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Concussion and PTSD: Not the Same, but Cousins

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[Dr. Geoffrey Ling] The question of post-traumatic stress disorder, we do recognize they are cousins. They often come together. They're not the same thing but they're very related. In the military, post-traumatic stress disorder is often a comorbid state— in other words, comes along with a traumatic brain injury— and that's because how did the soldier get a brain injury? They got an injury because they were exposed to an explosive blast. And you can imagine in that blast some of their friends may have been injured, potentially killed, and that of course is going to give them not only an injury to the brain but also an injury to the mind, which is what I consider post-traumatic stress disorder to be. So they're colocated. In the military system, it is very common for soldiers to get both care for a concussion, at the same time getting care for combat stress by the combat stress teams. In terms of our personal work trying to delineate the two, that has not been really fully accomplished yet. We recognize, as I said, that they often happen together, but we recognize they are two separate, distinct conditions. So the management of one is very different, necessarily, than the management of the other, and there is no, at the moment, combined way of approaching both. So, sadly, we have to approach each individually. It is very common for a person with a traumatic brain injury to be managed by medical professionals who are focused on the brain injury, at the same time being managed by behavioral health, mental health providers to manage the TBI issue. I think it comes in that system of care again. So if you recognize that it's not going to be one fix but maybe multiple fixes, it becomes a multidisciplinary approach, and that's probably the best. For me as a clinician who has taken care of many of these injured patients, many of whom have both at the same time a traumatic brain injury and a combat stress-related disorder, such as post-traumatic stress disorder, PTSD or PTS, I would say that my experience has really helped me in terms of managing these patients. Number one is I'm aware that first and foremost you won't know until you ask. And so to be aware that these two conditions often occur at the same time, the awareness is very important. The second thing is to recognize that the treatment of one doesn't necessarily impact the treatment of the other, either for good or bad, and that is very important because then I have learned how to become a good partner to my colleagues in the behavioral health world—the psychiatrists, the psychologists, the clinical licensed social workers. It's very important to work together to take care of a patient so that the left hand knows what the right hand is doing. And I would say third is that recognizing that before— early on before we recognize that these came together— is that in fact if you don't take care of one or the other, the recovery from the disease that you are managing is almost impossible. And in fact we've found that these soldiers with mild concussion who are not getting better, the vast majority is not because of the concussion but because of the untreated PTS, the untreated post-traumatic stress. And so that insight—which finally I think many of us have registered to— realize that if you don't treat one, you're not going to cure the other.

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Dr. Geoffrey Ling talks about the importance of an interdisciplinary team to treat TBI and PTSD because oftentimes, if one is left untreated, treatment for the other often stays stalled.

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Produced by Noel Gunther, Ashley Gilleland, and Erica Queen, BrainLine.


Geoffrey Ling, MD, PhD, Col. (Ret.)Geoffrey Ling, MD, PhD, Col. (Ret.), Geoffrey Ling, MD, PhD is a program manager at the Defense Advanced Research Projects Agency, where he has responsibility for a broad research portfolio. Dr. Ling is an authority on traumatic brain injury, especially as it pertains to the military.


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