LCDR Jeffrey Cook, with the National Naval Medical Center in Bethesda, presented on the diagnosis and treatment of Post-Traumatic Stress Disorder (PTSD). Events known to cause PTSD in military and civilian populations include combat zone experiences, rape, natural disasters, child physical and sexual abuse, domestic violence and vehicle accidents. Patients seeking care following a traumatic event, he pointed out, are likely to be in poor mental health as well as physical health.
Cook indicated that there is no consistent laboratory value or imaging result that can confirm the presence of PTSD—hippocampal atrophy was initially believed to be a biomarker, but is now thought to be more of a risk factor than a result of the disorder.
The military now consistently administers a post-deployment health assessment to all returning servicepeople to confirm PTSD and rule out any physical disorder that might cause similar symptoms. Unfortunately, said Cook, of the people who come up positive on these assessments, fewer than one in four will seek follow-up treatment.
Cook distinguished Acute Stress Disorder (ASD) from PTSD primarily by the time horizon—ASD is a syndrome that occurs between two days and one month after exposure to a trauma, while the symptoms of PTSD persist well past one month. PTSD indicators include intrusive thoughts, images, nightmares, flashbacks, intense psychological distress and physiological reactivity upon cue exposure.
Persistent avoidance of activities and people associated with the trauma, unresponsiveness, and diminished interest in pleasurable activities are all signals of PTSD as well. Further, patients with this syndrome exhibit persistent increased arousal, in terms of having difficulty sleeping or concentrating, being irritable and having angry outbursts, being hypervigilant or having an exaggerated startle response.
The more short-lived Acute Stress Disorder manifests in much the same way as PTSD, but with more emphasis on dissociative symptoms such as numbing, derealization (a sense of surrealism), depersonalization and dissociative amnesia.
Among soldiers deployed to Iraq, PTSD increases linearly with the number of firefights they witness. Pre-trauma risk factors for PTSD onset include evidence of previous trauma, psychiatric history, high hostility and family history. Post-trauma risk factors for the onset of PTSD include lack of social support, additional life stress (foreclosure, divorce, etc.) and the severity of injuries.
Cook said that the Psychological First Aid protocol is beginning to replace traditional Critical Incident Stress Debriefing (CISD), as research has revealed that CISD potentially re-traumatizes survivors. Psychological First Aid is a set of interventions that does not emphasize catharsis. The most effective psychotherapies are cognitive and exposure therapies and eye movement desensitization. There is no evidence to recommend mood stabilizers or atypical antipsychotics. Cook indicated that antidepressants may be effective, but not in the initial stage of the disorder.