PTSD and mTBI: Teasing Out the Differences for Treatment
Symptoms of PTSD and post-concussive syndrome can overlap significantly. Should they be treated the same way?
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.
Posted on BrainLine October 20, 2010.
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.