Post-traumatic stress disorder (PTSD).

Post-traumatic stress disorder (PTSD).

Post-traumatic stress disorder (PTSD) is a psychological condition characterized by severe anxiety disorder that usually develops after a severe emotional trauma, such as combat, terrorist incidents, natural disasters and riots. The emotional trauma destabilizes the physical and psychological integrity of a person thereby overwhelming the capacity of that person to cope with the trauma. It is estimated that 7% of all Americans will suffer from an episode of PTSD during their lifetime (Nelson, 2011). It is well known that most young war veteran suffer from PTSD which can be categorized into acute, delayed-onset and chronic sub-forms. Research has also shown that young war veterans have twice the risk for suffering from PTSD than the general population. This has been attributed to their frequent involvement in high-intensity guerilla warfare and the persistent threat of roadside IED (improvised explosive devices) explosions (Bromet, 2011). PTSD persists for a much longer duration (usually over 30 days) than acute stress response, thus PTSD is considered as a form of chronic stress disorder. Therefore, PTSD persists long after the veteran has been discharged from active combat duties. PTSD is associated with depression, substance abuse, cognition disorders and memory lapses. PTSD also complicates existing co-morbidities (Nelson, 2011).

PTSD develops after a person is exposed to a traumatic event in combat, and it develops in three distinct stages with each stage characterized by a specific set of symptoms which are outlined hereafter. Persistent re-experiencing characterizes the first stage whereby the veteran experiences the following: flashback memories of the traumatic event, recurrent distressing nightmares, subjective re-experiences of traumatic   incidents and extreme adverse psychological reactions to any reminder of traumatic incidents. Emotional numbness and persistent avoidance characterizes the second stage whereby the individual has the following symptoms: the person avoids behaviors, locations, stimuli and people associated (and/or could elicit memories) with traumatic incidents; and/or the person numbs certain emotions, and/or, forces himself/herself to forget the major events of the traumatic incidents. The third stage is termed the hyper-arousal stage and it is indicated by a set of symptoms which results from impaired physiological responses; and, it is characterized by hyper-vigilance, increased persistent arousal, angry outbursts, attention deficit, irritability and heightened startle response (Nelson, 2011).

PTSD adversely affects interpersonal relationships; thus, leading to family problems, occupational instability, divorces and social exclusion. The mainstay of PTSD therapy is psychotherapy and pharmacotherapy (mainly using antidepressants). Early management of PTSD reduces the chances of the patient developing chronic symptoms (Nelson, 2011).

          PTSD statistics among veterans aged 18-24 years.

Recent psychological studies on young veterans(aged 18-24 years) returning from the combat zones in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) has shown that about 34% of them suffer from psychosocial and mental disorders. In primary care settings, there was a definitive diagnosis of PTSD in 13% of all veterans. The prevalence of PTSD coexisting concurrently with other psychiatric co-morbidities (such as depression, anxiety disorders, adjustment disorder and substance abuse disorder) was 94% among the veterans aged 18-24 years. Both male and female veterans were affected in equal measure. There was a minimal absolute difference between married and single veterans; and also among ethnic and racial groups. The accuracy of these PTSD diagnoses was 90%; as 90% of all the PTSD diagnosis done at the primary care setting was definitively confirmed in mental hospitals (Bromet, 2011). These studies have thus shown that there is a high burden of co-existing psychological morbidities among young combat veterans.

Another study of PTSD among veterans of all age group has shown that there is a statistical and absolute significant downward trend towards an increased risk of PTSD among younger age-groups, with the highest prevalence of PTSD in this study being in the 18-24 years age group. This has been attributed to the fact that young combat soldiers are likely to hold a low rank in the military, and they are thus involved in most combat fighting as compared to the older combat soldiers. This study shows that there is a direct correlation between the effective degree of combat exposure and risk of PTSD. Moreover, this study has shown that there is need for enhanced strategies for prevention, detection and management of PTSD among veterans aged 18-24 years age group (Bromet, 2011).

        Causes of PTSD.

The main cause of PTSD among veterans aged 18-24 years is the physical and psychological trauma that they experienced during their duration of combat exposure (Brewin, 2011). Other causes of PTSD that have been identified in this age group are outlined below.

To start with, emotional dysregulation has been identified as a precursor of PTSD among veterans who came from broken homes located in crime-prone areas. This emotional dysregulation was never treated, or, it was treated inadequately. Secondly, research has shown that prior traumatic incidents that occurred during the pre-combat life of the veterans increase the risk of PTSD. Thirdly, over-reactive adrenaline response during flight-or-fight scenarios has been shown to significantly increase the risk of PTSD. This is attributed to the hyper-responsive nature of the affected individual. Fourthly, studies have shown that PTSD is more prevalent among Japanese-Americans and Hispanics as compared to other ethnic groups; and thus, these studies show a correlation between PTSD and genetics. Also, biochemical imbalances (such as, persistently low serotonin level and/or chronically low dopamine levels) in neurons located in the central nervous system has been shown to increase the risk of PTSD in the affected person. Another direct cause of PTSD is direct physical trauma (such as those caused by crash injuries and/or gunshots) to the amygdala, prefrontal cortex and hippocampus. Finally, peritraumatic dissociation is known to cause PTSD (Brewin, 2011).

The following specific groups of people have a high risk of developing PTSD: individuals directly exposed to traumatic incidents as either victims or witnesses, individuals who are injured during traumatic incidents, individuals who have experienced a severe persistent traumatic incident (such as frequent suicide bombings), individuals who witnessed their family members being assaulted and/or killed, individuals who have lost a close relative; and, individuals who have found themselves helpless during a previous traumatic experience. The following individuals have a moderate risk of developing PTSD: women, an individual who has experienced a non-lethal traumatic incident, an individual with a mental disorder, an individual with less education, a young person, an individual who has just experienced a stressful life change; and, an individual lacking social support (Brewin, 2011).

Ethnic minorities are at an increased risk of developing PTSD than whites due to the fact that they are exposed to traumatic incidents more frequently. Moreover, some cultural biases of various ethnic minorities do exacerbate PTSD (Brewin, 2011).

Symptoms of PTSD.

The symptoms of PTSD are categorized into the following three groups: re-experiencing symptoms, avoidance symptoms and hyper-arousal symptoms. These groups are discussed below (Nelson, 2011).

            Re-experiencing symptoms originate from the thoughts and emotions of the veteran. The symptoms are flashbacks (recurrent painful memories), nightmares and recurrent startling thoughts. These symptoms adversely affect the normal daily activities of the veterans (Bromet, 2011).

Avoidance symptoms protect the veteran from recalling traumatic occasions and/or events surrounding traumatic incidents. These symptoms are avoidance of locations, people, events or stimuli that may elicit the memories of the traumatic incident; emotional numbness, feeling of guilt, depression, anxiety, apprehension, impaired recall of major events of the traumatic experience. These symptoms compel an individual to modify his/her normal routine, and this leads to breakdown of interpersonal relationships (Bromet, 2011).

Hyper-arousal symptoms are persistent, and they cause the veteran to be irritable and stressed. The symptoms are hyper-vigilance, irritability, hyper-arousal, attention deficit and insomnia. These symptoms impair the normal functional status of the veteran. Acute stress disorder adversely affects the eating habits, sleeping patterns, concentration and operational capacity of the veteran (Bromet, 2011).

Diagnosis of PTSD.

The following four criteria are used in the diagnosis of PTSD: an episode of re-experiencing symptoms for a period exceeding one month, three or more episodes of avoidance symptoms with each episode lasting for a duration of over 30 days, two or more episodes of hyper-arousal symptoms with each episode lasting for a duration of over 4 weeks; and, symptoms that impede normal daily activities (Nelson, 2011). The veterans were diagnosed with PTSD when the psychologist identified all the four criteria in their presenting complaints (Bromet, 2011).

Management of PTSD.

Only a qualified and certified mental healthcare provider can manage a PTSD patient. The mainstay of PTSD management is psychotherapy and polypharmacy (Nelson, 2011). Research has shown that early detection of PTSD produces a good prognosis (Bromet, 2011). The preventive treatment modalities include psychological debriefings, risk-targeted interventions, stepped collaborative care and psychobiological treatment. The mainstay of early intervention in PTSD is cognitive behavioral therapy, critical incident stress management and propranolol. Psychotherapeutic programs have shown high efficacy when they are used concurrently with cognitive behavioral therapy (Nelson, 2011).

Pharmacotherapy is used for symptom prevention and symptom management. The following are the major classes of drugs used in management of PTSD: serotonin antagonists, SSRI (selective serotonin reuptake inhibitors), antipsychotics, anxiolytics, alpha-adrenergic antagonists, atypical antidepressants, benzodiazepines, MAO (monoamine oxidase) inhibitors, glucocorticoids, beta-blockers and heterocyclic antidepressants (such as sertraline and paroxetine) (Nelson, 2011).

Conclusion.

PTSD is characterized by emotional instability and anxiety disorders. The prevalence of PTSD in the 18-24 years age group is higher than in any other older age groups. This is attributed to the fact that young veterans have more combat exposure that the older soldiers in active duty. PTSD is caused by psychological trauma, genetic predisposition, over-reactive adrenaline response, direct physical trauma, emotional dysregulation, previous traumatic incidents and biochemical imbalances in the central nervous system. PTSD develops in the following three distinct stages: re-experience symptoms, avoidance symptoms and hyper-arousal symptoms. Four criteria are used in the diagnosis of PTSD. PTSD is treated by a combination of psychotherapy and pharmacotherapy.

                                                                References.

Nelson, F. (2011).  A meta-analysis study of Post-traumatic Stress Disorder (PTSD). Journal                  of Psychiatry, 87, 889-917.

Bromet, C. (2011). A meta-analysis of Post-traumatic stress disorder (PTSD) among war

            veterans. Journal of Physiological Psychology, 45, 789-806.

Brewin, D. (2011). Meta-analysis of risk factors and aetiology of post-traumatic stress              disorder in young combat veterans. Journal of Clinical Psychology, 68(5), 988-1016.