We thank the authors for reading the article with keen interest, appreciating the work and sending expert suggestions. Comments about their observations are as under: 1. The article was based on a short-term ICMR research studentship, among the first two ever completed by medical cadets in the Department of Psychiatry, Armed Forces Medical College. Since it was a time bound pilot study a simple design was preferred. It may interest the authors to know that it is only the second study in India (the first in Armed Forces which has a Artificial Limb Center functioning for over 50 years) in which psychiatric treatment of amputees was attempted. Despite a plethora of western studies showing high prevalence of PTSD in various populations, our own experience with patients with upper and lower limb fractures [1] as also troops in counter insurgency operation areas [2] showed a rather low prevalence. However we have an open mind and another department project is also looking into this aspect in amputees. 2. We agree with the authors’ contention that anxiety may have been higher in the early stages. However, as we saw the patients later no comments about their status at an earlier stage can be offered. 3. In the present study probably due to small sample size no correlations with socio-demographic characteristics was observed. 4. Alcohol related problems are very common in Armed Forces not only in India but also all over the world and is probably one of the most under-diagnosed conditions in medical setting. In earlier studies we found high scores on MAST in patients with primary hypertension [3], duodenal ulcer [4], psoriasis [5] fractures of lower limbs in eastern command [6], lower and upper limb fractures in northern command [1] and troops in counterinsurgency operations [2]. This led us to use the MAST in amputees. We agree that this aspect requires further detailed inquiry. 5. We agree with the authors’ opinion that psychiatric co-morbidity in musculoskeletal trauma should constitute an important area in the Armed Forces. We have carried out a study on patients with fractures and polytrauma in counterinsurgency operation areas and a study to develop a comprehensive psychotherapeutic package for amputees. A departmental project exploring body image, PTSD and pain in amputees is nearing completion. An ongoing AFMRC project is looking into comprehensive psychological assessment and management of amputees. However, much more is required to be done in this rather neglected field.
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