly or indirectly. Indirectly exposure is where individual witnesses traumatic event. Symptoms such as re-experience or intrusive symptoms are common in patients with PTSD. According to the research, intrusive symptoms are where an individual fails to regulate disturbing traumatic events. Additionally, person has no ability to other psychological or emotional responses to previous traumatic events. Another symptom presented on the DSM-V states that an individual tries as much as possible to avoid previous traumatic situations, places, people, or situations. Change of cognition or mood negatively after a traumatic event is another symptom common in PTSD patients. For example, a person will have difficulties in recalling previous traumatic event. Change in mood or cognition can start after a traumatic event or begin to worsen after traumatic event. An individual might start blaming others or self because of a traumatic event that resulted to changes he or she is experiencing (Vasterling et al. 2009). Post traumatic stress disorder and its relationship with Mild TBI and Post Concussive There has been disagreement previously that there is a relationship between post traumatic stress disorder and mild traumatic brain injury. The argument presented is based on the fact that impaired conciseness prevented the development of traumatic experience hence averted the common traumatic memories of PTSD. However, recent research shows that post traumatic stress disorder can develop after severe TBI. There is a close relationship between post concussive symptoms, MTBI, and PTSD. According to the research, post concussive symptoms are evident in a patient with MTBI and PTSD. However, it is not common in patients without PTSD but having MTBI (Sbordone et al. 2007). Study on Iraq and Afghanistan veterans that had served on Operation Enduring Freedom and Operation Iraqi Freedom showed that approximately 42% had both mild traumatic brain injury and PTSD. US veterans from both countries that had been diagnosed previously with MTBI had developed PTSD. Furthermore, close to 43.9% of US soldiers had experience loss of consciousness was regarded as PTSD patients. Analysis of the two disorders among the veterans shows that post concussive symptoms are diagnosed commonly on patients with PTSD as compared to patients with mild traumatic brain injury which had less post concussive symptoms. Additionally, study has been conducted on that have experience motor vehicle accident and it was concluded that there is a close relationship between PTSD, TBI and acute stress disorder. The three disorders coexist in times of consciousness. PTSD has been diagnosed on patients with moderate and severe TBI (Vasterling et al. 2009). Symptoms Research conducted on children with mild traumatic brain disorder shows that recover successfully. However, they would still have post concussive symptoms. The common post concussive symptoms are emotional, cognitive and somatic and they can be identified by symptoms such as poor concentration, headaches, anxiety, and lack of sleep. Additionally, research conducted on children with mild traumatic brain injury shows that they experience symptoms of PTSD such as, recall of traumatic events, increase provocation, and avoidance of traumatic places (Hajek 2010). Similarities PTSD and mild traumatic brain injury symptoms of tend to overlap making it difficult to diagnose the right disorder for treatment. Symptoms such as sleep disturbances are common on individuals with either PTSD or mild traumatic brain injury. Other similar symptoms include poor concentration, memory disturbance, irritability, avoidance or antisocial behaviour and depression. In addition, the study above shows that individual with mild traumatic brain injury are likely to be diagnosed with post traumatic stress disorder when compared to people who do not have a brain injury. Furthermore, it has been noted from the study that the two disorders are common in combat zones or veterans have high chances of developing the disorder. Chances are high that cognitive impairment caused by brain damage or TBI lead to PTSD. This is because the individual fails to manage effects of psychological trauma (Hoffman et al. 2012). Differences Despite the similarities presented above between post traumatic stress disorder and mild traumatic brain injury, research shows that the disparity exists mostly in the course of recovery. Research indicates that the neuropsychological problem relating to mild traumatic brain injury tend to recover after a short time of the injury. However, symptoms and neuropsychological problems relating to PTSD are noted for a longer period mainly more than a year after trauma. There is also another difference that has been noted, individuals with PTSD have difficulties in recalling traumatic events but their memory are intact and have the ability to learn. Conversely, mild traumatic brain injury individuals have preserved memories relating to previous events, but they have problems in keeping new memories (Bryant 2011) Conclusion From the study, it is evident that the prevalence rate of post traumatic stress disorder analysis differs in most countries. This has been attributed to differences in sampling strategies, DSM criterion strategies, the nature of combat, duration in combat zones and other related features. This explains the difference of prevalence rate of PTSD that has been noted between US and UK veterans. Furthermore, the study has shown that the prevalence rate of mild traumatic brain injury and post traumatic stress disorder are high in combat zones currently as compared to previous decades. This is because of the development of armour that reduces mortality rate. However, head and neck injuries are still high increasing development of mild traumatic brain injury. The study has also shown that there has been confusion between mild traumatic brain injury and post traumatic stress disorder. The uncertainty of the two disorders has led to poor recovery of the patient because of wrong diagnosis brought in by similarity of symptoms. However, some features have been discovered that help in differentiating between the two disorders. The study points out that the recovery stages between the two disorders differ. Additionally, post traumatic stress disorder is recurrent. This means that it can disappear or appear again after sometimes. Conversely, symptoms of mild traumatic brain injury appear for a short period after the trauma. Additionally, the study shows that veterans or any other individual with MTBI are likely to develop PTSD. References Arciniegas, D. B., Anderson, C. A. and McAllister, T. W. (2005). Mild Traumatic Brain Injury: A Neuropsychiatric Approach to Diagnosis, Evaluation and Treatment. Neuropsychiatric Disease and Treatment, Vol. 1(14). Pp. 311-327. Bryant, R. (2011). Post-Traumatic Stress Disorder vs. Traumatic Brain Injury. Dialogues in Clinical Neuroscience, Vol. 13 (3). Pp. 251-262. Frey KL, Rojas DC, Anderson CA. and Arciniegas, DB. 2007. Comparison of the O-Log and GOAT as Measures of Posttraumatic Amnesia. Brain Injury, Vol. 21(5). Pp. 513-20. Hajek, C. A., Yeates, K. O. and Wright, M. (2010). Relationships among Post-Concussive Symptoms and Symptoms of PTSD in Children Following Mild Traumatic Brain Injury. Brain Injury, Vol. 24(2). Pp. 100-109. Hoffman, J. M., Dikmen, S., Temkin, N. and Bell, K. R. (2012). Development of Posttraumatic Stress Disorder after Mild Traumatic Brain Injury, Arch. Phys. Med. Rehabil., Vol. 93. Pp 287-292. Pitman, R. K. (2010). Post Traumatic Stress Disorder Verses Traumatic Brain Injury. The American Academy of Physical Medicine and Rehabilitation, Vol. 2. Pp. 1051-1054. Ribbers, G. M. (2010). Brain Injury: Long Term Outcome after Traumatic Brain Injury. In: JH Stone, M Blouin, editors. International Encyclopedia of Rehabilitation. Retrieved from Richardson, L. K., Frueh, B., & Acierno, R. (2010). Prevalence estimates of combat-related post-traumatic stress disorder: critical review. Australian & New Zealand Journal Of Psychiatry, 44(1), 4-19. doi:10.3109/00048670903393597 Sbordone, R. J., Saul, R. E. and Purisch, A. D. (2007), Neuropsychology for Psychologists, Health Care Professionals, and Attorneys, Third Edition, USA: CRC Press. Stoler, D. R. (1998), Coping with Mild Traumatic Brain Injury, USA: Penguin. Vasterling, J. J., Bryant, R. A. and Keane,T. M. (2012), PTSD and Mild Traumatic Brain Injury, USA: Guilford Press. Vasterling, J. J., Verfaellie, M. and Sullivan, K. D. (2009), Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience, Clinical Psychology Review, 29: 674–684. Warden, W. (2006). Military TBI During the Iraq and Afghanistan Wars. J Head Trauma Rehabtl, 21(25), 398-402. Read More