Effects of war: PTSD and TBI defined Published Aug. 25, 2009 By Justin Oakes 56th Fighter Wing Public Affairs LUKE AIR FORCE BASE, Ariz. -- It wasn't until shortly after the Vietnam War that physicians identified two serious medical conditions found in servicemembers who engaged in combat - post traumatic stress disorder and traumatic brain injury. Dr. Cynthia Boyd, a neuropsychologist, and Kimberly Meyer, a neuroscience clinician, from the Defense and Veterans Brain Injury Center visited Luke Air Force Base, Aug. 21, to discuss the symptoms, similarities and the differentiation between PTSD and TBI. The Defense and Veterans Brain Injury Center has been assessing and treating both conditions since the early 90s. "Let me be clear that PTSD and TBI may share similar symptoms, but are not the same." said Dr. Boyd. "TBI occurs when a sudden trauma causes damage to the brain. It can result when the head suddenly and violently hits an object or when an object pierces the skull and enters brain tissue, and the individual must experience a loss of consciousness." Injuries from TBI can be both visible and invisible and encompass different severity levels. "Visible injuries will be apparent, but the invisible injury will be harder to detect,"Dr. Boyd said. "One of the most common invisible injuries is a concussion resulting from a blast." The severity of the injury is determined by multiple factors. The amount of time an individual remains unconscious is one such factor. If an individual remains unconscious for less than 30 minutes, then it would fall under the mild category. A moderate injury is classified as remaining unconscious for one to 24 hours, and a severe TBI would include a period of greater than 24 hours. "On the severe end of the spectrum, injuries would warrant immediate evacuation out of theater with a rare likeliness to return to duty, and would require rehabilitation," Dr. Boyd said. "A mild case of TBI does require rehab, but can be medically managed in theater if detected. Changes in performance and family discord are indicators in mild cases and may not be clear until out of theater." Physical symptoms of TBI include headaches, dizziness, fatigue, hearing impairment and light sensitivity. Cognitive symptoms would indicate memory loss, affect word-finding capabilities, concentration and problem-solving skills. Behavioral symptoms reflect personality changes, desire for solitude and irritability. "Most of the patients I see that suffer from TBI are from OEF and OIF," Dr. Boyd said. "In a majority of cases, conditions will gradually resolve from a period of days to weeks." There are several treatments that can speed up the recovery process. "Rest with non-stimulus, education, headache management and placing duty restrictions on the member are several ways we treat TBI," Ms. Meyer said. "We repeat evaluations every 72 hours and allow the individual to return to duty when he or she is symptom free and can test (exercise) without a recurring system." Along with TBI, PTSD is another result of war. The Encyclopedia of Mental Disorders defines PTSD as a complex disorder in which a person's memory, emotional responses, intellectual processes, and nervous system have all been disrupted by one or more traumatic experiences. A patient cannot be given a diagnosis of PTSD unless they have been exposed to an event that is considered traumatic, such as combat during war. "PTSD is an anxiety disorder and is the fifth most common psychological disorder," Dr. Boyd said. "Servicemembers from all eras are diagnosed with PTSD, but there is definitely a chronic case with individuals from the Vietnam War. Decades after Vietnam, 15 percent of combat veterans still have PTSD." Symptoms of PTSD include irritability, mood swings, withdrawal, sleep depravation, forgetfulness and lack of concentration. "There are several ways PTSD can be managed," Ms. Meyer said. "While the memory of a traumatic event may never be fully erased, individual therapy followed by group therapy and medication options help the person manage the disorder." For more information relating to TBI and PTSD, contact the Defense and Veterans Brain Injury Center at info@dvbic.org or call (800) 870-9244.