Multi-disciplinary Assessment and Treatment of PTSD

The model we present from a medical, psychological, psychiatric and neurological perspective, holds that there are a multitude of meanings, often encapsulated in the vivid dreams, from which new perceptions develop before they become the difficult to diagnose and treat behavioural, cognitive and affective manifestations of this disorder.

Various individuals who seem to cope very well with a multitude of significantly stressful situations may find themselves in environments where those coping mechanisms become largely inadequate, causing a rapid and disruptive transition from being coping individuals to inadequate individuals, simply because the defence mechanisms used in the past to cope with various stress situations cannot sustain and maintain the psychological safety net based on external factors such as trust and social support. Ironically it is often similar stressors that in past experiences were adequately managed, that for some incomprehensible reason in different circumstances become significantly traumatizing. Effective and appropriate psychological treatment when the reaction is still of a nature deemed to be acute stress, can do much to not only reduce but alleviate this reaction while serving as inoculation against future traumatic stressors.

However, the tendency to see all trauma and stress reactions as purely psychological may well have caused even further trauma. One of the strongest criticisms against many well-meaning psychologists and other trauma counsellors is the fact that we have created a fit-one-fit-all psychological treatment modality to treat PTSD, in the process missing the important changes that take place physiologically in PTSD patients.

This is were the very fascinating field of neurology plays a major role to show us how the brain functions and what changes in brain function are effecting mood, behaviour and daily function. In addition, many PTSD sufferers may also have sustained mild traumatic brain injury, adding to the complexity of the patients' presentation. Evidence gleaned from functional MRI and SPECT Scans suggests that PTSD simulates mild traumatic brain injury. Objective medical evidence from the neurological component, as well as sleep studies, invariably feed further investigation aimed developing models of understanding the phenomenon. Aside from the devastating impact of PTSD symptoms, many of our patients smoke excessively and this requires the assistance also of respiratory medicine.

Psychiatry with its perspective based on the biological model lends itself well to the pharmacology of PTSD. The function of psychiatry in the management of Posttraumatic Stress Disorder consists of the critical use of the diagnostic criteria according to DSM IV and the use of pharmacological agents either directly or in consultation to the family physician. The function of psychiatry in the management of PTSD is best deployed in cooperation with the other disciplines involved in the management and treatment of the impairments and symptoms associated with this syndrome. Psychiatry can also play a major role in the treatment of symptomatic interference with function and a complementary role with other disciplines in the management and correction of deficits.

One area specifically the most affected by PTSD, is sleep. Our neuropsychiatry investigations point strongly towards the role of REM sleep that is selectively impaired in PTSD, losing its function to preserve the permanent characteristics of the organism, in a species with no or limited capacity for neurogenesis of the species. In particular, the work of Jouvet shows how acute stress can interfere with the normal architecture of sleep and the integration of stressful environmental changes with the individual system of emotionally charged memories, thus leading to the disturbing and massively distressing nightmares so characteristic of many PTSD sufferers. This model serves well to explain why some PTSD sufferers fiercely resist sleep, opting to stay in the wide awake state, rather than allow themselves to be subjected to these very distressing, overwhelming and affect laden sleep experiences.