̽��ֱ�� of Cambridge - PTSD

Opinion: ̽��ֱ��challenges faced by doctors and nurses in conflict zones

Anonymous — Tue, 15 Mar 2022 15:34:40 +0000

Quite aside from the deadly and disorienting consequences for Ukraine’s citizens, Russia’s invasion places unique pressure on its doctors and nurses.

Cardiac arrests, caesareans and appendectomies are now often accompanied by injuries that should be relatively rare: gunshot and shrapnel wounds, third-degree burns, double or triple amputations, loss of sight, brain and spinal cord injuries. Were chemical weapons to ever be deployed, one can add blistering, convulsions and muscle paralysis. Then there are decisions unimaginable to many of us but unavoidable when resources are scarce: who will live and who will not.

With advance notice, medical staff can stock up on vast blood supplies, platelet-rich plasma and refrigerators. They can hone the specialist skills required for resuscitating and then repairing what war destroys. During the long war in Afghanistan, for example, military medical staff from allied forces underwent rigorous training before deployment. British surgeons and anaesthetists were required to complete a five-day military operational surgical training course at the Royal College of Surgeons where they practised damage control surgery on human cadavers, deliberately “wounded” to mimic typical injuries sustained during war.

From London, they’d move to an old aeroplane hanger outside the ancient English cathedral city of York to reappear, as if by magic, in a replica of Camp Bastion field hospital in Helmand province, Afghanistan. Here, they relied on actual amputees and theatrical makeup artists to reenact the patient journey from a helicopter to an intensive care unit. Even the thumping of an approaching Chinook was played over the sound system as doctors and nurses rolled up their sleeves.

Given the speed at which the conflict is advancing, Ukraine’s doctors make do instead with a 12-hour online equivalent designed and run by Dr David Nott and Dr Henry Marsh. Nott has 30 years’ experience working in conflict and disaster zones as a general and vascular surgeon and, through his David Nott Foundation, offers lifesaving treatment for victims by better equipping local doctors who care for them.

Unseen injuries

Other challenges facing doctors and nurses are more subtle, longer lasting, and more personal. War can be deeply traumatising, even for doctors and nurses not in the line of fire, meaning that rates of post-traumatic stress disorder (PTSD) are often as high for medical staff as for those at immediate risk of injury or death.

Until recently, the causes of PTSD were not well understood. We now know more about the extent to which cultural expectations, professional role identity, and organisational protocol (or formal rules) can exacerbate feelings of senselessness, futility, and surreality, and threaten people’s existential grounding.

This is because these contexts can trigger and amplify repeated experiences of senselessness (or the inability to justify war and its consequences), of futility (or the inability for medics to live up to their own expectations of “making a difference” as “compassion fatigue” sets in), and of surreality (or the inability to reconcile the absurdities of war with “life as normal”).

Senselessness, futility and surreality characterise the experience of war for many who are exposed to it. And when these experiences are sustained, they can dislocate a person’s sense of what they consider “meaningful”, “good” and “normal” to the point where they become an existential threat. They are war’s invisible injuries.

To compensate for this sense of dislocation, doctors and nurses have been observed to resort to innovative coping strategies. For example, they will refrain from publicly criticising the war effort for fear of hurting morale. They avoid emotional engagement by not attending funerals. They use humour to deflect and manage constant exposure to the cruelty of war. They establish enclaves of normality by importing home comforts (for example, in Camp Bastion, doctors organised Friday night pizzas and Sunday morning pancakes). They create improvised spaces in which to temporarily withdraw from war and catch up on Netflix. They grow flowers in the most uninhabitable spaces.

Sadly, the unintended consequence of this is often that it makes war even more surreal and cruel and the ability to help turn the tide more difficult.

Under circumstances such as those facing doctors and nurses in Ukraine today, the best prevention may be to accept that war is ugly, indiscriminate and savage. It is also a reminder of what is lost and what we must now work hard to preserve and repair.

This article is republished from ̽��ֱ��Conversation under a Creative Commons license. Read the original article.

Professor Mark de Rond from Cambridge Judge Business School outlines some of the unique pressures faced by doctors and nurses in Ukraine, in this piece originally published in ̽��ֱ��Conversation.

Ministry of Defense of Ukraine

Patient being treated in a Kharkiv hospital during a 2015 military operation

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Licence type:

Attribution-ShareAlike

Scientists identify mechanism that helps us inhibit unwanted thoughts

cjb250 — Fri, 03 Nov 2017 09:13:20 +0000

We are sometimes confronted with reminders of unwanted thoughts — thoughts about unpleasant memories, images or worries. When this happens, the thought may be retrieved, making us think about it again even though we prefer not to. While being reminded in this way may not be a problem when our thoughts are positive, if the topic was unpleasant or traumatic, our thoughts may be very negative, worrying or ruminating about what happened, taking us back to the event.

“Our ability to control our thoughts is fundamental to our wellbeing,” explains Professor Michael Anderson from the Medical Research Council Cognition and Brain Sciences Unit, which recently transferred to the ̽��ֱ�� of Cambridge. “When this capacity breaks down, it causes some of the most debilitating symptoms of psychiatric diseases: intrusive memories, images, hallucinations, ruminations, and pathological and persistent worries. These are all key symptoms of mental illnesses such as PTSD, schizophrenia, depression, and anxiety.”

Professor Anderson likens our ability to intervene and stop ourselves retrieving particular memories and thoughts to stopping a physical action. “We wouldn’t be able to survive without controlling our actions,” he says. “We have lots of quick reflexes that are often useful, but we sometimes need to control these actions and stop them from happening. There must be a similar mechanism for helping us stop unwanted thoughts from occurring.”

A region at the front of the brain known as the prefrontal cortex is known to play a key role in controlling our actions and has more recently been shown to play a similarly important role in stopping our thoughts. ̽��ֱ��prefrontal cortex acts as a master regulator, controlling other brain regions – the motor cortex for actions and the hippocampus for memories.

In research published today in the journal Nature Communications, a team of scientists led by Dr Taylor Schmitz and Professor Anderson used a task known as the ‘Think/No-Think’ procedure to identify a significant new brain process that enables the prefrontal cortex to successfully inhibit our thoughts.

In the task, participants learn to associate a series of words with a paired, but otherwise unconnected, word, for example ordeal/roach and moss/north. In the next stage, participants are asked to recall the associated word if the cue is green or to suppress it if the cue is red; in other words, when shown ‘ordeal’ in red, they are asked to stare at the word but to stop themselves thinking about the associated thought ‘roach’.

Using a combination of functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy, the researchers were able to observe what was happening within key regions of the brain as the participants tried to inhibit their thoughts. Spectroscopy enabled the researchers to measure brain chemistry, and not just brain activity, as is usually done in imaging studies.

Professor Anderson, Dr Schmitz and colleagues showed that the ability to inhibit unwanted thoughts relies on a neurotransmitter – a chemical within the brain that allows messages to pass between nerve cells – known as GABA. GABA is the main ‘inhibitory’ neurotransmitter in the brain, and its release by one nerve cell can suppress activity in other cells to which it is connected. Anderson and colleagues discovered that GABA concentrations within the hippocampus – a key area of the brain involved in memory – predict people’s ability to block the retrieval process and prevent thoughts and memories from returning.

“What’s exciting about this is that now we’re getting very specific,” he explains. “Before, we could only say ‘this part of the brain acts on that part’, but now we can say which neurotransmitters are likely important – and as a result, infer the role of inhibitory neurons – in enabling us to stop unwanted thoughts.”

“Where previous research has focused on the prefrontal cortex – the command centre – we’ve shown that this is an incomplete picture. Inhibiting unwanted thoughts is as much about the cells within the hippocampus – the ‘boots on the ground’ that receive commands from the prefrontal cortex. If an army’s foot-soldiers are poorly equipped, then its commanders’ orders cannot be implemented well.”

̽��ֱ��researchers found that even within his sample of healthy young adults, people with less hippocampal GABA (less effective ‘foot-soldiers’) were less able to suppress hippocampal activity by the prefrontal cortex—and as a result much worse at inhibiting unwanted thoughts.

̽��ֱ��discovery may answer one of the long-standing questions about schizophrenia. Research has shown that people affected by schizophrenia have ‘hyperactive’ hippocampi, which correlates with intrusive symptoms such as hallucinations. Post-mortem studies have revealed that the inhibitory neurons (which use GABA) in the hippocampi of these individuals are compromised, possibly making it harder for the prefrontal cortex to regulate activity in this structure. This suggests that the hippocampus is failing to inhibit errant thoughts and memories, which may be manifest as hallucinations.

According to Dr Schmitz: “ ̽��ֱ��environmental and genetic influences that give rise to hyperactivity in the hippocampus might underlie a range of disorders with intrusive thoughts as a common symptom.”

In fact, studies have shown that elevated activity in the hippocampus is seen in a broad range of conditions such as PTSD, anxiety and chronic depression, all of which include a pathological inability to control thoughts – such as excessive worrying or rumination.

While the study does not examine any immediate treatments, Professor Anderson believes it could offer a new approach to tackling intrusive thoughts in these disorders. “Most of the focus has been on improving functioning of the prefrontal cortex,” he says, “but our study suggests that if you could improve GABA activity within the hippocampus, this may help people to stop unwanted and intrusive thoughts.”

̽��ֱ��research was funded by the Medical Research Council.

Reference
Schmitz, TW et al. Hippocampal GABA enables inhibitory control over unwanted thoughts. Nature Communications; 3 Nov 2017; DOI: 10.1038/s41467-017-00956-z

Scientists have identified a key chemical within the ‘memory’ region of the brain that allows us to suppress unwanted thoughts, helping explain why people who suffer from disorders such as anxiety, post-traumatic stress disorder (PTSD), depression, and schizophrenia often experience persistent intrusive thoughts when these circuits go awry.

Our ability to control our thoughts is fundamental to our wellbeing. When this capacity breaks down, it causes some of the most debilitating symptoms of psychiatric diseases

Michael Anderson

Jacob Bøtter

Thinking RFIP

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

Yes

Licence type:

Attribution