Overview of Post Traumatic Stress Disorder and Traumatic Brain Injury

1. Overview of Post Traumatic Stress Disorder and Traumatic Brain Injury Bob Evans Director of Psychological Health Wisconsin NG

2. TRAUMATIC BRAIN INJURY (TBI)

3. TRAUMATIC BRAIN INJURY (TBI) Damage to the brain due to externally inflicted trauma Mild traumatic brain injury is the lower-grade forms of TBI Caused by a penetrating or blunt trauma or from the force of rapid acceleration and deceleration

4. TBI the signature injury of this war Many soldiers are experiencing blast exposures at greater frequencies than in past wars The significance of the blast wave itself is not yet well understood Vets are returning with c/o memory, concentration and problem solving difficulties

5. Difficulties with identifying mTBI Difficult to determine if a mTBI has occurred when we see the soldier 1 to 2 years after the injury Neuropsychological evaluations are conducted to help identify current strengths and limitations

6. TYPES OF HEAD INJURY Closed Head Injury Contusion/concussion Coup/Contre-Coup Bloodflow and metabolic changes Cerebral edema Diffuse Axonal Injury Blast Injury Open Head Injury

7. CONTUSION/CONCUSSION A mild injury or bruise to the brain which may cause a short loss of consciousness It may cause headaches, nausea, vomiting, dizziness, and problems with memory and concentration

8. DIFFUSE AXONAL INJURY (DAI) Brain injury does not require a direct head impact During rapid acceleration of the head, some parts of the brain can move separately from other parts This type of motion creates shear forces that can destroy axons necessary for brain functioning These shear forces can stretch the nerve bundles of the brain

9. BLAST INJURY Blast injuries are the number one cause of injury or death in Iraq 69.4% of Wounded In Action caused by Blast or Explosion 62% of Blast Injuries result in Traumatic Brain Injury (TBI) 85% of TBIs are closed head Injuries

10. SYMPTOMS OF MTBI Emotional Behavioral Physical Cognitive Social

11. EMOTIONAL Depression Anxiety Hopelessness Helplessness Reduced confidence Apathy Emotional numbness Intense fear

12. BEHAVIORAL Impatience Anger Frustration Confrontational behaviors Impulsivity Increased avoidance of situations or activities that feel uncomfortable (like being around others, riding in cars) Withdrawal

13. PHYSICAL Headaches Chronic pain Fatigue Weakness or numbness Changes in vision Changes in hearing Other sensory changes (touch, taste, smell)

14. PHYSICAL Changes in sleep Changes in appetite Vertigo (dizziness) Nausea Impairments in fine motor speed and coordination Changes in sexual functioning

15. COGNITIVE Changes in attention Diminished memory Slowed speed of mental processing Confusion Disorientation Changes in decision making Alterations in judgment Changes in ability to plan and organize

16. SOCIAL Changes in relationships Changed ability to engage in hobbies and leisure activities Decreased ability to perform at work or school Isolation Increased alienation from others

17. POST TRAUMATIC STRESS DISORDER

18. Topics: Fight or Flight Response Effects on our brain & body PTSD Symptoms Treatment Options

19. Fight or Flight Response Hard-wired instinct Essential tool for survival Begins when we perceive something as a threat When triggered, the brain alerts the body to danger and initiates a series of important changes

20. When Fight or Flight is Triggered… Glucose and fats are released into the bloodstream – they provide fuel for the muscles Oxygen is needed to burn the fuel – so our breathing rate increases In order to get this fuel to our muscles as soon as possible – our heart begins to beat faster

21. Fight or Flight Blood is shunted away from our digestive tract and directed into our muscles and limbs, which require extra energy and fuel for running and fighting Our pupils dilate Our awareness intensifies Our sight sharpens Our impulses quicken

22. Fight or Flight Our perception of pain diminishes Our immune system mobilizes We become prepared physically and psychologically for fight or flight We scan and search our environment, “look for the enemy”

23. Our rational mind is disengaged – the blood supply to the parts of our brain that allows us to think rationally is reduced, while the blood supply to the more primitive parts is increased We rely on our instincts and reflexes Military drills are used to build a conditioned reflex - so, even when fight or flight is triggered – you are able to follow orders/training

24. PTSD can develop when… The threat is severe The threat persists over a long period of time The individual was in close proximity to the threat (direct or witnessed) There is lack of support from family and/or community after the event There is a history of other traumatic events prior to the event

25. PTSD In PTSD, the fight or flight state remains activated The body continues to respond as though it were under threat The body’s physical, mental, and emotional batteries are drained

26. Our immune system is prevented from running at full capacity. There is an increased likelihood of developing stress-related illnesses We are likely to use the fight or flight reaction in situations that are NOT life or death

27. Summation • What is referred as PTSD or more accurately Stress Reactions is not a Diagnosis of PTSD. • Many people experience symptoms of PTSD during their life. Accidents, tragedies, violence, physical and emotional insults. • Most people recover fairly rapidly, however re exposures are mixed in response • Understanding what is occurring is critical for the afflicted person to normalize the response.