Karen Loftus (Host): This is Community Connect, presented by Tampa General Hospital. I'm Karen Loftus. Joining me is Dr. Lindsay Niccolai, clinical neuropsychologist at TGMG and for the Home Base Program, which provides clinical care and support for veterans, service members, and their families. Dr. Niccolai, welcome to the podcast.

Dr. Lindsay Niccolai: Thank you for having me.

Host: We're here to talk about post-traumatic stress disorder, commonly referenced by its acronym PTSD. Dr. Niccolai, as we get this conversation going, can you explain what PTSD is?

Dr. Lindsay Niccolai: Yes. PTSD is a mental health disorder that develops after someone is exposed to a traumatic event, such as an injury or a near-death experience. It can also happen if you witness an injury or a death of another individual. PTSD symptoms tend to last one month or longer, and sometimes they develop directly following the event, but they may even begin in the months or years following that event.

PTSD symptoms include distressing memories or flashbacks of that traumatic event. People may also avoid reminders of the trauma and experience multiple emotions related to that, such as fear, anger, or even being emotionally numb. These PTSD symptoms significantly impact their life and their relationships with others.

Host: Now, as a clinical neuropsychologist, where does your specialty come into the picture for either diagnosing or treating PTSD?

Dr. Lindsay Niccolai: As a neuropsychologist, I'm tasked with seeing if the cognitive changes someone is experiencing are related to PTSD or other medical or psychological factors such as TBI. So, in my work with the Home Base Program, I evaluate memory and concentration, but also other aspects of their functioning. People may experience gaps in their memory of these traumatic events actually related to the PTSD rather than lingering impacts from a TBI. So when we do identify an individual having PTSD, we may then recommend mental health treatments that are intended to improve their mood, cognition, and overall quality of life.

Host: I know this next question could go down the clinical jargon rabbit hole, but if you could maybe keep it high level for us, can you describe how PTSD affects the brain? What's actually going on in the brain when someone has this disorder?

Dr. Lindsay Niccolai: PTSD affects the brain in many different ways. So first, it leads to an overactivation of the amygdala, which is the brain's fear center. And then, there can also be an underactivation of the prefrontal cortex, which is typically tasked with inhibiting a stress response. So then, you see a prolonged stress response, someone being in fight or flight mode and releasing more stress hormones such as cortisol.

PTSD may also impact the hippocampus, the brain's memory center, which is responsible for encoding new memories and can actually contribute to someone re-experiencing those traumatic memories while not encoding other memories related to an event.

Host: Okay. Now, I'm sure you've seen many instances of this in your professional career. Are there other conditions that you've seen that can coexist with PTSD?

Dr. Lindsay Niccolai: Absolutely. So many veterans we see also have other mental health diagnoses. So, upwards of 80% of people with PTSD will also have an other mental health condition, commonly depression, anxiety, or even substance use disorders such as abusing alcohol or other substances to cope with the trauma. We also see other conditions such as TBI. So, TBI and PTSD often go hand-in-hand with this traumatic event. So ultimately, we're treating the PTSD, but also other conditions that are on board.

Host: You mentioned that PTSD can affect anyone who's experienced a traumatic event. You've also touched on the veteran side of this. Can you go into a little more detail about how PTSD specifically affects the veteran population?

Dr. Lindsay Niccolai: PTSD is more common in the veteran population than civilians, with roughly 7% of veterans experiencing PTSD at some point in their life. Clearly, that means that not everyone will go on to develop PTSD who has served in the military. And those individuals may have some more protective factors, such as more social support or resiliency.

But there are many different risk factors for PTSD in the veteran population. A big one is combat exposure, so exposure to war, being a younger veteran, being a female veteran, especially those who have experienced military sexual trauma, and then also veterans who have served in different eras. So, ones who served in operations Iraqi Freedom and Enduring Freedom tended to have higher PTSD rates than some other service eras.

So when an individual is in the military, as you can imagine, they see combat and other life-threatening experiences. This really puts their body in that constant fight or flight mode. When they return back to civilian life, that threat is no longer present, but they still may feel on edge or hypervigilant of their surroundings.

Veterans also tend to avoid loud noises or crowds or other situations that remind them of these combat scenarios. They may also experience nightmares or flashbacks to combat situations. Many veterans we see also have mood disturbance. So, emotional fluctuations, mood swings, increased irritability and anger, or even feelings of guilt, like survivor's guilt when other people's lives have been lost during their military service.

As you can imagine, these mood symptoms and other symptoms can impact sleep, and they can also impact concentration and other cognitive processes. Some veterans also may experience suicidal thoughts, and we do have many resources out there to help those who are struggling.

Host: Now, you mentioned those resources. What are some steps and those resources available for veterans with PTSD?

Dr. Lindsay Niccolai: Fortunately, there are many PTSD resources available for veterans. First off, if a veteran is experiencing suicidal thoughts or if they're in a crisis mode, there is the Veterans Crisis Line. So, they can call 988 and then press 1. There are also multiple evidence-based treatments out there for PTSD. Many are offered at the VA, but we also have other resources outside the VA. One of those is the Home Base Program that I'm actively involved in that really helps veterans identify other treatment options in the community or even nationally.

So just to tell you a bit more about the Home Base Program, it was originally developed in Boston, and they had partnered with Mass General. And then, we started a program down here in Tampa to really serve the veteran population. Tampa, surprisingly, has the largest concentration of veterans in the country. And we really wanted to meet that need down here and identify some other treatment options in addition to the VA that veterans could consider. So, veterans within the program, they're evaluated by a physical medicine and rehabilitation doctor who specializes in TBI. They also see a rehabilitation psychologist who gets a thorough intake of their psychological history. And then, if we do identify they have PTSD, we can then offer different treatment options locally, such as psychotherapy and psychiatry services, or even national programs such as the Wounded Warrior Project and Home Base's Intensive Clinical Program up in Boston.

So fortunately, PTSD is treatable, and there are many different ways we can help veterans cope and promote recovery with this condition.

Host: Wonderful. Thank you so much, Dr. Niccolai, for being on our podcast and sharing your knowledge on this important topic.

Dr. Lindsay Niccolai: Yes, you're very welcome. Thank you again for having me.

Host: That has been Dr. Lindsay Niccolai. For more information, please visit www.tgh.org/tbi. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect presented by TGH on your favorite podcast platform. I'm Karen Loftus, and this is Community Connect, presented by TGH. Thanks for listening.