Over the past few years, there has developed a deeper understanding of the inter-relationship between physical and mental health. Mental health problems are real, affecting one’s thoughts, body, feelings and behavior. These feelings and behaviors are not just a passing phase and can be sufficiently severe to seriously interfere with the conduct of a sufferer’s life. And nowhere does this more apply than with posttraumatic stress disorder, or PTSD. Commonly most associated these days with the effects on adults of war and terrorist events, PTSD can in fact occur in persons of all ages, including childhood, for a variety of reasons; it is an anxiety disorder that can occur after a person has been through any traumatic event, grandiose or personal.
According to the DSM-IV-TR, the essential feature of PTSD is the development of certain symptoms following an extremely stressful event involving direct personal experience that involves actual or threatened death or serious injury, a threat to one’s physical integrity, witnessing an event that involves death/ injury, a threat to the physical integrity of another person, or learning about the unexpected or violent death, serious harm, threat or injury to another close associate. The person’s response to the event involves intense fear, helplessness or horror.
There are four types of symptoms related to PTSD: Reliving the event, Avoidance; Numbing, and Increased arousal. Such symptoms may occur immediately following the event, as a delayed experience, or intermittently over several years. Symptoms can be terrifying, disrupt individuals’ lives and impede their ability to function in their daily activities. In patients with PTSD, the body’s failure to return to its pretraumatic state differentiates posttraumatic stress disorder from a simple fear response. Symptoms must occur for a period of more than one month to qualify for a diagnosis of PTSD; symptoms occurring for less than three months are diagnosed as acute PTSD and for longer than three months as chronic PTSD.
Estimated rates of the prevalence of posttraumatic stress disorder in the community range between 7% and 12% (Yager, 2007). Approximately 25 to 30 percent of victims of significant trauma develop PTSD (Grinage, 2003). PTSD has been associated with high use of medical services. The condition is associated with significantly higher odds of having asthma, chronic obstructive pulmonary disease, chronic fatigue syndrome, arthritis, fibromyalgia, migraine headaches and other respiratory, cardiovascular, gastrointestinal or pain disorders (Yager, 2007). Individuals with PTSD have higher risks for mood and anxiety disorders, alcohol and drug dependence, and suicide attempts (Yager, 2007). Approximately 80% of patients with PTSD have at least one comorbid psychiatric disorder, with the most common disorders including depression, alcohol and drug abuse and other anxiety disorders (Grange, 2003).
According to the National Cancer Institute, people with histories of cancer are considered to be at risk for posttraumatic stress disorder. The physical and mental shock of having a life-threatening disease, of receiving treatment for cancer, and for living with repeated threats to one’s body and life are traumatic experiences for many cancer patients. For the person who has experienced a diagnosis of cancer, the specific trauma that triggers PTSD is unclear. Cancer is an experience of repeated traumas and undetermined length. The patient may experience stress symptoms anytime from diagnosis through completion of treatment and cancer recurrence. Because avoiding places and persons associated with cancer is part of PTSD, the syndrome may prevent the patient from seeking medical treatment. It is important that cancer survivors receive information about possible psychological effects of their cancer experience and early treatment of PTSD symptoms (NCI, 2007).
Treatment options include patient education, social support and anxiety management through psychotherapy and psychopharmacological intervention. It is important for the therapist to focus on problem solving, teaching coping skills and providing a supportive setting for the patient. Cognitive behavior therapy is an effective approach used in the treatment of posttraumatic stress disorder. Some patients are helped by methods that teach the patient to change their behaviors by changing their thinking patterns. Relation techniques or other stress management skills, understanding symptoms, desensitization of upsetting triggers and redirection of negative thoughts can be very helpful techniques for some patients with PTSD. Support groups may help de-stigmatize the mental health diagnosis and provide patients with emotional support by introducing them to other people with similar experiences and symptoms. A physician may prescribe medications, including antidepressants, anti-anxiety medications and antipsychotic drugs.
The mental health program at the Visiting Nurse Services in Westchester (VNSW) has and continues to service many patients with posttraumatic stress disorder. The agency works with providers in the community to help patients recover from PTSD by helping them manage, monitor and pre-fill medications. If needed, VNSW is able to utilize locked medication boxes to ensure compliance and safety, and the agency’s mental health nurses monitor patient mood and symptoms. The VNSW nurses provide patient education and employ a variety of the techniques used to treat PTSD and work collaboratively with the patient’s providers to ensure continuity of care.
After many years of experience in treating patients with posttraumatic stress disorder, VNSW believes strongly in taking into account the entirety of a patient’s health status. Since PTSD patients often exhibit comorbid psychiatric and medical conditions, VNSW integrates into their treatment many specialized nursing services that target indicated medical and psychiatric needs. The agency’s nursing specialties include pain management, palliative care, cardiac care, wound care, mental health and diabetic management including a certified diabetic specialist who is also a mental health nurse. In addition to nursing care, VNSW provides a full range of rehabilitative therapies, social work and home health aide services; PTSD patients receive comprehensive care from a coordinated team of health care professionals versed in, and sensitive to, their complete history and needs, providing a complete package of essential multidisciplinary services to help them attain and maintain optimal health and functioning.
With its dedicated Mental Health Home Care Program, Visiting Nurse Services in Westchester is working actively toward this objective, emphasizing treatment of the whole person with the agency’s core multidisciplinary approach. For details, visit www.vns.org, call (914) 682-1480 Ext. 648 or e-mail MentalHealth@vns.org.