Treatment Options for Individuals with PTSD and Concurrent TBI: A Literature Review and Case Presentation

Abstract

Posttraumatic stress disorder (PTSD) is a well-studied mental health condition with existing guidelines and algorithms for treatment of PTSD. Those guidelines, while acknowledging an increased complexity, fail to provide clear PTSD treatment guidelines when an individual has a concurrent traumatic brain injury (TBI) diagnosis. Therefore, a literature review along with an accompanying case presentation is presented to demonstrate the minimum necessary considerations for approaching treatment of this complex population. Treatment approaches must be lead by providers that have the expertise and training necessary to consider all facets of the patient and their potential options. The provider must consider the pathophysiology of PTSD and TBI and be capable of leading a team to identify the patient's source(s) of dysfunction, current cognitive abilities, and potential indications for psychotropic medications and/or other types of therapeutic intervention.

Visualizing traumatic stress-induced structural plasticity in a medial amygdala pathway using mGRASP

“…As of 2021, nearly one in five adults in the United States were diagnosed with a mental illness, and depressive disorders are a leading cause of disability (National Institutes of Health and the Substance Abuse and Mental Health Services Administration). Current treatment modalities, including pharmacotherapy and psychotherapy, have remained largely unchanged for decades, and often come with limitations such as adverse side effects and low remission rates ( Sachsse et al, 2006 ; American Psychiatric Association [APA], 2013 ; Watson et al, 2016 ; Bartsch and Nordman, 2022 ). These issues underscore the urgent need for innovative research methods to enhance our understanding and treatment of psychiatric conditions.…”

A Pilot Study of the Effects of Mindfulness-Based Stress Reduction on Post-traumatic Stress Disorder Symptoms and Brain Response to Traumatic Reminders of Combat in Operation Enduring Freedom/Operation Iraqi Freedom Combat Veterans with Post-traumatic Stress Disorder

“…Previous studies have outlined a network of brain regions involved in symptoms of PTSD ( 63 – 65 ) that show functional responses to successful treatment ( 66 ). Brain imaging studies have identified a network of brain regions involved in the symptoms of PTSD that includes the amygdala, prefrontal cortex, hippocampus, parietal cortex, and insula ( 63 ), brain regions that play an important role in both memory, fear learning, and the physiological response to threat ( 67 ).…”

“…A hypoactive frontal lobe leads to impairment in the differentiation of benign stresses from true stresses, consequently leading to reduction in the suppression of the amygdala manifesting as a hypervigilant state that is seen in PTSD ( 65 ). Fear learning paradigms have shown an increase in amygdala function in PTSD, and studies have shown both smaller hippocampal volume ( 91 – 93 ) and decreased function with memory tasks in PTSD patients.…”