Welcome to the TBI-HELP Live Chat
Today's topic is:
"PTSD - Post Traumatic Stress Disorder"
Our Guest is: Dr. Catherine Mindolovich,
Psychologist, Jamaica Hospital Medical Center
Tonight's Topic Summary:
Post Traumatic Stress Disorder (PTSD) results from exposure to an overwhelmingly
stressful event or series of events, such as war, assault, accidents such as
traumatic brain injury. It is thought to be a normal response t an abnormal
event. Events that lead to PTSD are generally thought to be serious or traumatic
and that nearly anyone's coping abilities would be challenged or stressed by
them. Symptoms include increased anxiety, physiological arousal, and avoidance
of traumatic event. Symptoms may be apparent for a relatively short period of
time or may persist for years of even decades. There are many strategies for
managing symptoms of PTSD including talk therapy, cognitive-behavioral therapy,
breathing retraining, and progressive muscle relaxation techniques.
[19:01:10] mod: Welcome! I hope that this finds everyone in good health. Tonight it is our pleasure to have Dr. Catherine Mindolovich, Psychologist from Jamaica Hospital Medical Center as our guest speaker. Her topic is " Post Traumatic Stress Disorder (PTSD). Welcome Dr. Mindolovich.
[19:01:46] DrMindolovich: Good evening. Thank you for having me.
[19:02:37] mod: Rail: How often does PTSD complicate the recover of TBI patients, and what kind of complications are the most common?
[19:05:02] DrMindolovich: First of all, it may be helpful to ask what PTSD entails. For instance, for a diagnoses of PTSD, one must first be exposed to a traumatic stressor, that is, an event that
involves actual and/or threatened death, serious injury, or violation of the body of the self and or of others. Not all TBI is the result of this kind of event.
PTSD can complicate recovery of TBI patients because often it goes undetected.
PTSD symptoms often overlap with TBI symptoms. For
instance problems with attention, concentration, memory, anxiety, irritability etc.
[19:11:03] DrMindolovich: However, TBI would be distinguished by such symptoms as increased processing time, problems with abstract thinking, muscle fatigue, loss of coordination, and problems with
speech, hearing, vision etc. On the other hand PTSD would have associated cognitive problems but be marked by specific symptom
profile.
[19:11:56] mod: Rail: What are symptoms associated with PTSD?
[19:14:11] DrMindolovich: The first criteria involved in diagnosing PTSD is that the person must have experienced some sort of traumatic event, e.g., a work-related accident, perhaps an assault involving injury. After the event, an individual may experience symptoms from three symptoms categories:
1 Re-experiencing; 2 Arousal;
3 Avoidance.
[19:16:37] DrMindolovich: So, similar to TBI, an individual may become anxious, agitated, startle easily, be irritable... but also express symptoms such as avoidance of situations where the TBI was acquired. For example, it's not hard to imagine someone who was injured in a car accident avoiding driving. But that person may also avoiding walking along busy streets, or be hypervigilent when crossing a street. So, agitated arousal itself would not result in a diagnosis of PTSD, but that in combination with other symptoms might.
[19:21:33] mod: Al: Are patients with a
TBI more susceptible to PTSD symptoms?
[19:21:53] DrMindolovich: It can go either way. If you have experienced a traumatic event in the past, you may be more vulnerable to experiencing PTSD after the TBI related event.
By the same token, if you have TBI related PTSD, another, even less severe event may trigger a PTSD response, even if the event is not directly related. For instance, I often work with war veterans who have unresolved PTSD from the war, and who then experience an assault or accident and now have two life threatening events impacting on their well-being and functioning.
[19:27:06] mod: Ron: For Post-coma TBI wouldn't the symptoms of PTSD indicate
reasonable return of higher cognitive functions? Or are these more primitive reactions to the stress?
[19:29:17] DrMindolovich: Ron, What kind of higher cognitive functions do you mean? There is an evaluative component to determining whether something is life threatening or extremely stressful. People may just experience pure fear e.g., "That car's coming right at me." At that moment, non-verbal terror certain could be a primitive
response. And that does take me to the point, that treatment for PTSD is often, indeed, talking about what happened.
[19:31:20] mod: Al: How can you help someone that has these PTSD symptoms? Also, can people with PTSD have physical signs?
[19:31:44] DrMindolovich: 2nd question first. One cluster of symptoms, arousal, would involve physiological indicators of
arousal, for instance, sweating, shaking, trembling, restlessness, difficulty falling asleep,
exaggerated startle response even poor concentration. The treatment for these kind of symptoms may involve such techniques as breathing retraining, progressive muscle relaxation, and imagery techniques.
[19:36:35] mod: Rail: If the TBI has reduced communications - how difficult is it to discover the Re-experiencing symptoms?
[19:43:34] DrMindolovich: It would be difficult. And that may be one reason PTsd may go undetected . Individuals may not be aware that symptoms may be related to psychological aspects of the incident. Indeed, without some communication. Indeed, without some form of
commutation, knowing anyone's symptoms would be hard. But let me suggest, that whether
attributable to the PTSD or not, there is help for those suffering from poor sleep, agitation, motor restlessness, etc. Ask your medical doctor about potential meds for these symptoms.
As for re-experiencing, nightmares, startle, "freezing" or startle behavior in response to specific triggers may be a clue that someone may be
re-experiencing. I am not aware of research that might address this issue.... although I do know of a study that did determine PTSD in a patient, who had total amnesia for the
traumatic event. But in that case, the patient could actually communciate the distress even though he did not remember the distressful event itself.
[19:53:55] mod: Rail: Can PTSD return once treatment has ended?
[19:55:48] DrMindolovich: Yes, due to exposure to circumstances that closely resemble those at the time of the trauma, a trigger event, or a new trauma, even if not as severe as the original. The body seems to become sensitized to other traumatic events, the
threshold is lower than before the trauma. Hopefully, one has learned to apply techniques learned in therapy, such as deep breathing, muscle relaxation, etc. to symptoms as they pop up.
And, it is not at all unusual to return to treatment/therapy if needed or if the individual would find it helpful. The key is to get to know what you can handle and when you need to go get help. For TBI pts, there is a lot going on not directly related to the psychological aspect of their injury. Yet, somewhere along the way, questions of feeling safe in the world and reconnecting to other becomes important. Getting treatment from an experienced individual trained in both relaxation techiques and talk therapy approaches can be a helpful way to ease people back into their routines again.
[20:03:06] mod: Well I see that our time is over for this evening. I want to thank all of you for your support tonight and I look forward to seeing you next week. I want to thank Dr Mindolovich for a very interesting discussion. Have a good week and be safe! Good Night.
[20:03:34] DrMindolovich: Thank you for having me. It was a very stimulating discussion.