Treating Brain Injury and PTSD in Veterans
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Thursday, August 18, 2011
Tuesday, August 9, 2011
PTSD More Common Among Migraine Sufferers
By Teri Robert,
http://www.healthcentral.com/migraine/related-conditions-287522-5_pf.html
The objective of a new study by Peterlin et. al. was:
"To evaluate the relative frequency of posttraumatic stress disorder (PTSD) in episodic migraine (EM) and chronic daily headache (CDH) sufferers and the impact on headache-related disability."1
Background information:
The prevalence of PTSD in the general population is estimated to be 8%. Two earlier studies have looked at PTSD in patients with headache disorders. One study seemed to show that Migraine and headache patients have a higher risk of developing PTSD than those without the disorders. Unfortunately, Migraineurs and tension-type headache patients were studied together in one group and compared to patients with pain unrelated to headache disorders. Thus, it was impossible to draw information specific to Migraine from the study. A second study might have shown PTSD as a risk factor for Migraine advancing from episodic to chronic. However it was a very small study group, and assessment of depression was self-reported by the patients and not clinically verified.
Study methods:
- The study was conducted with patients from six Migraine and headache treatment centers.
- All study participants were examined by a Migraine and headache specialist.
- Patients were recruited in the age group of 18 to 65.
- Headache disorder diagnoses were classified in accordance with the International Headache Society's International Classification of Headache Disorders, Second Edition (ICHD-II).
Study results:
- Analysis included 593 patients who fulfilled the criteria for episodic Migraine (EM) or chronic daily headache (CDH).
- PTSD was diagnosed in 30.3% of the participants with CDH.
- PTSD was diagnosed in 22.4% of the participants with Migraine.
- Participants with both major depressive disorder and PTSD were more likely to have CDH (24.6% of participants) than EM (15.79%).
- Disability was greater in participants with EM and PTSD.
Study conclusions:1
- "The frequency of PTSD in Migraineurs, whether episodic or chronic, is higher than the historically reported prevalence of PTSD in the general population.
- In addition, in the subset of Migraineurs with depression, PTSD frequency is greater in CDH sufferers than in episodic Migraineurs.
- Finally, the presence of PTSD is independently associated with greater
headache-related disability in Migraineurs."
Study author comments:
"Despite the clinical perception that military combat is the most common (cause), the most common causes of PTSD are interpersonal traumas, including sexual abuse... In women, the lifetime prevalence of PTSD is twice that of men... The implications are such that abuse causes not just psychological distress from PTSD but also physical pain such as migraine, and there is an increased disability seen in those migraine sufferers with PTSD than those without PTSD." ~~B. Lee Peterlin, DO3
"Pharmacologically, dual action antidepressants have efficacy for both migraine and PTSD, but the serotonin-reuptake inhibitor antidepressants regarded as first-line treatments for PTSD have performed poorly for migraine prophylaxis." ~~Dr. James L. Griffith2, 3
Summary and comments:
The data from this study clearly establishes that PTSD is more common among those with Migraine and chronic daily headache. Dr. Griffith's comments in his research commentary are well placed. There are significant treatment implications to the increased prevalence of PTSD in those with Migraine and chronic daily headache. Some Migraine and headache specialists are now leaning more toward SNRI antidepressants that affect both serotonin and norepinephrine than the SSRI antidepressants that affect serotonin only. The SNRIs are working quite well for Migraine and headache prevention in some patients.
Hopefully, more research will be forthcoming about the connections between Migraine and major depressive disorder, and PTSD, and other mental health issues. The development of additional treatments that could be used to treat both headache disorders and mental health disorders could be quite beneficial.____________
Resources:
1 B. Lee Peterlin, DO; Gretchen E. Tietjen, MD; Jan L. Brandes, MD; Susan M. Rubin, MD; Ellen Drexler, MD; Jeffrey R. Lidicker, MSc; Sarah Meng, DO. "Posttraumatic Stress Disorder in Migraine." Headache 2009;49:541-551.
2 James L. Griffith, MD. "Posttraumatic Stress Disorder in Headache Patients: Implications for Treatment." Headache 2009;49:554-554.
3 Rauscher, Megan. "Post-traumatic stress common in migraine sufferers." Reuters. April 3, 2009.
Tuesday, August 2, 2011
Forrmer Child Soldiers With PTSD Improve After Targeted Treatment Intervention
02 Aug 2011Written by Grace Rattue
http://www.medicalnewstoday.com/articles/232122.php
According to a study of JAMA, (August 3 theme issue on violence and human rights) former child soldiers from Northern Uganda who underwent a short-term trauma-focused intervention showed a greater reduction of symptoms of post-traumatic stress disorder than soldiers who received other therapy.
Current estimates state that approximately 250,000 children under the age of 18 are currently active as child soldiers in hostilities in 14 countries or territories worldwide. The Northern Uganda civil war lasted over 2 decades and has virtually affected the entire population.
According to background information in the article:
"The Northern Ugandan communities have been confronted with large numbers of formerly abducted children, adolescents, and young adults returning after their rescue, flight, or release throughout the war and thereafter. The successful reintegration of these former child soldiers continues to be a major challenge. Despite high rates of impairment, there have been no randomized controlled trials examining the feasibility and efficacy of mental health interventions for former child soldiers."
Verena Ertl, Ph.D., of Bielefeld University, Bielefeld, Germany, and her fellow researchers conducted a randomized controlled trial testing the feasibility and effectiveness of narrative exposure therapy for treating former child soldiers with posttraumatic stress disorder (PTSD).
Narrative exposure therapy (NET) is a short-term treatment for trauma victims developed for use in low-resource countries affected by crisis and war. NET enables participants to recollect details of their traumatic and often fragmented experiences in cooperation with a therapist who reconstructs their memories of traumatic events to achieve habituation. The trial consisted of 85 former child soldiers between the ages of 12 to 25 with PTSD from a population-based survey of 1,113 Northern Ugandans and was conducted in internal displacement camps between November 2007 and October 2009.
Participants were randomly split into 1 of 3 groups consisting of narrative exposure therapy (n = 29), an academic catch-up program with elements of supportive counseling (n = 28), or a waiting list (n = 28) with treatments carried out in 8 sessions by trained local lay therapists in their respective communities.
The symptoms of PTSD, depression, and related impairment were evaluated before treatment commenced and at 3 months, 6 months, and 12 months post-intervention using various analytic tools. Researchers discovered that the severity of PTSD symptoms improved significantly more in the NET group compared to the academic catch-up and waiting-list groups.
During one measure of clinically significant change, 80% (20 of 25 participants) in the NET group had reduced the severity of their PTSD.
The authors wrote:
"In the academic catch-up and waiting-list conditions, 11 of 23 (47.8%) and 14 of 28 (50%), respectively, showed clinically relevant improvement. Subgroup comparisons revealed that improvement was significantly greater in the narrative exposure therapy group vs. the academic catch-up group and the narrative exposure therapy vs. the waiting-list groups."
After 12 months of trial, 68% of NET participants, 52.2% of academic catch-up participants, and 53.6% of waiting-list participants no longer fulfilled criteria for PTSD. The 12-month follow up revealed that NET participants experienced a larger within-treatment effect of 51.6% of reducing the severity of PTSD compared to 30.9% of the academic catch-up group and 30.4% of the waiting list group.
The Researchers stated:
"Moreover, results indicated that there were additional positive effects of treatment on associated problems not primarily targeted, such as depression, suicidal ideation, feelings of guilt, and important indicators of readjustment such as stigmatization and functioning."
The author concludes that the results of this study indicate that community-based lay therapists without a mental health or medical background can apply narrative exposure therapy successfully.
Monday, April 18, 2011
Survivor's Guilt Haunting the Military
By Dr. Keith AblowPublished April 18, 2011 | FoxNews.com
On March 31, 2011, Clay Hunt, a 28-year-old Marine veteran who had served with great honor in Iraq and Afghanistan, receiving a Purple Heart, finally succumbed to the psychological fallout of that service, killing himself in his Sugar Land, Texas, apartment.
Hunt, a leading voice in helping other veterans get psychological help, had struggled publicly with the demons of war, especially the loss of four friends in his platoon.
“Two were lost in Iraq, and the other two were killed in Afghanistan,” his mother, Susan Selke, told the Houston Chronicle. “When that last one went down, it just undid him.”
Suicide rates are up across all branches of the military, even the National Guard, where the rate has increased 82 percent since 2009.
Posttraumatic stress disorder (PTSD)—marked by distressing, intrusive traumatic memories, flashbacks and a feeling of extreme emotional detachment from others—is one of the reasons. “Survivor’s guilt” of the kind Clay Hunt experienced is a particular manifestation of PTSD.
Survivor’s guilt is a psychological syndrome in which someone believes he has done wrong by surviving a traumatic situation that claimed the lives of others. It was prominent in survivors of Nazi concentration camps who came to believe—irrationally—that they must have lacked courage or been otherwise morally flawed in order to have lived through the horrors that brought death to their spouses or children or parents or friends.
Those with survivor’s guilt can torture themselves with unfair, unending questions like whether they could or should have done more to prevent catastrophe befalling those they cared deeply about, whether they should have offered themselves instead, whether their ability to avoid being killed was actually due to self-interest, or a willingness to curry favor with the enemy, or blind luck of which they were very undeserving.
Perhaps some of these questions plagued Clay Hunt.
Maybe they plagued many of the other veterans who have taken their lives after returning from Iraq and Afghanistan. Maybe many are more hobbled by guilt than by terror, awakened in the night not by flashbacks to their own near-death experiences, but to the deaths of others; not by terror, but by guilt—by the very fact that they somehow do not deserve to be alive, even that others died because of something lacking in them.
Survivor’s guilt is like empathy or selflessness gone awry, twisted back on itself until it becomes a dagger through the heart or a bullet through the brain. It is testimony to how the best qualities of the human soul can be made malignant by psychological trauma.
We are, it turns out, exquisitely—miraculously—sensitive creatures. We can care deeply about our fellow man. And, while we would never trade our sensitivity for callousness, that sensitivity also makes us vulnerable to psychiatric illness.
This is the way that some of the best of us, heroes like Clay Hunt, come to believe we are reprehensible, rightly guilty, worthy of scorn, representing the worst of us. This is the way that such valuable lives as Hunt’s are lost long after distant battles have ended.
It is time that the U.S. military, which has focused far too much attention on concepts, actually designed to make soldiers feel less--like desensitization and learned optimism—begins to join soldiers in the spiritual, moral and emotional journeys that begin when they return home and feel so much more.
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