One of the main dilemmas that we face
in the military sector right now is that
both mild traumatic brain injury and post-traumatic stress disorder
are reported to be extremely prevalent
in today's military population, particularly amongst those serving
in Iraq and Afghanistan.
To complicate matters further, we also know that there is a large body of military
personnel that likely have overlapping disorders.They have the comorbidities
of mild traumatic brain injury and post-traumatic stress disorder
that are co-existing.
To complicate matters even further, the signs and symptoms of those two disorders
oftentimes are nonspecific. They overlap,
meaning the signs and symptoms of post-traumatic stress disorder
may be identical to those that are observed in mild traumatic brain injury.
The dilemma that the clinician faces is trying to split that hair
as to determining whether or not this military person in front of me in clinic
has primarily post-traumatic stress disorder or primarily the lingering effects
of mild traumatic brain injury, and based on that distinction, what's the
best-practice course of treatment that I could prescribe for that individual?
In the case of post-traumatic stress disorder, there are reasonably well-established
cognitive behavioral approaches to treatment that have demonstrated
success, both in the military and in the civilian populations over many years.
Those treatment methods are tried and true
for individuals with diagnosed PTSD,
and they are often customized to the form of trauma and the
predominant pattern of symptoms that the individual is exhibiting--
either predominantly anxiety, depression, avoidance of daily activities
that remind them of the trauma, etc.
Unfortunately, the approaches to treatment for mild traumatic brain injury
are less well-developed and not as well-understood.
We're in the process of developing interventions--
cognitive behavioral interventions that are along a parallel of what
has been established for PTSD over the years
that we're hoping will be effective in managing many parts of the
biopsychosocial model following mild traumatic brain injury
and ultimately reducing the incidence
of post-concussion syndrome
These interventions are intended to
reduce post-concussive symptoms during the acute and subacute phase
and decrease an individual's risk of eventuating into chronic post-concussion syndrome.
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Symptoms of PTSD and post-concussive syndrome can overlap significantly. Should they be treated the same way?
Produced by Victoria Tilney McDonough and Brian King, BrainLine.
Michael McCrea, PhD is the executive director of the ProHealth Care Research Institute and Neuroscience Center near Milwaukee, Wisconsin. He is a board-certified clinical neuropsychologist and has headed up the Neuropsychology Service at Waukesha Memorial Hospital since 1996.
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