PTSD Comorbid Conditions and Suicidal Ideation Interventions

Craig Bryan, PsyD, ABPP, professor of psychiatry and behavioral health, College of Medicine, Ohio State University, Columbus, Ohio, who recently gave a session titled "Helping your patient manage suicidal ideation behavior: a crisis response plan" at Psych Congress 2021 in San Antonio, Texas, explores clinical signs that help diagnose a patient with post-traumatic stress disorder (PTSD), the common comorbid conditions, and suicidal ideation.

In the upcoming part 2, Dr Bryan, who is also the Director of the Division of Recovery and Resilience Program and of the Suicide Prevention Program at Ohio State University, discusses creating a crisis response plan that is tailored to individuals and how these plans help patients feel more in control of their mental health. He will also explain how clinicians can talk with patients to build trust faster and increase the efficacy of the intervention.

Read the transcript:

Heather Flint, Senior Digital Managing Editor, Psych Congress Network: Hello, Psych Congress Network. I am excited to sit down today with Dr. Craig Bryan to talk about his sessions at Psych Congress 2021. Dr. Bryan, if you can introduce yourself, please.

Craig Bryan PsyD, ABPP: I'm Craig Bryan. I'm a clinical psychologist at The Ohio State University College of Medicine. My research primarily focuses developing and testing treatments and interventions for suicide prevention.

Flint: Thank you so much for joining us today.

Dr Bryan: Thank you.

Flint: Building off of your session, what are some clinical signs to help diagnose a patient with PTSD rather than other mental health disorders?

Dr Bryan: One of the cardinal symptoms of PTSD that best distinguishes it from other mood and anxiety disorders is intrusion symptoms. The classic examples of these are nightmares or unwanted dreams about the traumatic event. Sometimes unwanted or intrusive memories during the day or while awake, flashbacks.

One of the key features of this notion of intrusion is that the person feels like they don't have control over the memories. It's different from other bad memories that all of us have where sometimes we just spontaneously think about unfortunate or disappointing moments in our lives but we might be able to distract ourselves. We can move on and keep focused on what we're doing.

In PTSD, those unwanted memories come to the forefront and take over the person's mental capacity such that they really cannot shift away. In some cases, they will actually feel as if they are back in the moment, reliving the trauma as if it's happening to them right now.

Flint:  Interesting. Do people with PTSD suffer from comorbid mental health disorders? If so, what is the most commonly seen disorder?

Dr Bryan:  PTSD is actually commonly comorbid with lots of different clinical conditions and diagnoses. The most common is probably major depressive disorder. The way that I've often talked about it with my patients is that if you're struggling with PTSD and that is untreated and it continues over time, it can be depressing.

You're isolated from others. You're not sleeping well. Things like that. Some research suggests that PTSD often is the precursor, it comes first, and then depression will often come later after some time.

Substance use disorders are also very highly comorbid with PTSD and often serves as a form of avoidance, a way to cope or relieve those memories, help the person to sleep. We also see other anxiety disorders. Panic disorder, generalized anxiety disorder. Sometimes phobic disorders, as well.

Oftentimes, it is a combination of clinical presentations. I'd say the last comorbidity that we sometimes see more than others is comorbid personality disorders, especially borderline personality disorder. This seems to be more common amongst those who have experienced early life trauma like childhood sexual abuse, things like that.

There's some speculation, some research that would suggest that maybe borderline personality disorder is, perhaps, a cousin to PTSD or other trauma related disorders.

Flint:  What are some clear indications that patients might be at risk for taking their own life when suffering from some of these disorders?

Dr Bryan:  The classic hallmark indicators are things like having thoughts about death or suicide. Some of the research that we've been conducting over the past few years suggests that a lot of times people with PTSD don't necessarily experience suicidal thoughts in the way that a lot of clinicians typically define it.

What I mean by that is researchers, clinicians, we think of suicidal ideation as thoughts about killing yourself or thoughts of ending your life. A lot of what we're seeing is that trauma survivors will experience not explicitly suicidal but adjacent. It will be like, "I don't want to be around anymore. I can't take this any longer. It would be better if I were dead."

We're starting to realize now that maybe a lot of our traditional ways of screening and assessing for suicide risk in general, but especially amongst those with PTSD...Perhaps we need to develop new ways to be a little bit more broader because it does seem as though suicide risk will manifest in different types or different flavors.

Maybe we're not doing an adequate job of really, truly understanding all of the different ways in which it can emerge.

Craig Bryan, PsyD, ABPP is a board-certified clinical psychologist with expertise in cognitive-behavioral treatments for individuals experiencing suicidal thoughts and post-traumatic stress disorder (PTSD). Dr Bryan conducts research to help military veterans, first responders and other adults who are dealing with mental health issues. In collaboration with his colleagues, he has developed and demonstrated the effectiveness of brief cognitive-behavioral therapy (BCBT) for suicidal military personnel. Dr Bryan earned both a Master of Science degree in clinical psychology and a Doctor of Psychology in clinical psychology from Baylor University, Waco, Texas, and completed a clinical psychology residency at the Wilford Hall Medical Center, Lackland Air Force Base, Texas. He received a Graduate Certificate in Applied Statistics from Penn State, Centre County, Pennsylvania.