Disorders In Veterans Research Articles

Psychotherapeutic strategies for management of neurotic disorders in veterans of modern combat

Psychotherapeutic strategies for management of neurotic disorders in veterans of modern combat

Neurofeedback: A noninvasive treatment for symptoms of posttraumatic stress disorder in veterans

This paper discusses positive therapeutic gains made with veterans whose primary treatment for PTSD was artifact corrected neurofeedback. Assessments completed after both 20 and 40 half-hour sessions of treatment identified significant improvements for both auditory and visual attention using the IVA-2 CPT and the veterans reported significant improvements in their well-being based on the General Well-Being Scale (GWBS). It was discovered that neurofeedback impacted individuals’ overall auditory attention and that the IVA-2 global auditory test scores significantly improved after both 20 (p < .007, Cohen’s d = 0.5) and 40 training sessions (p < .0001, Cohen’s d = 0.8). Veterans were found to have significant enhancements specifically in auditory vigilance (p < .03), processing speed (p < .0009) and focus (p < .01). The IVA-2 global measure of visual attention was also found to show significant improvements after 20 sessions (p < .004, Cohen’s d = 0.5) and after 40 sessions (p < .06, Cohen’s d = 0.4). Specific improvements in visual processing speed (p < .04) and focus (p< .02) were identified after 40 sessions. Ratings of well-being also significantly improved after treatment (p < .001, Cohen’s d = 0.8) with 84% of the veterans improving five points or more on the GWBS. These improvements in well-being were found to be significantly correlated with increases in veterans’ overall auditory attention (r = .44, p < .03) and auditory processing speed (r = .57, p < .005).

Physiologic Effects of Posttraumatic Stress Disorder in Veterans.

Physiologic Effects of Posttraumatic Stress Disorder in Veterans.

Concurrent Dialectical Behavior Therapy and Prolonged Exposure Reduces Symptoms and Improves Overall Quality of Life for a Veteran With Posttraumatic Stress Disorder and Borderline Personality Disorder

This article presents a case study illustration of integrated, concurrent dialectical behavior therapy (DBT) and prolonged exposure (PE), conducted within a Veterans Affairs health care system. Treatment in this case effectively reduced symptoms and improved overall quality of life. Based on clinical complexities encountered (e.g., substance use, nonsuicidal self-harm, treatment setting constraints), recommendations are provided for concurrent treatment of posttraumatic stress disorder and borderline personality disorder in veterans. Recommendations include consideration of flexibility in duration of pre-PE stabilization, modification of DBT phone coaching protocol, management of structural barriers to treatment access, full use of consultation, and coordination of clinician roles.

Emotional Freedom Techniques to Treat Posttraumatic Stress Disorder in Veterans: Review of the Evidence, Survey of Practitioners, and Proposed Clinical Guidelines.

High prevalence rates of posttraumatic stress disorder (PTSD) in active military and veterans present a treatment challenge. Many PTSD studies have demonstrated the efficacy and safety of Emotional Freedom Techniques (EFT). To develop clinical best practice guidelines for the use of EFT to treat PTSD, on the basis of the published literature, practitioner experience, and typical case histories. We surveyed 448 EFT practitioners to gather information on their experiences with PTSD treatment. This included their demographic profiles, prior training, professional settings, use of assessments, and PTSD treatment practices. We used their responses, with the research evidence base, to formulate clinical guidelines applying the "stepped care" treatment model used by the United Kingdom's National Institute for Health and Clinical Excellence. Most practitioners (63%) reported that even complex PTSD can be remediated in 10 or fewer EFT sessions. Some 65% of practitioners found that more than 60% of PTSD clients are fully rehabilitated, and 89% stated that less than 10% of clients make little or no progress. Practitioners combined EFT with a wide variety of other approaches, especially cognitive therapy. Practitioner responses, evidence from the literature, and the results of a meta-analysis were aggregated into a proposed clinical guideline. We recommend a stepped care model, with 5 EFT therapy sessions for subclinical PTSD and 10 sessions for clinical PTSD, in addition to group therapy, online self-help resources, and social support. Clients who fail to respond should be referred for appropriate further care.

Uptake of long-acting reversible contraception among homeless versus housed women veterans

Objectives: We aimed to assess the uptake of long-acting reversible contraceptive (LARC) methods and prevalence of psychiatric and medical comorbidities among homeless versus housed women veterans accessing care within the Veterans Healthcare Administration (VHA), the largest US provider of homeless health care services. Methods: All women veterans aged 18–44 who accessed VHA services in FY2001–2015 with administrative evidence of homelessness were identified. Controls were identified by matching on military service period. We extracted demographic characteristics, ICD-9 codes for chronic diseases based on the CDC Medical Eligibility high-risk conditions and other prevalent mental health disorders in veterans and ICD-9/CPT/HCPCS codes for LARC method insertion, removal or surveillance. Comparisons were made between homeless and housed veterans on all variables. Results: Some 42,197 homeless women veterans and 46,768 housed women veterans were included. Mean age at first homeless designation was 38. Uptake of a LARC method was 9.4% among homeless veterans and 5.6% among housed veterans (p<.001). Prevalence of all comorbidities was significantly higher among homeless versus housed veterans: mental health disorders, 84.5% versus 48.9% (p<.001), substance abuse disorders, 35.9% versus 8.6% (p<.001) and one or more high-risk medical conditions, 74.9% versus 56% (p<.001). Conclusions: Homeless women veterans seeking care in the VHA are a vulnerable population with an extremely high prevalence of comorbidities that increase risk of adverse pregnancy outcomes. Despite their higher rate of LARC method uptake, their frequency of medical complexities mandates further prioritization of comprehensive contraceptive services to minimize risk of an unintended pregnancy.

Incidence and Risk Factors for Intensive Care Unit-related Post-traumatic Stress Disorder in Veterans and Civilians.

The incidence and risk factors of post-traumatic stress disorder (PTSD) related to the intensive care unit (ICU) experience have not been reported in a mixed veteran and civilian cohort. To describe the incidence and risk factors for ICU-related PTSD in veterans and civilians. This is a prospective, observational, multicenter cohort enrolling adult survivors of critical illness after respiratory failure and/or shock from three Veterans Affairs and one civilian hospital. After classifying those with/without preexisting PTSD (i.e., PTSD before hospitalization), we then assessed all subjects for ICU-related PTSD at 3 and 12 months post hospitalization. Of 255 survivors, 181 and 160 subjects were assessed for ICU-related PTSD at 3- and 12-month follow-up, respectively. A high probability of ICU-related PTSD was found in up to 10% of patients at either follow-up time point, whether assessed by PTSD Checklist Event-Specific Version (score ≥ 50) or item mapping using the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). In the multivariable regression, preexisting PTSD was independently associated with ICU-related PTSD at both 3 and 12 months (P < 0.001), as was preexisting depression (P < 0.03), but veteran status was not a consistent independent risk factor for ICU-related PTSD (3-month P = 0.01, 12-month P = 0.48). This study found around 1 in 10 ICU survivors experienced ICU-related PTSD (i.e., PTSD anchored to their critical illness) in the year after hospitalization. Preexisting PTSD and depression were strongly associated with ICU-related PTSD.

Long-Term Mental Health Outcomes of Military Service: National Linkage Study of 57,000 Veterans and 173,000 Matched Nonveterans.

We used data from the Scottish Veterans Health Study to examine long-term mental health outcomes in a large cohort of veterans, with a focus on the impact of length of service. We conducted a retrospective, 30-year cohort study of 56,205 veterans born from 1945 through 1985, including 14,702 who left military service prematurely, and 172,741 people with no record of military service, using Cox proportional hazard models, to examine the association between veteran status and length of service and cumulative risk of mental health disorder. We stratified the veterans by common lengths of service, defining Early Service Leavers as those who had served for less than 2.5 years. There were 2,794 (4.97%) first episodes of any mental health disorder in veterans, compared with 7,779 (4.50%) in nonveterans. The difference was statistically significant for all veterans (adjusted hazard ratio [HR] = 1.21; 95% CI, 1.16-1.27; P < .001). Subgroup analysis showed the highest risk to be in Early Service Leavers (adjusted HR = 1.51; 95% CI, 1.30-1.50; P < .001), including those who failed to complete initial training. The risk reduced with longer service; beyond 9 years of service, risk of mental health disorder was comparable to or lower than that in nonveterans. The veterans at highest risk of mental health disorder were those who did not complete training or minimum engagement, while those with longest service were at reduced risk, suggesting that military service was not causative. The high risk among the earliest leavers may reflect pre-service vulnerabilities not detected at recruitment, which become apparent during early training and lead to early discharge.

Symptoms of Post-Traumatic Stress Disorder and Major Depressive Disorder in Veterans of Operations Enduring Freedom/Iraqi Freedom in Comparison With Those Veterans of Other Conflicts

ABSTRACTLimited research exists on comparing psychiatric symptomatology in veterans of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) and other conflicts. The present study investigated psychiatric symptoms in 238 treatment-seeking veterans. After controlling for demographic differences, participants from OEF/OIF demonstrated a significantly smaller percentage of full diagnosis post-traumatic stress disorder (PTSD), smaller percentage of comorbid depression, and less severe self-reported PTSD intrusions than veterans from other conflicts. The present findings may help to explain previously identified differences in treatment outcome in veterans from OEF/OIF and other conflicts.

Psychoneuroimmunology alternations as a comorbidity of post-traumatic stress disorder in veterans – case report

Post Traumatic Stress Disorder (PTSD) is defined as an extensive response to a major traumatic event. Psychoneuroimmunology represents an integrative approach in tackling and understanding various human diseases and disorders such as cardiovascular, autoimmune and physical complaints/chronic pain. Psychosocial context influences brain stress response pathways and modifies stress-related behavior. In this case report, we observed 5 patients, veterans from Croatian War of Independence (1990-1995), who suffer from PTSD. They have altered stress reactivity, as well as distinct expression for genes involved in immune activation. Those patients have been found to exhibit a number of immune changes including increased circulating inflammatory markers, increased reactivity to antigen skin tests, lower natural killer cell activity, and lower total T lymphocyte counts. The traumatic event (Croatian War of Independence) generates downstream alterations in immune function. This case report imply that immune dysfunction caused by PTSD may mediate or facilitate somatic conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Functional network topology associated with posttraumatic stress disorder in veterans.

Posttraumatic stress disorder (PTSD) is a disabling disorder associated with resting state functional connectivity alterations. However, whether specific brain regions are altered in PTSD or whether the whole brain network organization differs remains unclear. PTSD can be treated with trauma-focused therapy, although only half of the patients recover after treatment. In order to better understand PTSD psychopathology our aim was to study resting state networks in PTSD before and after treatment. Resting state functional magnetic resonance images were obtained from veterans with PTSD (n = 50) and controls (combat and civilian controls; n = 54) to explore which network topology properties (degree and clustering coefficient) of which brain regions are associated with PTSD. Then, PTSD-associated brain regions were investigated before and after treatment. PTSD patients were subdivided in persistent (n = 22) and remitted PTSD patients (n = 17), and compared with combat controls (n = 22), who were also reassessed. Prior to treatment associations with PTSD were found for the degree of orbitofrontal, and temporoparietal brain regions, and for the clustering coefficient of the anterior cingulate cortex. No significant effects were found over the course of treatment. Our results are in line with previous resting state studies, showing resting state connectivity alterations in the salience network and default mode network in PTSD, and also highlight the importance of other brain regions. However, network metrics do not seem to change over the course of treatment. This study contributes to a better understanding of the psychopathology of PTSD.

Severity of Musculoskeletal Pain and Its Effect on Psychosocial Factors in Veterans With Posttraumatic Stress Disorder

PURPOSE: The aim of this study is to investigate the relationship between psychosocial factors and the severity of musculoskeletal pain in veterans with posttraumatic stress disorder (PTSD). METHODS: A total of 60 subjects were recruited from among the veterans with musculoskeletal pain at D Veterans Hospital. PTSD was evaluated by using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; severity of pain was measured by using the short-form McGill Pain Questionnaire (SF-MPQ); depression and anxiety were measured by using the Symptom Checklist-90-Revision; and the quality of sleep was measured by using the Pittsburgh Sleep Quality Index. All data were analyzed using SPSS 18.0 software for Windows. RESULTS: The averages cores of pain intensity (<TEX>$7.48{\pm}1.67$</TEX>), SF-MPQ-sensory (<TEX>$13.84{\pm}7.52$</TEX>), SF-MPQ-affective (<TEX>$4.41{\pm}3.79$</TEX>), depression (<TEX>$19.30{\pm}11.37$</TEX>), anxiety (<TEX>$13.39{\pm}7.99$</TEX>), and quality of sleep (<TEX>$10.05{\pm}5.89$</TEX>) were obtained in veterans with PTSD. SF-MPQ-sensory measures sleep quality (r=0.346, p<0.01), SF-MPQ-affective measures depression (r=0.318, p<0.01) and anxiety (r=0.404, p<0.01), and these showed a statistically significant positive correlation in veterans with PTSD. Pain levels were observed to be higher in veterans with PTSD. Moreover, in these subjects, physical pain had a significant influence on the anxiety variable among the psychosocial factors. CONCLUSION: These findings suggest that musculoskeletal pain provides meaningful information about depression, anxiety, and sleep disorder in veterans with PTSD. Our data suggest that musculoskeletal pain may need to be addressed as part of the health management process of veterans.

The association between inflammatory markers and psychological disorders in veterans and military personnel: a systematic review protocol

Review question(s)/objective(s) The objective of this systematic literature review is to identify whether there is an association between inflammatory markers and psychological disorders in veterans and military personnel. The primary question to be examined is: Is there an association between increased inflammatory markers and psychological disorders in military personnel or veterans? Inclusion criteria Types of participants This review will consider studies that include currently serving military personnel, as well as individuals who have already left the military (veterans). Military populations of all countries and all ethnicities will be considered. Both females and males will be considered. No age restrictions will be applied. This review will exclude studies that involve participants undergoing basic recruit or military training as this population is not considered to have met the definition of being a currently serving military member, or a military veteran in the sense of having had a period of service, or been deployed and involved in a period of active duty. Phenomena of interest The phenomena of interest in this review are inflammatory markers and psychological disorders. Studies that seek to identify changes in inflammatory markers and the presence or absence of psychological disorders will be considered. Specific inflammatory markers are likely to include C-Reactive Protein, Interleukin-6, and Tumour Necrosis Factors. Psychological disorders of interest will include posttraumatic stress disorder, depression and anxiety related conditions, adjustment disorder as well as somatic complaints; however, studies which have sought to identify other psychological disorders will also be considered. Types of outcomes: TRUNCATED AT 250 WORDS

The association between inflammatory markers and psychological disorders in veterans and military personnel: a systematic review protocol

The association between inflammatory markers and psychological disorders in veterans and military personnel: a systematic review protocol

The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel

Post-traumatic stress disorder (PTSD) may be the most urgent problem the U.S. military is facing today. Pharmacological and psychological interventions reduce the severity of some PTSD symptoms however these conventional approaches have limited efficacy. This issue is compounded by the high rate of co-morbid traumatic brain injury (TBI) and other medical and psychiatric disorders in veterans diagnosed with PTSD and unresolved system-level problems within the Veterans Administration and Department of Defense healthcare services that interfere with adequate and prompt care for veterans and active duty military personnel. This paper is offered as a framework for interdisciplinary dialogue and collaboration between experts in biomedicine and CAM addressing three primary areas of need: resiliency training in high risk military populations, prevention of PTSD following exposure to combat-related trauma, and treatment of established cases of PTSD.The evidence for widely used conventional pharmacological and psychological interventions used in the VA/DOD healthcare systems to treat PTSD is reviewed. Challenges and barriers to adequate assessment and treatment of PTSD in military personnel are discussed. A narrative review of promising CAM modalities used to prevent or treat PTSD emphasizes interventions that are not widely used in VA/DOD clinics and programmes. Interventions reviewed include virtual reality graded exposure therapy (VRGET), brain–computer interface (BCI), EEG biofeedback, cardiac coherence training, EMDR, acupuncture, omega-3 fatty acids and other natural products, lucid dreaming training, and energy therapies. As meditation and mind-body practices are widely offered within VA/DOD programmes and services addressing PTSD the evidence for these modalities is only briefly reviewed. Sources included mainstream medical databases and journals not currently indexed in the mainstream medical databases. Although most interventions discussed are applicable to both civilian and military populations the emphasis is on military personnel. Provisional integrative guidelines are offered with the goal of providing a flexible and open framework when planning interventions aimed at preventing or treating PTSD based on the best available evidence for both conventional and CAM approaches. The paper concludes with recommendations on research and policy within the VA and DOD healthcare systems addressing urgent unmet needs associated with PTSD.

Biopolitical screens: image, power, and the neoliberal brain

In Biopolitical Screens, Pasi Valiaho charts and conceptualizes the imagery that composes our affective and conceptual reality under twenty-first-century capitalism. Valiaho investigates the role screen media play in the networks that today harness human minds and bodies—the ways that images animated on console game platforms, virtual reality technologies, and computer screens capture human potential by plugging it into arrangements of finance, war, and the consumption of entertainment. Drawing on current neuroscience and political and economic thought, Valiaho argues that these images work to shape the atomistic individuals who populate the neoliberal world of accumulation and war. Valiaho bases his argument on a broad notion of the image as something both visible and sayable, detectable in various screen platforms but also in scientific perception and theoretical ideas. After laying out the conceptual foundations of the book, Valiaho offers focused and detailed investigations of the current visual economy. He considers the imagery of first-person shooter video games as tools of “neuropower”; explores the design and construction of virtual reality technologies to treat post-traumatic stress disorder in veterans of Iraq and Afghanistan; and examines three instances of video installation art that have the power to disrupt the dominant regime of sensibility rather than reinforce it.

Exposure, Agency, Perceived Threat, and Guilt as Predictors of Posttraumatic Stress Disorder in Veterans

Using a sample of 289 Iraq/Afghanistan veterans, this study examined the contributions of combat exposure, agency, perceived threat, and guilt to posttraumatic stress disorder (PTSD) symptoms. Regression analyses indicated the four variables (together with demographic variables) accounted for 79% of the variance in PTSD symptoms. Guilt was the most important predictor. In addition, guilt mediated between exposure and PTSD symptoms, perceived threat and PTSD symptoms, and agency and PTSD symptoms. Implications of these findings are discussed.

The epworth sleepiness scale in the assessment of sleep disturbance in veterans with tinnitus.

Purpose. Tinnitus and sleep disturbance are prevalent in veterans, and a better understanding of their relationship can help with tinnitus treatment. Materials and Methods. Retrospective chart review of 94 veterans seen in audiology clinic between 2010 and 2013 is presented. Results. The mean age was 62 years, and 93 of 94 veterans were males. The majority (96%) had hearing loss. The positive predictive value of the ESS for sleep disorder was 97% and the negative predictive value was 100%. Veterans with a Tinnitus Handicap Inventory (THI) score ≥38 had significantly higher Epworth Sleepiness Scale (ESS) scores compared to those with THI score <38 (P = 0.006). The former had a significantly higher incidence of PTSD, anxiety, and sleep disorder. A subgroup of patients had normal sleep despite rising THI scores. Bilateral tinnitus, vertigo, and anxiety were found to be predictors of sleep disturbance. Conclusions. The ESS can be used as a tool in the initial assessment of sleep disorders in veterans with tinnitus. Higher tinnitus handicap severity is significantly associated with greater sleep disturbance. Optimal management of tinnitus may require concomitant treatment of sleep disorder, PTSD, anxiety, and depression.

Post-traumatic stress disorder in veterans of Operation Enduring Freedom/Operation Iraqi Freedom: Retrospective review of treatment received compared to evidence-based practice guidelines

Background: Post-Traumatic Stress Disorder (PTSD) is a syndrome that can emerge after exposure to a traumatic event. In the veteran population, the strongest predictor of developing PTSD is frequency and intensity of direct combat exposure. The 2010 Veterans Affairs (VA)/Department of Defense (DoD) guidelines for the treatment of PTSD published in 2010 recommend psychotherapy techniques and/or pharmacotherapy (selective serotonin reuptake inhibitor or venlafaxine) as initial management.Objective: This study aimed to determine whether Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans received treatment for PTSD in concordance with VA/DoD guidelines.Methods: A retrospective chart review was conducted for 400 patients at the South Texas Veterans Health Care System (STVHCS) with OEF/OIF service who had a PTSD-related encounter between September 1, 2011 and August 31, 2012. The primary outcome was the percentage of OEF/OIF veterans with PTSD who received treatment in concordance with VA/DoD guidelines. Secondary outcomes included length of time veterans waited to see mental health (MH) providers, and comparison of outcomes between patients who received evidence-based treatment to those that did not.Results: Two-hundred and seventy-nine patients met the inclusion criteria and the majority of patients (n = 183, 65.5%) received treatment consistent with the VA/DoD Guidelines. The overall median wait time to see a MH provider was 10 +/−26.64 days, and did not differ significantly between groups. Patients whose treatment did not follow guideline recommendations had statistically more psychiatric emergency department (ED) visits (10 vs. 17, p=0.0026).Conclusions: The majority of patients at the STVHCS received treatment for PTSD in concordance with the VA/DoD guidelines, and 67.7% of patients saw MH providers within 14 days. Patients who did not receive guideline-supported treatment had more frequent ED visits, but the reason for this is unknown and may be due to a number of factors not accounted for in this review. The number of ED visits may be reduced by fully utilizing the processes in place that work to improve veteran access to MH care and the provision of guideline-based treatment. Prospective studies are needed to clearly elucidate the factors that may impact whether or not patients receive recommended treatment.

Topiramate treatment of alcohol use disorder in veterans with posttraumatic stress disorder: a randomized controlled pilot trial.

The course of posttraumatic stress disorder (PTSD) is frequently and severely complicated by co-occurring alcohol use disorder (AUD), yet there are few reports of pharmacologic treatments for these comorbid conditions. The objective of this pilot study was to obtain a preliminary assessment of the efficacy and safety of topiramate in reducing alcohol use and PTSD symptoms in veterans with both disorders. This was a prospective 12-week, randomized, double-blind, placebo-controlled pilot trial of flexible-dose topiramate up to 300mg/d in 30 veterans with PTSD and AUD. The primary outcome measure was frequency of drinking. Secondary outcomes consisted of other measures of alcohol use and PTSD symptom severity. Within-group analyses showed that topiramate treatment was associated with significant reductions in frequency and amount of alcohol use and alcohol craving from baseline through week 12. Between-group analyses showed that topiramate reduced frequency of alcohol use and alcohol craving significantly more than placebo and tended to reduce drinking amount. Topiramate treatment was also associated with decreased PTSD symptom severity and tended to reduce hyperarousal symptoms compared with placebo. Topiramate transiently impaired learning and memory, with significant recovery by the end of treatment. These preliminary results indicate that in veterans with co-occurring PTSD and AUD, topiramate may be effective in reducing alcohol consumption, alcohol craving, and PTSD symptom severity-particularly hyperarousal symptoms. Topiramate was associated with transient cognitive impairment but was otherwise well tolerated.