Posttraumatic Stress Disorder in Wartime Veterans - Coursework Example

Posttraumatic Stress Disorder in Wartime Veterans al affiliation Objective: To determine prevalence of Posttraumatic Stress Disorder (PTSD) among wartime veterans and the disorder prognosis, treatment, medication and how to prevent the disorder. Conclusions: PTSD has been diagnosed among war veterans. It has been established that the prevalence is quite high therefore impacting on the quality of life of the individuals and their families negatively. Preventive measures can be taken to avoid development of PTSD. Treatment can also be administered to the patients. Social work has also proven to be important in effective treatment of PTSD. Further studies are needed to improve the current treatment of PTSD. Keywords: Posttraumatic Stress Disorder, treatment, diagnosis, social work Introduction Post-traumatic stress disorder (PTSD) is a severe nervousness disorder that can occur among people exposed to a traumatic event involving threatened death, serious injury, who responds with intense terror, defenselessness or dismay especially among wartime veterans. Symptoms include, unpleasant thoughts, feeling of unresponsiveness, being socially separated from family and friends and hyper-vigilance or avoiding situations that may remind the person of the trauma (Coughlin, 2014). Most research shows that deployment off to Iraq and Afghanistan is consistently associated with higher rates of mental health problems in general, specifically PTSD. Deployments are also associated with increased risk for reports of post-deployment somatic complaints. The disorder is significant and expensive to veterans, their families and society as a whole (Richardson, 2010). Incidence A study was done on a group of infantry soldiers at 3 to 12 month time periods after their deployment to establish prevalence rates of depression. The results indicated that the prevalence rates for PSTD and depression after returning from combat, depending on the reported level of functional weakness, was quite high. It ranged from 9% to 31%. After deployment, it is necessary to perform inclusive screening among wartime veterans who indulge in alcohol misuse and violence. Persistent effects of war zone service are demonstrated through elevated prevalence rates at twelve months compared to at three months and provide important information to monitor post deployment care (Thomas, et al., 2010). The rate of prevalence of PTSD related to combat in US military veterans since the Vietnam War approximately ranged from 2% to 17%. Among US Iraq War veterans, studies suggest that PTSD related to combat afflicts are between 4% and 17% of recent conflicts. However, only 3 to 6% of returning UK Iraq war veterans are affected by PTSD. Therefore, the prevalence is less among non-US Western nation’s combat veterans. Differences in DSM-IV measurement, strategies for measurement, strategies for sampling, inclusion, timing and impairment in the criteria that is clinically significant, and latency of assessment, bias and experiences during combat are the likely cause of variation in prevalence. PTSD course, chronicity and comorbidity, symptom overlap with psychiatric disorders, socio-political and cultural factors that may differ over time and nation issues may affect prevalence (Richardson, 2010). Etiology Development of PTSD after serious injury may be related to age, gender, other injury like brain injury and clinical characteristics. Elevation of symptoms and diagnosis of post-traumatic stress disorder after deployment may be increased significantly by low mental and physical status during pre-combat exposure. New onset post-traumatic stress disorder can target and help identify the most vulnerable who can benefit from intervention (LeardMann, Smith, Smith, Wells, & Ryan, 2009). Immediate onset and delayed onset PTSD had the same number and type of symptoms which were reported at the beginning. The delayed group differed since they showed progressive accumulation of symptoms that began earlier and continued throughout the military career. Prior to PTSD onset, this group was more likely to report depression and alcohol abuse. They were also more likely to report shame, dissociation and peri-traumatic dissociation. Both the immediate and delayed onset of PTSD groups described same amounts of trauma exposure. Veterans with delayed onsets were more likely than veterans with no PTSD to report the presence of severe, life stressor in the year before the onset. Therefore, the results indicate that delayed onsets experience a high sensitivity to the general stress and a slow, gradual failure to adapt to stress exposure that is continuous (Andrews, Brewin, Stewart, Rosanna, & Hejdenberg, 2009). Treatment Psychological treatments that are trauma focused are more effective in PTSD. This means that treatments that do not focus on the patients’ trauma memories are usually less effective. International treatment guidelines therefore recommend trauma focused psychological treatments as first-line PTSD. Both pharmacotherapy and psychotherapies are current treatments for PTSD. Diverse drugs are used to treat symptoms of PTSD, however the efficiency is limited. Selective serotonin reuptake inhibitors (SSRIs) that are sertraline and paroxetine are the only medications used for indication by FOOD and Drug Administration (FDA). The most extensively recognized methods of psychotherapy for PTSD are cognitive behavior therapy, psychodynamic psychotherapy and Eye Movement Desensitization and Processing (EMDR), (Mithoefer, Wagner, Mithoefer, Jerome, & Doblin, 2011). Eye movement desensitization and reprocessing (EMDR) EMDR is one of the most worthwhile psychological treatments for PTSD. The most disturbing images of the shocking event are identified and processed successively during EMDR therapy. The patient is constantly asked to trail the therapist’s finger making saccadic movements in adjustment to the patient’s connotation after the patient has focused on images with the analogous destructive perception to locate the stressful emotion and bodily location of the emotion. Contemporary distress is assessed every 5 to 10 minutes until the distress level has diminished to 0 or 1, after which a more affirmative cognition is introduced in relation to the target image. This process is repeated for distressing images and treatment sessions are stopped when the trauma recollection feels impartial. Auditory bilateral stimulation can be used if problems with eye movements are encountered (Nijdam, Gersons, Reitsma, Jongh, & Miranda, 2012). Stress management psychodynamic treatments Stress inoculation treatment now used in the treatment of PSTD has been previously used for rape victims. The package includes relaxing muscles, retraining the breathing; self-dialogue that is guided and stopping the thoughts to reduce worry as well as playing the specific role, concealed modeling and graduated in vivo exposure to address avoidance often related to anxiety and PTSD symptoms. Exposure therapy, cognitive therapy and their combination are more superior to these therapies (Cloitre, 2009). Hypnotherapy Clinical reports and observations dating back to two decades indicate that treatment of PTSD can be effectively treated by hypnotherapy. Hypnotherapy may contribute to positive treatment outcome and speed up the formation of a therapeutic coalition. Hypnotic techniques would be important in patients who experience anxiety, sleep disturbances, dissociation, and widespread somatoform pain complaints. Hypnotic techniques may also enable the evasion of working through experiences that were traumatic, elevating coping skills and promoting competency (Abramowitz & Bonne, 2013). Cognitive behavioral treatment (CBT) A broad cognitive model of PTSD has a substantial explanatory value, providing a clear explanation for the presence of sensory and visual re-experiencing symptoms which are often experienced as memory fragments. The model shows association and efficient outcomes of the regularly observed relationships among event stimuli, fear experienced by the subjects and behavioral routines that are related to trauma (Cloitre, 2009). CBT has been proven to be efficient to prevent and treat traumatic stress symptoms beginning within three months of a traumatic event, irrespective of the diagnosis. Previous research indicates that PSTD is increased in wartime veterans particularly women. CBT is an affirmative supportive intervention for the treatment of PSTD. It is viable to implement an extended exposure through a variety of clinical settings (Roberts, Kitchiner, Justin, & Bisson, 2009). PTSD has been reported to be treated via the internet. Therapist support through online treatment can be done with a Diagnostic and Statistical Manual of Mental Disorder clinical diagnosis of PTSD via email. Treatment measures before and after PSTD and related symptomatology were compared with a variety of traumatic experiences. There were significant reductions in PTSD severity and symptomatology, the program content displayed moderate tolerance and therapeutic alliance ratings were high. Internet-based therapist assisted cognitive behavioral treatment for PTSD has proven to be effective and accessible clinical treatment for people with a confirmed PTSD diagnosis (Klein, et al., 2009). Prognosis A study done on 218 female veterans and soldiers with PTSD who participated in a randomized clinical trial of treatment for PTSD to examine the impact of treatment on work related quality of life outcomes and the relationship between clinically significant alteration during treatment and work related outcomes. It was concluded that present-centered therapy in a randomized clinical trial was less effective than prolonged exposure in PTSD symptom outcomes. However, it did not result in better work related quality of life outcomes. The improvement in occupational impairment associated with loss of diagnosis suggests the importance of continuing treatment until clinically meaningful change has been attained. Exposure therapy is effective in the treatment of PTSD despite the fact that most patients do not benefit from the treatment and therefore it is not effective (Schnurr & Lunney, 2012). Medication Non-drug therapy is regarded as a first line option for PTSD and should be routinely incorporated into management plans for patients with PTSD. However, some patients do not achieve a sufficient response to non-drug therapy or are left with disabling residual symptoms in one or more areas. Antidepressants are currently the preferred medication for PTSD, with the most substantial evidence available to support the use of selective serotonin reuptake inhibitors. Many patients with PTSD have symptoms that are resistant to initial drug treatment, meaning that it is often necessary to explore additional pharmacotherapy options such as antipsychotics, anti-adrenergic drugs, anxiolytics and anticonvulsants are the treatments for PSTD (Alderman, McCarthy, & Marwood, 2009). Methylenedioxymethamphetamine (MDMA) Methylenedioxymethamphetamine (MDMA) is a ring substituted phenylisopropylamine derivative with an exclusive outline of psychopharmacological effects. MDMA was patented in 1914 by the German chemical and pharmaceutical company Merk kGaA as an intermediate compound in the synthesis of other drugs. MDMA has been reported to diminish fear while maintaining alertness. In recent times, clinical trials have demonstrated that MDMA induces a 2 to 4 hour experience typically characterized by euphoria, increased well-being, sociability, self-confidence and extroversion. MDMA can be administered without damage to the health of the pre-screened subjects (Mithoefer, Wagner, Mithoefer, Jerome, & Doblin, 2011). However, side effects that usually occur within 7 days of MDMA include; tightness of the jaw, nausea, loss of appetite, feeling cold, dizziness, and impaired balance. Other side effects include, fatigue, headache, anxiety and low mood (Mithoefer, Wagner, Mithoefer, Jerome, & Doblin, 2011). MDMA should be administered in a clinical setting with minimal risk to patients may become dependent on the drug. The therapeutic setting and close follow up should be essential components of the treatment (Mitheofer, et al., 2012). Propranolol In addition to MDMA, propranolol has been proven to alleviate PTSD symptoms and in turn prevent the development of PTSD. Propranolol is a synthetic β-adrenergic receptor blocker that crosses the blood brain barrier and has both peripheral noradrenergic effects and central inhibitory effects on protein synthesis. Protein synthesis is necessary to associate new memories and protein synthesis inhibitor could interfere with the process. Side effects include light-headedness, nausea, weakness, fatigue, hypotension, bradycardia, congestive heart failure and vomiting. In addition, propranolol has also been proven to lower blood pressure (de Kleine, Rothbaum, & van Minnen, 2013). D-Cycloserine (DCS) Loss of fear has been linked to N-methyl-D-aspartate glutamatergic receptor activity in the basolateral amygdala. Using DCS in post exposure therapy for PSTD leads to decline of symptoms over time. DCS is orally taken and usually well tolerated by patients. Side effects only occur when administered in high dosages. These include convulsions, drowsiness, headache and tremor. Cardiovascular problems, allergy and skin rash have also been reported. Morphine Use of morphine in trauma care may be protective against the consequent development of PTSD after serious injury. The use of morphine has been associated with reduced risk of PTSD in injury personnel. The use of morphine during initial resuscitation and trauma care has been considerably associated with lower risk of PTSD after injury (Holbrook, Galarneau, Dye, Quinn, & Dougherty, 2010). Diagnosis Preliminary examination of the effectiveness of prolonged exposure therapy for the treatment of posttraumatic stress disorder with veterans from Iraq and Afghanistan could be done through clinical or diagnostic interview, neuropsychological and neuro - imaging evaluation. Impact of Event Scale is a self-report questionnaire that is also used for diagnosis. Psychological indices are used to identify and categorize cases of PTSD on basis of audio, audio-visual and imagery-based indications (Wolf, Strom, Kehle, & Eftekhari, 2012). A person may be diagnosed with PTSD if the individual has experienced a real or imaged event that is physically threatening to him and induced terror, vulnerability or shock. The person experiences symptoms related to re-experiencing the traumatic event such as disturbing memories, thoughts and nightmares. A PTSD patient tends to avoid thoughts, feelings and triggers that would remind them of the trauma. The person also describes symptoms of hyper-arousal such as insomnia, hyper vigilance and exaggerated scared response. Finally, these symptoms should have continued at least one moth post exposure to the traumatic event (Campbell, Greenberg, & Weil, 2012). A clinical interview The PTSD Checklist (PCL) has been the most often used measure of PTSD symptoms for self-evaluation. Findings indicate that PCL has numerous strengths as a PTSD screening test. It is a useful tool, especially when followed by a complimentary diagnostic test such as a standardized interview. However, the PCL’s diagnostic accuracy is affected by the spectrum and bias. The Structured Clinical Interview for DSM-IV (SCID) has been used to establish diagnosis of PTSD and other disorders related to anxiety. Patient Health Questionnaire (PHQ) is used to measure somatic symptoms, anxiety and depression. Functional impairment was measured by the Medical Outcomes Study Short-Form General Health Survey (SF-20), (Lowe, et al., 2011). Neuropsychological and neuro - imaging evaluation Neuropsychology approaches are vital in identifying weaknesses and resiliency factors relating to the development and maintenance of the PTSD symptoms post-exposure trauma. Indeed, use of neuro - imaging and neuropsychological test results can aid in diagnosis and planning of treatment, especially those with moderate to severe PSTD. The exploration of systems and compensatory recruitment can be done through neuro - imaging techniques. However, further work is needed to identify objective biomarkers to facilitate the process of diagnosis among those with one or both of these conditions (Brenner, 2011). Applicability to Social Work Practice Social support has proven to be effective in treating PTSD. Social work has an important role of the interdisciplinary team who promotes rehabilitation and community reentry for Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) (Speziale, Kulbago, & Menter, 2010). Mental illness recovery is described by recovery research as a complex individual process. Social relationships have emerged to be important in all dimensions contributing to recovery. It is important that social workers are knowledgeable about current literature on how to serve wartime veterans with PTSD. Findings indicate that assessments, social support and depression symptoms should be assessed in addition to trauma symptoms following traumatic events. It is useful that war time veterans have adequate social support. Future research should also develop trauma specific measures of social support. Critical evaluation of literature All titles were helpful and were able to outline the content in their respective journals. This made it easier and possible to link the information from the journal articles to the topic of this research paper in reference to PTSD and wartime veterans. For example, Prevalence estimates of combat-related post-traumatic stress disorders: critical review. The level of education of most authors was indicated with most having a PhD level of education. It gave an indication that the writers had the ability to carry out a valid research. This confirms that the articles were written with expertise. This formed the basis of this research paper to be high standard. The articles gave a handy summary of the content with indications of aims, methods, results and the importance of the study. It made it easier to identify relevant information from the articles without reading the entire journals. They also fully indicated how well the studies were conducted. All the sources cited in the journals used in this research paper were peer reviewed. The articles clearly indicated where they were published, and gave clues to its potential value that was necessary for this research paper. The journal articles had the research question stated clearly in the introduction. The research aims were described clearly in most articles. The theoretical issues and the hypothesis should be introduced. Most articles clearly stated why the research was done. The current state of knowledge about the research topic was also included, in addition to an indication of the gaps in knowledge which the current study hoped to fill. The methods used were also clear and concise, giving detail that was sufficient to this research paper. The study design and data collection methods were clearly outlined. In most of them, participants were involved. All the relevant results were included. The literature related findings in the discussion in aim of the research as it was outlined in the introduction. It was possible to examine, interpret and qualify the results and draw inferences from them. In general, the existing literature highlighted current knowledge that would be important in the current research. The references were up to date, and based on wide and thorough a search of sources. The researchers were unbiased and also presented ideas which contradicted their own. Conclusion PTSD has been diagnosed among war veterans. It has been established that the prevalence is quite high therefore impacting on the quality of life of the individuals and their families negatively. Preventive measures can be taken to avoid development of PTSD. Treatment can also be administered to the patients. Social work has also proven to be important in effective treatment of PTSD. Further studies are needed to improve the current treatment of PTSD. References Abramowitz, E. G., & Bonne, O. (2013). Use of hypnosis in the treatment of combat post traumatic stress disorder. Harefuah, 490-497. Alderman, C. 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A., Rothbaum, B. O., & van Minnen, A. (2013). Pharmacological enhancement of exposure-based treatment in PTSD: a qualitative review. European Journal of Psychotraumatol, 26-32. Holbrook, T. L., Galarneau, M. R., Dye, J. L., Quinn, K., & Dougherty, A. L. (2010). Morphine use after combat injury in Iraq and post-traumatic stress disorder. The New England Journal of Medicine, 110-117. Klein, B., Mitchell, J., Gilson, K., Shandley, K., Austin, D., Kiropoulos, L., . . . Cannard, G. (2009). A Therapist‐Assisted Internet‐Based CBT Intervention for Posttraumatic Stress Disorder: Preliminary Results. Cognitive Behavior Therapy, 121-131. LeardMann, C. A., Smith, T. C., Smith, B., Wells, T. S., & Ryan, M. A. (2009). Baseline self reported functional health and vulnerabiltiy to post-traumatic stress disorder after combat deployment: prospective US military cohort study. British Medical Journal, 25-29. Lowe, B., Kroenke, K., Spitzer, R. L., Williams, J. B., Mussell, M., Rose, M., . . . Spitzer, C. (2011). Trauma exposure and posttraumatic stress disorder in primary care patients: cross-sectional criterion standard study. The Journal of Clinical Psychiatry, 304-312. Mitheofer, M. C., Wagner, M. T., Mithoefer, A. T., Jerome, L., Martin, S. F., Yazar-Klosinski, B., . . . Doblin, R. (2012). Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. Journal of Psychopharmacology, 28-38. Mithoefer, M. C., Wagner, M. T., Mithoefer, A. T., Jerome, L., & Doblin, R. (2011). The safety and efficancy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study . Journal of Psychopharmacology, 439-452. Nijdam, M. J., Gersons, B. P., Reitsma, J. B., Jongh, A. d., & Miranda, O. (2012). Brief eclectic psychotherapy v. eye movement desensitisation and reprocessing therapy for post-traumatic stress disorder: randomised controlled trial. The British Journal of Psychiatry, 224-231. Richardson, L. K. (2010). Prevalence estimates of combat-related post-traumatic stress disorders: critical review. Australian and New Zealand Journal of Psychiatry, 4-19. Roberts, N. P., Kitchiner, N. J., Justin, K., & Bisson, J. I. (2009). Sysrematic review and meta-analysis of multiple-session early interventions following traumatic events. The American Journal of Psychiatry, 293-301. Schnurr , P. P., & Lunney, C. A. (2012). Work-related outcomes among female veterans and service members after treatment of posttraumatic stress disorder. Psychiatric services, 1072-1079. Speziale, B., Kulbago, S., & Menter, A. (2010). Diagnosing and Treating Traumatic Brain Injury Among Veterans of the Afghanistan and Iraq Wars: Implications for Social Work. 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