PTSD – An examination of PTSD

• Introduction 3

• Article 1 4

• Article 2 5

• Article 3 6

• Conclusion 7

• References 8
Introduction

Posttraumatic stress disorder (PTSD) is a psychiatric disorder

that can occur in people who have experienced or witnessed a
traumatic event such as a natural disaster, a serious accident, a
terrorist act, war/combat, rape or other violent personal assault.

The technical diagnosis of PTSD — And why it is important.

- Misdiagnosis is common
- Misunderstandings are common
- Great reason not to focus on other issues
- Serious but treatable when it is present
- Typically NOT present alone

PTSD Criterion A Stressor

Exposure to a traumatic event in which:

The person has experienced, witnessed, or been confronted with an
event or events that involve actual or threatened death or serious
injury, or a threat to the physical integrity of oneself or others.
The person's response involved intense fear, helplessness, or horror.

Article 1 -
“An examination of PTSD symptoms and their effects on suicidal ideation and behavior in non-
treatment seeking veterans”

Suicide is often discussed as an outcome associated with a variety of psychiatric disorders

including depression, anxiety, and post-traumatic stress disorder. Indeed, among Iraq and
Afghanistan War veterans, suicidal ideation has been found to be four times more likely to
occur when veterans screened positive, as opposed to negative, for PTSD.
In a nationally representative sample of the United States, found that each additional traumatic
experience in an individual's lifetime contributes to a 20.1% increase in the likelihood of
suicidal ideation and a 38.9% increase in the probability of making a suicide attempt.
Furthermore, past studies have found that the combined (vs. independent) presentation of major
depressive disorder and PTSD is associated with greater levels of suicidal ideation.

Additionally, individuals who are experiencing PTSD symptoms alone or with major
depressive disorder seem to demonstrate a greater frequency of suicide attempts than those who
experience major depressive disorder symptoms alone. Examining the records for individuals
who have died by suicide, found that after accounting for other psychiatric and demographic
variables, the presence of a PTSD diagnosis increased the odds of dying by suicide by
approximately 10%. A meta-analysis examining the association between PTSD and suicide also
found PTSD to be associated with prior suicide attempts and suicidal ideation even after
controlling for other psychiatric disorders.

Extant research examining the role of PTSD on suicidality in US military service members
have yielded incongruent conclusions in regards to the specific PTSD symptom clusters that
contribute to suicidal ideation and suicidal behavior. These disparate findings likely emerged
from the use of statistical models that did not consider a General PTSD factor. Specifically, past
studies examining the relationship between specific PTSD symptom clusters and suicidality
often used correlated factor models which do not account for the shared variance between the
symptom clusters. The use of these models suggest that individual PTSD symptom clusters
independently contribute to suicidal ideation and behavior and imply that treatment, for
individuals exhibiting PTSD symptoms and elevated suicidality, should prioritize and address
the specific symptom clusters most strongly with suicidal ideation and behavior. Given the lack
of consistency in PTSD symptoms found to impact suicidality, however, it is still unclear as to
which PTSD symptom clusters should be prioritized in treatment to decrease suicide risk.

Article 2 -
“Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A
randomized clinical trial in military veterans“

Substance use disorders and posttraumatic stress disorder (PTSD) are two of the most prevalent
psychiatric disorders in the United States. In the general population, lifetime estimates are
approximately 29.1% for alcohol use disorder, the most common SUD, and 8.3% for PTSD.
Among military personnel and veterans, rates of SUD and PTSD are 2–4 times higher than in
the general population

Integrated treatments, in which both disorders are addressed concurrently, may help optimize
outcomes. Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged
Exposure (COPE) is an integrated treatment that utilizes Prolonged Exposure in combination
with cognitive behavioral therapy for SUD. Previous studies of COPE among civilians
demonstrate efficacy in reducing SUD and PTSD severity

Given the sustained military operations in Afghanistan and Iraq, and the disproportionately
high rates of SUD and PTSD among veterans, the current study addresses a clinically important
need by evaluating, for the first time, the efficacy of COPE among military veterans. An active
treatment control group was used to control for time and therapeutic attention. Article
hypothesized that the integrated treatment would reduce self-report and clinician-rated PTSD
symptoms, as well as SUD severity (i.e., percent days using and abstinence rates) significantly
more than the control group at the end of treatment (session 12).

In summary, in this sample of veterans with extensive military-related trauma, COPE resulted
in significantly greater reductions in PTSD severity, higher rates of PTSD diagnostic remission,
and comparable reductions in SUD, as compared to RP. Importantly, there were no treatment
group differences in measures of therapeutic alliance, retention, or number of adverse events.
Article 3 -
“Examining the nonresponse phenomenon: Factors associated with treatment response in a
national sample of veterans undergoing residential PTSD treatment”

Treatment nonresponse in PTSD remains poorly characterized. Investigations of this topic are
commonly based on secondary analyses of randomized trials that have utilized stringent
exclusion criteria and, consequently, their findings may not generalize to the more complicated
patients with PTSD who are typically treated by the Department of Veterans Affairs (VA). It is
likely that the small sample sizes and relatively homogenous composition of these studies may
also contribute to their inconsistent findings.
For example, controlled trials may exclude individuals who are likely to be poorly responsive to
treatment. As opposed to controlled trials, standard clinical care is often conducted with providers who
have less time to devote to patient care and must treat a broader spectrum of patient presentations.
Thus, outcomes of standard clinical care may vary substantially from the outcomes of clinical trials. In
order to answer the critical question of what predicts poor treatment response in standard care,
additional research using naturalistic datasets that include a broader range of severity and comorbidity
is needed. The current study addresses this critical area by identifying predictors of poor treatment
response in a large, national sample of individuals undergoing routine care at residential PTSD
programs.

Article analyzed predictors of treatment response among a national sample of Veterans engaged in
residential treatment and found that several individual-level factors predicted treatment response. These
included modifiable factors such as self-efficacy, social support, and pain, and non-modifiable factors
such as sex, race, and level of education. These findings highlight factors that place individuals at risk
of poor treatment response. Methods for optimizing treatment to better fit the needs of these at-risk
subgroups merit future study. Future work is also needed to determine whether these factors generalize
to outpatient or non-Veteran populations. Overall, 65% of Veterans experienced a decrease in PTSD
symptoms and only 36% experienced clinically significant improvement, highlighting the need for
continued efforts to improve treatment outcomes for this population.
In conclusion, article investigated predictors of treatment response among a large national sample of
Veterans undergoing residential PTSD treatment, and found that minority Veterans, Veterans with pain,
and Veterans with fewer protective factors were at risk for poor treatment response. Recommendations
for future research might include augmenting evidence-based treatment with interventions to address
these risk factors. Further research is needed on potential treatment disparities between subgroups
within programs and on methods for modifying treatment to better fit the needs of such at-risk
subgroups. Improving access to and delivery of high-quality care for individuals at risk of poor
outcomes remains a priority for VA.

Conclusion
Psychotraumatization continues to be a pervasive aspect of life in the 21st century all over the
world so we should better understand psychological trauma and PTSD for the sake of
prevention and healing.

PTSD is a complex highly disabling and suffering disorder where the past is always present in
people haunted by the dread frozen in memory of the traumatic events. However, PTSD also
represents an oportunity for psychological and spiritual growth due to the human ability to
adapt and thrive despite experiencing adversity and tough times.

Most chronic PTSD sufferers presenting for treatment will receive medication [35]. Many will
also receive some form of psychological treatment, although there are often long waits for such
treatment
Some anti-depressants appear to have a modest beneficial effect and are recommended as a
second-line treatment. The current evidence base has allowed the development of guidelines
that now require implementation. This has major implications in terms of planning and
developing services that allow appropriately qualified and trained individuals to be available to
cater adequately for the needs of survivors of traumatic events.
References