PTSD

[Doc_Pardue]

Traumatic Stress Disorder, Dementia Linked In WWII Vets


Science Daily (http://www.sciencedaily.com/) — WINSTON-SALEM, N.C. - For World War II and Korean War veterans who develop dementia as they age, there's a risk that painful war memories may be unlocked, triggering violent episodes of post-traumatic stress disorder (PTSD), reports Dr. Deirdre Johnston of Wake Forest University Baptist Medical Center in January's issue of the Journal of the American Geriatrics Society. "In appears that some veterans are able to suppress their war memories and function quite normally for most of their lives," said Johnston, assistant professor of psychiatry. "But, with the onset of dementia, the ability to manage the traumatic memories can be lost, which can give rise to violent outbursts that can threaten spouses or caregivers."


Johnston said PTSD symptoms can appear for the first time with the onset of dementia or re-appear after years of "managing" the memories. Johnston - the first to report the possible link - said more research is needed because of the large number of war veterans who are at risk of developing dementia.

"There are about 600,000 war veterans older than 65 who are at risk of developing dementia," said Johnston. "We need to learn how frequently dementia and PTSD occur together and find out how the ability to manage these distant memories breaks down as dementia develops."

Johnston, who has seen numerous examples of the phenomenon in Veterans Administration treatment centers and other settings, reported on three cases in the article. In one, a 78-year-old combat veteran attempted to strangle his wife in her sleep. On an earlier occasion, she was awakened by him shooting at the bedroom drapes, which he believed were assailants. Another veteran, 77-years-old, without any prior history of aggression towards his wife, piled furniture in the living room to create a fort and ambushed her when she returned from the grocery store. He shot her five times with a .22 caliber rifle.

The third veteran, 68-years-old, would call out in his sleep, "We're under attack." At times, we would wake his wife by calling out from behind the bed, "Get down, get down, we're under fire." He began to keep a loaded gun under the bed. In each case, the veterans showed no signs of violence until they developed dementia.

PTSD has been recognized in combat veterans, ex-prisoners of war, disaster survivors and survivors of sexual and physical abuse. It can occur when someone experiences or witnesses a life-threatening or dangerous situation and feels intense horror, fear or helplessness. People with PTSD avoid things that remind them of the trauma. Their symptoms can include anxiety, restlessness, disturbed sleep, nightmares, irritability, outbursts of anger and hostile behavior. Though PTSD has been studied extensively in Vietnam War veterans, there is evidence it is under-diagnosed in WWII veterans. One study indicates that serving in combat increases the likelihood of PTSD; veterans exposed to heavy combat were found to have a 13 times greater risk of having PTSD than non-combat veterans after 45 years.

"The evidence suggests that many of the individuals who served in combat are likely to have dormant or partially controlled PTSD," said Johnston. "It is of pressing importance to explore the relationship between PTSD and dementia in this aging population."


Note: This story has been adapted from a news release issued by Wake Forest University Baptist Medical Center.

[Doc_Pardue]

When war memories interfere with your everyday life

Clinical psychologist says holidays can be a trigger for vets

By PAUL FATTIG
Mail Tribune

The holidays are often stressful for war veterans, particularly those suffering post-traumatic stress disorder, observed clinical psychologist Je t'aime Hood.

"The holiday period is a hard time for them," said Hood, head of the trauma rehabilitation program in psychology services at the U.S. Department of Veterans Affairs' Southern Oregon Rehabilitation Center and Clinics in White City.

"Post-traumatic stress disorder and all trauma effects are directly related to memories of the past interfering with our normal, everyday functioning, " she explained. "That happens by something going on in the environment bringing up or triggering the memory."

And no holidays compare with Christmas and New Year when it comes to generating memories, she said.

"It can be anything - songs on the radio, the smell of cookies baking, Santa in somebody's office," she said.

"Those memories may be good but just the fact your brain is working more on memories is going to make the other stuff come up," she added. "This time of year, we focus a lot on helping people get through the holidays and how to take care of yourself."

If a veteran is about to leave the facility before the holidays, he is encouraged to stay on until after New Year's Day, she said.

"This is a safe place to do that," she said. "There are other people to talk to. There are other vets they can rely on."

Since the United States sent troops into Afghanistan and Iraq, some 250 soldiers returning from those wars have sought help at SORCC, she estimated.

"It's still a trickle but we are seeing a gradual increase," Hood said.

About 17 percent of the soldiers returning from combat zones suffer from PTSD, according to Scott McCrae, director of the Oregon National Guard post-deployment reintegration team. A recent U.S. Department of Defense study concluded that roughly 20 percent of those returning from Iraq have mental health issues.

"Anger is the biggest issue they are dealing with," Hood said of her experience working with veterans. "That includes anger that things have changed, anger that they've come back and things aren't like they dreamed how it would be, and anger that they've changed.

"A lot of them are angry that they no longer enjoy the things they used to," she added. "Many have a feeling of distance from their old lives, feeling a loss of connection."

However, unlike veterans of Vietnam or Korean conflicts, veterans returning home since the Gulf War have been met with open arms, she observed.

"What they want to do is get back to their lives, to their loves ones, to their jobs," she said. "Most of them are young. They have dreams and hopes."

In addition to PTSD, many soldiers are returning with physical trauma to their heads after surviving roadside bombs, she said, referring to what is known as "improvised explosive devices" in today's military parlance.

"Because of the armor and because our physical trauma treatment has gotten so much better, more people are surviving," she said. "That's a great thing. But more people are surviving with more serious head trauma. It's hard to protect the brain.

"That means we will have more people who are dealing with physical or emotional trauma," she added. "And that requires long-term care."

Psychologists commonly use two approaches to help veterans resolve PTSD issues, including the classic method known as habitation, she said.

"A example of that would be if you have a new puppy in your house," she said. "Every time you go through your screen door, it bangs shut. The first day the puppy is in the house and the screen door bangs, the puppy is going to jump, bark and look around. But the longer that puppy is in the house, the smaller and smaller that reaction will be."

Likewise, veterans who come in and talk about their traumas over and over tend to have smaller and smaller reactions, she said.

"Unfortunately, recent research has shown there is a subgroup of people whose reaction gets bigger and bigger instead of smaller," she said.

Those folks may be initially helped by the habitation approach only to have a relapse with even worse symptoms, she said.

"They would react stronger to things like someone cutting them off in traffic," she said.

A newer method doesn't involve talking to the veteran about his or her specific experiences, she said.

"Instead, we teach them how their brain and body have been affected by trauma," she said. "Then we teach them some specific techniques they can do to either manage that change or actually start to undo that change over time."

The latter works best in a group format because there are no problems with confidentiality, she said.

"We focus on what our lives are like today, what we want our lives to be like tomorrow and how we get there," she said. "We are finding it very successful for both the older veterans from other wars and the newer returning vets."