Chapter 42

War-Related Psychiatric Disorders in Soldiers

Psychiatric-Mental Health Nurses Association of the Philippines, Inc. (PMHNAP)

Learning Objectives
Recognize the criteria and terminology used in the DSM-IV-TR for posttraumatic stress disorder (PTSD). Describe the primary symptoms of PTSD. Describe the neurological alterations associated with PTSD. Explain the mechanism of damage causing traumatic brain injury.

Keltners Psychiatric Nursing Philippine edition

Learning Objectives
Identify criteria for traumatic brain injury. Describe neurological alterations associated with traumatic brain injury. Identify treatment options for PTSD and traumatic brain injury patients.

Keltners Psychiatric Nursing Philippine edition

Overview
I. Posttraumatic stress disorder Primary symptoms: a. Reexperiencing Recurrence and intrusive thoughts Recurring dreams Flashbacks Psychological and physiological distress

Keltners Psychiatric Nursing Philippine edition

Overview
b. Avoidance Avoidance of trauma-related thoughts and activities Amnesia for trauma Feeling detached or estranged Restricted affect Sense of foreshortened future

Keltners Psychiatric Nursing Philippine edition

Overview
c. Hyperarousal Insomnia Irritability Difficulty concentrating Hyper vigilance Exaggerated startle reflex

Keltners Psychiatric Nursing Philippine edition

Neurological Alternations Associated with PTSD

I. Neuroanatomic changes Individuals with PTSD tend to have reduced volume in key brain areas. Alterations in function of the amygdala (major role in memory and emotions), prefrontal cortex (center of inhibition), and hippocampus (responsible for memory and contextualization).

Keltners Psychiatric Nursing Philippine edition

Neurological Alternations Associated with PTSD

Impaired amygdala function opens the opportunity for overreaction, whereas impaired hippocampal function compounds that tendency with an inability to read the environment correctly.

Keltners Psychiatric Nursing Philippine edition

Neurochemical Changes in PTSD

- Adaptive physiological responses happen at times of stress, but prolonged elevations that can occur during combat may result in a system continually turned on, thus morphing alertness into hyperalertness/insomnia and vigilance into hypervigilance.

Keltners Psychiatric Nursing Philippine edition

Traumatic Brain Injury

Characteristics of soldiers suffering from TBI: Engaged in high combat intensity Injured by a blast Experienced more than one explosion Younger Lower rank Male

Keltners Psychiatric Nursing Philippine edition

Criteria for Mild TBI

Any period of confusion, disorientation, and impaired consciousness Any dysfunction of memory around the time of injury Loss of consciousness Onset of observed neurological or neuropsychological signs and symptoms

Keltners Psychiatric Nursing Philippine edition

Treating PTSD and TBI

Goals for treating PTSD include the following: Reducing primary symptoms Improving functioning Strengthening resilience Relieving comorbid symptoms Preventing relapse

Keltners Psychiatric Nursing Philippine edition

Treating TBI
Both PTSD and TBI are treated with psychotropic medications based on symptoms

Keltners Psychiatric Nursing Philippine edition