Post Traumatic Stress Disorder
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History and Background of PTSD (Myths, Misconceptions, and Treatment of the Past)
Experimental and clinical studies in neuroscience helped to justify that posttraumatic stress disorder (PTSD) may increase the stress conditioned by fear, event perception, and behavior sensitization and furthermore contribute to the frequent addiction (Koslow, 2001). The question is why did not actual term “PTSD” appear until 1980, when there was so many signs and symptoms related to the different medicine branches?
Looking through the background of the illness, there are findings that verify the oldest known description of traumatic stress dated 5000 years ago (Ford, 2009). In the Sumerian Epic of Gilgamesh, there was a description of Gilgamesh’s reactions, which reflected several classic symptoms of PTSD, namely: traumatic grief, terrifying memories, inability to sleep, anger, sense of foreshortened future, etc. (Ford, 2009). Similar emotions were depicted by Greek storyteller Homer in Odyssey, which narrated Odysseus’ inability to return home after experiencing traumatic betrayal of Achilles (Ford, 2009). Accounts of psychological trauma and its aftermath were described in works during Renaissance and Reformation period. The most vivid of them were Shakespeare’s works, which narrated impacts of natural disasters, wars, rape, political violence and exile, family violence, and murder (Ford, 2009).
In the 1860s, physicians addressed PTSD and began to describe chronic syndromes characterized by fatigue, tremors, pain, anxiety, and depression following life-threatening injuries (Ford, 2009). Combat soldiers’ chronic anxiety and dysphoria were described by Arthur B.R. Myers and Jacob Mendez DaCosta in 1871 and the phenomenon was named as traumatic neurosis (Ford, 2009). In 1918, the US Surgeon General classified this illness as neurocirculatory asthenia – a muscular weakness, caused by some combination of neurological and cardiologic/circulatory disease (Ford, 2009). Freud’s psychological theory formulated the phenomena as psychopathology based on traumatic experience from the childhood (Ford, 2009). During and after World War II, military psychiatrists formulated principals of immediate prevention of so called war neurosis, combat stress reaction, and combat fatigue. They emphasized its treatment as temporary removal form of danger, rest, and maintaining ongoing combat contact (Ford, 2009).
Controversy of the introduction of PTSD surrounded the claims of critics based on the foregoing feminists’ and veterans’ strikes and, therefore, mistaken the criteria of the illness (Boriskin, 2005). Those mistaken criteria included the following aspects: reaction of events should not be pathologized; the syndrome is not legitimate but rather created by the feminist and veteran interest groups; multitude lawsuit proclaimed the syndrome as a server for a litigious purposes; patients’ reports of PTSD syndromes are not reliable (Friedman, Keane & Resick, 2010).
All this misconceptions created the myths of the way the illness should be treated, namely: a) catharsis is the target of the treatment (although it may become self-reinforcing and increase clinical dependence): b) trauma is treated before addiction (however, when the latter is neglected addiction is very likely to occur); c) severity of the event is the deciding factor of the trauma (however, perception and age of the event are the most important determiners of the trauma-related disorder); d) teaching clients to contact with their instincts is an initial part of the treatment (however, triggering clients urges fear-based intrusions and flashbacks); e) only survivor can treat a fellow survivor (however, integrity, balance, empathy, and attention will be the best help); f) unconditional positive regard should be provided (however, patients’ distortions area reinforced, since they are endangered); g) confrontation is the best medicine (however, if clients are not treated by Twelve Step Model, which starts from the positive note and ends in tears); h) do the best to endure the trauma (misery and rejection turn back to the patients, when the words “just get over it” said out load); i) changing behavior is the primary goal (however, self-acceptance should be facilitated) (Boriskin, 2005).
Abovementioned misconceptions and myths were the obstales of the real diagnosis and sufficient treatment of the disease
Signs and Symptoms of the PTSD
Signs of the PTSD can be present for the next 30 days or any other shorten period after the trauma was experienced (Post-Traumatic Stress Disorder, 2012). Symptoms fall into three main categories and generally include dysphoria, distractibility, impulsivity, emotional numbing, social avoidance, sleep disturbances, dissociation, depression, irritability (MayoClinic, 2011).
Relation of the Neurotransmitters with the Signs and Symptoms of the PTSD
Researches in neuroscience helped to identify the correlation between brain and physical activities (Martin & Volkmar, 2007). According to Koslow (2001) “the amygdale as a part of the limbic system of the brain facilitates the body’s ability to respond instantaneously to violent stimuli” (p. 169). When danger is perceived, amygdale allows the evaluation of incoming stimuli (Koslow, 2001). Release of hormones, adrenaline, and norepinephrine increasing of the heart and breathing rates allow the organism to be more sensitive and respond faster (Koslow, 2001). This is called the first response of the organism to the violent stimuli (Boriskin, 2005). The secondary response allows the organism to stop and consider (Boriskin, 2005).
If traumatic experience is encoded in the amygdale, the first response can be triggered and can cause hypervigilance as a symptom of the PTSD (Koslow, 2001). Triggers as neurotransmitters can cause heightened activity and result in re-experiencing the trauma in flashbacks (Koslow, 2001). Distraction, disorganization, and memory difficulties are caused by the interference of the moderate stress with prefrontal cortical function (Koslow, 2001). Other neurotransmitters, which cause arousal in various brain regions are: a) NE which is also responsible for hunger, mood control; b) dopamine, which controls posture and movement, emotion, and cognitive functions; c) serotonin, which is responsible for sleep, mood control, and pain suppression; d) acetylcholine, which is necessary for cognition memory and motor control (Introduction to the Best Known Neurotransmitters, n.d.).
However, separate brain scans are required to activate specific brain region of interest in order to acquire accurate symptoms and signs of PTSD (Foa, Keane & Friedman, 2009). Because of its cost and complex design, these studies are conducted directly through neuropsychological, neuroimagining, and electropsychological techniques (Foa et al., 2009).
Diagnosis and Tests of PTSD
To diagnose PTSD, there should be at least one symptom uniquely associated with depressed mood and suicidality (Martin & Volkmar, 2007). PTSD diagnoses require careful assessment and evaluation of behavior pattern, because some symptoms are misattributed with mental development diagnosis (MDD) (Martin & Volkmar, 2007). These misattributions are met in the following areas: concentration difficulties are mistakenly reported as attention deficit hyperactivity disorder; extreme irritability – as mania or oppositional defiant disorder and trauma-related flashbacks – as primary psychotic disorder (Martin & Volkmar, 2007).
Various structural interviews conducted by qualified mental health professional are based on systematic, comprehensive approaches to obtain a patient’s clinical history in a face-to-face interview (MayoClinic, 2012). The Heart and Soul Study examined the relation between mental health disorders and cardiovascular events based on Computer Diagnostic Interview Schedule (CDIS) and Diagnostic Statistics Manual IV (DSM - IV) (Zen, Zhao, Whooley & Cohen, 2012). 1,024 patients completed baseline examinations between September 2000 and December 2002 that included structured psychiatric interview, echocardiogram, exercise treadmill test, fasting blood draw, and a questionnaire packet (Zen et al., 2012). CDIS diagnostic is widely used in epidemiologic studies and requires 4-Day training sessions of the qualified staff (Zen et al., 2012). According to the researches of the study, 95 participants among 1,022 were diagnosed with PTSD after they met its criteria in questionnaire questions, namely: physical activity, smoking, medical adherence, covariates (Zen et al., 2012). The study verified the reelation between PTSD and cardiovascular events; however, it showed no significant difference of alcohol use between participants with and without illness (Zen et al., 2012).
Therefore, the validity of the data collected cannot be fully reliable because of the limitations it faced and possible inaccurate self-report.
Promoting and Detracting Environment of the Available PTSD Treatment
The diagnosis of PTSD is graded by five level marking grind, which corresponds to the severity of the illness and number of the encountered symptoms (Foa et al., 2009). The most common treatment of PTSD is based on the cognitive-behavior theory and includes the following approaches: a) breathing control, which help to focus on pace and is closely related with stress inoculation training; b) grounding techniques, which help to focus on safety during experienced flashbacks and is closely related to biofeedback therapy, which promotes deeper level of relaxation; c) thought-stopping techniques, which define clinician’s initial work to stop upsetting and compulsive thoughts and is based on assertion training and muscle relaxation; d) the sequence of stopping, evaluating, and putting into action techniques, which help to cut the root of the violent stimuli; this technique is closely related with the dialect behavior therapy (Boriskin, 2005; Foa et al. 2009). Moreover, these approaches included avoidance of the over stimulated activities, self-soothing and safety declaration in the beginning of the treatment, usage of transitional objects, and declarative self-statement (Boriskin, 2005). These techniques are considered as favorable promotion of the successful treatment in undisturbed and safe environment. Psyhopharmacotherapy is basically a drug application approach that should be carefully considered as possibly effective approach, since it provokes further addiction of already agitated instincts (Friedman et al., 2010).
Hypnosis methods, no dominant handwriting, classic conditioning methods were commonly used before, and studies show that they resulted in further distortion, production of the false memory and made many clients victims of these techniques (Boriskin, 2005). These techniques and therapies presented unfavorable environment for the successful treatment of PTSD.
Advanced diagnosis and treatment methods of PTSD
Eye Movement Desensitization radically improved over last 15 years among the latest trends in the PTSD treatment (Foa et al., 2009). It entails eight stages of treatment, which comprises history gathering, planning of treatment, preparation of patient, systematic assessment of the triggers, installation of the positive cognitions, and body scan (Foa et al., 2009). There is a possibility that mindful awareness and implication of medication will provide advantages for the conventional exposures for traumatic memories (Boriskin, 2005). It is considered more effective than traditional direct touch techniques and open-ended techniques, based on the patients’ recalls and subsequent clinicians’ reflection of the situation (Friedman et al., 2010). Somatic sensory processing treats the effects of trauma directly through the autonomic nervous system involvement and defensive responses, which resolve the point of rest and satisfaction in the body (WebMD, 2012). It is considered more effective than classical conditioning methods when body stimuli are triggered for the desired result of confession, situation realization, and acceptance (Foa et al., 2009).
Medical scanning technology allows examining of the brain structure and brain activity, but it does not see the cause and consequence of the trauma and related disorders (Boriskin, 2005). Moreover, this technology assists biological imbalance and cannot provoke trauma-related flashbacks (Foa et al., 2009).
In addition, additional data collection on the patients’ medical history should be collected in order to diagnosis and prescribe the most precise treatment. Since, most of the symptoms and signs correlated with other mental disorders, addiction problems and health illnesses should be accurately addressed. Trauma-related experience if not immediately treated can cause subsequent cardiovascular and mental disorders. Combination of the psychological, pharmacological, and neuroscience advanced therapies are designated to solve health after growths.
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