Posttraumatic Stress disorder (PTSD) is an anxiety disorder that can occur after you have been through a event. A traumatic event is something horrible and scary. During the event , an individual believes that his/her life or the lives of others are at risk.

Combat or military exposure Childhood sexual or physical abuse Terrorists attacks Sexual or physical assaults Serious accidents, such as a car wreck Natural Disasters, such as a fire,

tornado, flood or earthquake

The recent RAND Center for Military Health Policy Research “Invisible Wounds of War - Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery” report on OIF/OIE veterans, discussed that of the1.64 million service members who have been deployed for OIF/OIE as of October 2007, they estimate that 300,000 individuals currently suffer from PTSD or major depression and that 320,000 individuals experienced a probable TBI during deployment.

Rand Study:1. 69.3% have no

diagnosis2. 11.2% PTSD or

depression3. 7.3% have

PTSD/Dep/TBI4. 12.2% have TBI

only

Estimated prevalence of lifetime PTSD to be 7.8% in the general population.

Women are twice as more likely to than man to develop PTSD at some point in their lives.

Men are more likely to experience a trauma. ( National Center for PTSD)

1.Had an earlier life-threatening event or trauma, such as being abused as a child

2.Poorly educated3.Younger age4.Having another mental health

problem5.Family with mental health problems6.Limited support from friends and

family7.Recent loss of a loved one8.Recent stressful life changes9.Alcohol abuse10.Female

Bad dreams Flashbacks Scary thoughts Staying way from

places and things that remind you of what happened

Feeling worried, guilty, or sad

Feeling alone Trouble sleeping Feeling on the edge Angry outbursts Thoughts of hurting

yourself or others

Regression: behaving like they did when they were younger

Somatic preoccupations Behavioral Disruptions Poor School performance Refusing to play or play with friends.

A traumatic brain injury is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Not all blows or jolts to the head result in a TBI.

Degree of Injury: Injuries may range from mild( brief changes

in mental status) to severe (extended periods of unconsciousness or amnesia after the injury.

TBI can result in short or long-term problems with independent functioning (CDC,2006)

Centers for Disease Control and Prevention. “Traumatic Brain Injury in the United States: A Report to Congress.” (January 16, 2001).

Traumatic brain Traumatic brain injury is classified injury is classified as a public health as a public health

epidemic in epidemic in America.America.

1. Military personnel 2. Males are about 1.5 times more likely

than females to sustain TBI

Cost: Direct medical cost and indirect cost such

as the loss of productivity of TBI totaled $60 billion in the U.S. in 2000 (Finkelstein,2006)

Centers for Disease Control and Prevention

1.4 million injured

50,000 die from a TBI

235,000 are hospitalized

1.1 million treated and released from ED

5.3 million, approximately 2% of the U.S. population, currently have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI.

An

nu

al

The number reported with TBI underestimates the magnitude of the problem because the following are not included in those estimates: › Those treated by private physicians.› Those treated in private clinics, urgent

cares.› Individuals who did not seek medical

care.

The leading causes of TBI are:

Falls Motor vehicle-traffic

crashes Struck by/against

events Assaults

› (Defense and Veterans Brain Injury Center,2005)

In intimate partner violence, the head and face are targeted half the time.

In non-intimate assaults against women, nearly 60% of the assaults are to the head and face.

Greenfield, L. Et al, Violence by Intimates, NCJ-167237, US Department of Justice, Bureau of Justice Statistics, March 1998

Many children have neurological deficits caused by repeated blows to the head and face and/or by the chemical reaction to prolonged stress of witnessing and living in a violent home.

…Physical, sexual and psychological trauma in childhood are now being connected to mental health difficulties, that show up in childhood, adolescence, or adulthood.

The report further discussed that › Of those reporting a probable

TBI, 57 per cent had not been evaluated by a physician for brain injury

› Some specific groups that were understudied (e.g. Reserve Components, those who left military service) may be at higher risk for suffering from these conditions.

Mild TBI: headaches, confusion, lightheadedness, dizziness, blurred vision, ringing in ears, bad taste in mouth, fatigue, sleep disturbance, mood changes, decrease memory, difficulty with concentration, attention or thinking. The injury may or may not result in a brief period of unconsciousness (TBI Recovery Center,2006)

Moderate or Severe TBI: symptoms may be similar to mild but they may also include a headache that gets worst and never goes away, repeated vomiting or nausea, convulsions or seizures, inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the arms or legs, loss of coordination, increased confusion, restlessness, or agitation.

( TBI Recovery Center,2006)

5.3 million Americans have long-term or lifelong need for help to perform daily living(Thurman,1999)

40% of those hospitalized for TBI had at least one unmet need for services. The most frequent unmet needs:

a. Improving memory and problem solving

b. Managing stress and emotional upsets c. Controlling one’s temper d. Improving one’s job skills

(Corrigan,2004)

There is a potential for symptoms to be dismissed, rejected, misdiagnosed, or misunderstood due to a delay in the manifestations of some of the symptoms and the similarities to mental illness.

Individuals may be presenting with possible psychiatric illnesses where brain injury is really the underlying cause or driving the illness.

Cognitive changes following brain injury may impair the individual’s ability to access and use cognitive behavioral strategies.

TBI1. Increased

anger/irritability2. Rage3. Depression4. Memory impairment5. Sleep disturbance6. Headaches7. Avoidance of

crowds/social isolation8. Substance Abuse9. Suspicion/paranoia10. Anxiety

PTSD1. Increased anger/irritability2. Rage3. Depression4. Memory impairment5. Sleep disturbance6. Headaches7. Avoidance of crowds/social

isolation8. Substance Abuse9. Suspicion/paranoia10. Anxiety (Brain Injury

Association of Arizona)

TBI1. Impaired decision

making2. Work retrieval

problems3. Low frustration

problems4. Low frustration

tolerance5. Impulsive behavior6. Noise Sensitivity7. Easily confused

PTSD1. Easily Startled2. Hyper-vigilant of

surroundings3. Strong reaction to

flashbacks4. Nightmares5. Intrusive thoughts6. Guilt

(Brain Injury Association of Arizona)

Cognitive, emotional, and/or behavioral challenges after brain injury can result in referrals to systems and services that do not have adequate knowledge, understanding, training, and/or experience working with individuals with brain injury and their families.

This may result in: › inappropriate evaluations, assessments and

treatment; › inaccurate assessment of response to

treatment;› exacerbation of symptoms;› Inappropriate medications or overmedication;› Substance abuse.