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Treatment Options for Individuals with PTSD and Concurrent TBI: A Literature Review and Case Presentation

  • Military Mental Health (CH Warner, Section Editor)
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Abstract

Posttraumatic stress disorder (PTSD) is a well-studied mental health condition with existing guidelines and algorithms for treatment of PTSD. Those guidelines, while acknowledging an increased complexity, fail to provide clear PTSD treatment guidelines when an individual has a concurrent traumatic brain injury (TBI) diagnosis. Therefore, a literature review along with an accompanying case presentation is presented to demonstrate the minimum necessary considerations for approaching treatment of this complex population. Treatment approaches must be lead by providers that have the expertise and training necessary to consider all facets of the patient and their potential options. The provider must consider the pathophysiology of PTSD and TBI and be capable of leading a team to identify the patient’s source(s) of dysfunction, current cognitive abilities, and potential indications for psychotropic medications and/or other types of therapeutic intervention.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Defence Centers of Excellence For Psychological Health & Traumatic Brain Injury [Internet]. Maryland: Defence Centers of Excellence For Psychological Health & Traumatic Brain Injury; 2016 [cited 2016 Feb 15]. Available from: http://www.dcoe.mil/psychologicalhealth/provider_resources.aspx.

  2. VA/DoD Clinical practice guideline for management of post-traumatic stress [Internet]. Washington DC: U.S. Department of Veterans Affairs National Center for PTSD; Date of first publication unknown 2016 Jan 5; [cited 2016 Feb 15]. Available from: http://www.ptsd.va.gov/professional/index.asp.

  3. Kaufman DM, Milstein MJ. Kaufman’s clinical neurology for psychiatrists. 7th ed. Traumatic Brain Injury. New York: Saunders Elsevier; 2015. p. 527–536.

  4. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock’s synopsis of psychiatry, Trauma and stressor related disorders. 11th ed. New York: Wolters Kluwer; 2015. p. p. 437–450.

    Google Scholar 

  5. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock’s synopsis of psychiatry, Neural sciences. 11th ed. New York: Wolters Kluwer; 2015. p. 1–92.

    Google Scholar 

  6. Welton R, Kay J. The neurobiology of psychotherapy. Psychiatric Times [Internet]. 2015 October [cited 2016 Feb 15]. Available from Psychiatric Times: http://www.psychiatrictimes.com/neurobiology-psychotherapy This study used neuroimaging to demonstrate that therapy restores frontal lobe functioning and brings the amygdala back into regulation. Thus demonstrating the mechanism of action found with the resolution of the neuroanatomic dysfunction found in PTSD.

  7. Hoffman SW, Harrison C. The interaction between psychological health and traumatic brain injury: a neuroscience perspective. The clinical neuropsychologist [Internet]. 2009 October [cited 2016 Feb 15]. Available from Taylor & Francis Online: http://www.tandfonline.com/doi/abs/10.1080/13854040903369433.

  8. Tasman A, Kay J, Lieberman JA, First MB, Maj M. Psychiatry. 3rd ed. In: Meaney MJ, LeDoux JE, Liebowitz ML. Neurobiology of anxiety disorders. West Sussex, England: Wiley-Blackwell; 2008 p. 317–338.

  9. Silver JM, McAllister TW, Yudofsky SC. Textbook of traumatic brain injury. 2nd ed. Arlington: American Psychiatric Publishing Inc; 2011.

    Google Scholar 

  10. Arciniegas DB, Zasler ND, Vanderploeg RD, Jaffee MS, Garcia TA. Management of adults with traumatic brain injury. 1st ed. Arlington: American Psychiatric Publishing Inc; 2013.

    Google Scholar 

  11. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock’s synopsis of psychiatry. 11th ed. Examination and diagnosis of the psychiatric patient. New York: Wolters Kluwer; 2015. p. 192–289.

  12. Hetrick SE, Purcell R, Garner B, Parslow R. Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD). The Cochrane Collaboration. 2010: issue 7.

  13. Mintz D. Meaning and medication in the care of treatment-resistant patients. Am J Psychother. 2002;56(3):322–37.

    PubMed  Google Scholar 

  14. Hoskins M, Pearce J, Bethell A, Dankova L, Barbui C, Tol WA, et al. Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. The British Journal of Psychiatry. 2015;206:93–100. This study demonstrates that certain SSRI medications have a small benefit to PTSD treatment.

    Article  PubMed  Google Scholar 

  15. Puetz TW, Youngstedt SD, Herring MP. Effects of pharmacotherapy on combat-related PTSD, anxiety, and depression: a systematic review and meta-regression analysis. PLoS One [Internet]. 2015 May [cited 2016 Feb 15]. 10(5) Available from Public Library of Science: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126529 This study demonstrates the lack of data to support efficacy of a unilateral pharmacologic approach for PTSD Treatment.

  16. Anacker C, Zunszain PA, Cattaneo A,Carvalho LA, Garabedian MJ,Thuret S, et al. Antidepressants increase human hippocampal neurogenesis by activating the glucocorticoid receptor. Pub Med Central [Internet]. 2011 Jul [cited 2016 Feb 15]. Available from PMC: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121947/.

  17. Abrams TE, Lund BC, Bernardy NC, Friedman MJ. Aligning clinical practice to PTSD treatment guidelines: medication prescribing by provider type. Psychiatric Services [Internet]. 2013 Feb [cited 2016 Feb 15]; 64 (2):142–148. Available from Psychiatric Services: http://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201200217 This study demonstrates that in spite of literature supported contraindications to certain traditional treatment for PTSD, such as benzodiazapines, providers continue with traditional treatment modalities in spite of the contraindications.

  18. Guina J, Rossetter SJ, DeRhodes BJ, Nahhas RW, Welton RS. Benzodiazepines for PTSD: a systematic review and meta-analysis. Journal of Psychiatric Practice. 2014 Jul. 21(4) 281–303. This study demonstrates that, though traditionally used, the long term harm associated with the use of benzodiazepines merits a contraindication.

  19. Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults (Review). The Cochrane Collaboration. 2013: issue 12.

  20. Levi O, Bar-Haim Y, Kreiss Y, Fruchter E. Cognitive-behavioural therapy and psychodynamic psychotherapy in the treatment of combat-related post-traumatic stress disorder: a comparative effectiveness study. Clinical Psychology and Psychotherapy [Internet]. 2015 Available from wiley online library: http://onlinelibrary.wiley.com/doi/10.1002/cpp.1969/abstract This study demonstrates that long term outcomes PTSD treatment are not dependent on therapy styles as multiple styles have similar long term outcomes.

  21. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. soldiers returning from Iraq. N Engl J Med. 2008;358(5):453–63.

    Article  CAS  PubMed  Google Scholar 

  22. Carlson KF, Kehle SM, Meis LA, Greer N, MacDonald R, Rutks I, et al. Prevalence, assessment, and treatment of mild traumatic brain injury and posttraumatic stress disorder: a systematic review of the evidence. J Head Trauma Rehabil. 2011;26(2):103–15.

    Article  PubMed  Google Scholar 

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Correspondence to Hans R. Watson.

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The views expressed in this paper are those of the authors and do not reflect the views of the US Department of Defense. None of the authors have a conflict of interest to report.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Military Mental Health

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Watson, H.R., Ghani, M. & Correll, T. Treatment Options for Individuals with PTSD and Concurrent TBI: A Literature Review and Case Presentation. Curr Psychiatry Rep 18, 63 (2016). https://doi.org/10.1007/s11920-016-0699-9

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  • DOI: https://doi.org/10.1007/s11920-016-0699-9

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