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PTSD requires individualized care

We asked Dr. Dodge Slagle, a psychiatrist and assistant professor at Touro University Nevada College of Osteopathic Medicine, about post-traumatic stress disorder.

Review-Journal: Post-traumatic stress disorder is most often associated with military veterans. What are other triggers of this condition?

Dr. Slagle: Any person exposed to actual or threatened death, serious injury or sexual violence may develop symptoms of PTSD. Persons involved in serious motor vehicle accidents, victims of physical or sexual assault, as well as the family members and close friends of such individuals, may develop PTSD symptoms. First responders (police, firefighters, medical personnel) may develop symptoms of PTSD.

Do treatment options vary based on what has caused a person’s PTSD?

Every person’s experience of a severe trauma is different, although there are some commonalities. Two soldiers in the same foxhole may experience the trauma of the battle differently. Children will have a different experience of trauma than an adult will have of that same event. Treatment plans are best individualized to the kinds of symptoms each patient is experiencing. When group psychotherapy is used as a treatment, it is best to have patients who have had similar traumatic experiences. (Survivors of rape will understand each others’ experiences better than they would understand the experiences of survivors of combat.)

How has treatment of PTSD evolved over time and does the medical community agree on a preferred treatment?

The treatment of PTSD involves individual, family or group psychotherapy, exposure therapy, stress management, eye movement desensitization and reprocessing (EMDR), medication, or some combination of these treatments. Psychotherapy is often focused on correcting the distorted thoughts that a patient has about his experience of the trauma, such as survivor guilt. Controlled exposure to memories or actual environmental factors that have provoked symptoms is usually coupled with relaxation exercises. EMDR is a relatively new treatment, and still requires study, but has some evidence of effectiveness for PTSD. Medication usually involves antidepressants for patients with substantial depressive and anxiety symptoms. More recently, prazosin has shown promise for nightmares and hypervigilance. These are the most widely accepted treatments, although all will benefit from further research.

Many patients have reported on the benefits of medical marijuana, but medical research on this remains scant.

Once a person has been diagnosed with PTSD, will she always suffer its effects on some level?

This likely largely depends on the severity of the symptoms. PTSD varies in duration among individuals, often relating to personal characteristics and the nature of the trauma to which a person is subjected. Some patients recover fully, and most patients are able to resume a normal level of functioning after a period of recovery or treatment. Unfortunately, many patients with PTSD never engage treatment, or fail to complete treatment. Any of us who experiences a substantial trauma, whether we warrant a diagnosis of PTSD or not, are forever changed by the experience. This change can be positive, such as in enhancing an individual’s appreciation of his life.

What do you see in the offing or in research being done on the future of treatment?

Future directions for research will include increasing accessibility of treatment for specific populations. Studies will help us better understand the mechanisms of different treatments and help us better individualize treatment.

If you are a medical professional who would like to be considered for this feature, please send an email with your name, a brief description of your expertise and your contact information to health@reviewjournal.com.

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