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1.
Pathologica ; 111(2): 79-85, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31388201

RESUMO

In the conviction that a look at the past can contribute to a better understanding of the present in the field of science too, we discuss here two aspects of the relationship between early 20th century anatomic pathology and psychiatry that have received very little attention, in Italy at least. There was much debate between these two disciplines throughout the 19th century, which began to lose momentum in the early years of the 20th, with the arrival on the scene of schizophrenia (a disease histologically sine materia) in all its epidemiological relevance.The First World War also contributed to the separation between psychiatry and pathology, which unfolded in the fruitless attempts to identify a histopathological justification for the psychological trauma known as shell shock. This condition was defined at the time as a "strange disorder" with very spectacular symptoms (memory loss, trembling, hallucinations, blindness with no apparent organic cause, dysesthesias, myoclonus, bizarre postures, hemiplegia, and more), that may have found neuropathological grounds only some hundred years later.Among the doctors with a passed involvement in the conflict, Ugo Cerletti, the inventor of electroshock treatment, focused on the problem of schizophrenia without abandoning his efforts to identify its organic factors: if inducing a controlled electric shock, just like an experimentally-induced epileptic seizure, seems to allay the psychotic symptoms and heal the patient, then what happens inside the brain? In seeking histological proof of the clinical effects of electroconvulsive therapy ("the destruction of the pathological synapses"), and attempting to isolate molecules (that he called acroagonins) he believed to be synthesized by neurons exposed to strong electric stimulation, Cerletti extended a hand towards anatomic pathology, and took the first steps towards a neurochemical perspective. However his dedication to finding a microscopic explanation for schizophrenia - in the name of a "somatist" approach that, some years earlier, the psychiatrist Enrico Morselli had labelled "histomania" - was unable to prevent psychiatry from moving further and further away from anatomic pathology.


Assuntos
Eletroconvulsoterapia/tendências , Psiquiatria/tendências , Choque Traumático/psicologia , Choque Traumático/terapia , Distúrbios de Guerra/patologia , Distúrbios de Guerra/psicologia , Distúrbios de Guerra/terapia , Eletroconvulsoterapia/métodos , Eletrochoque , Humanos , Itália , Psiquiatria/métodos , Choque Traumático/patologia , I Guerra Mundial
2.
Neuropsychology ; 33(7): 913-921, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31192654

RESUMO

OBJECTIVE: Cognitive complaints, such as attentional or memory concerns, are commonly reported by veterans diagnosed with posttraumatic stress disorder (PTSD) or a history of mild traumatic brain injury (mTBI). The degree to which those complaints actually map onto measurable cognitive deficits is unclear and is likely complicated by the severity of trauma-related sequelae. In the present study we sought to characterize the degree to which PTSD symptoms and mTBI accounted for the relationship of subjective cognitive complaints to objective cognitive performance, with the goal of facilitating the accurate assessment of trauma-exposed veterans complaining of cognitive decline. METHOD: A sample of 203 U.S. military veterans previously deployed to Iraq and/or Afghanistan were assessed for PTSD severity, history of blast and impact mTBI, objective cognitive function, and subjective cognitive complaints. Separate mediation analyses were conducted to explore the degree that PTSD severity, blast mTBI severity, and impact mTBI severity influenced the association between subjective cognitive complaints and objective cognitive performance. Models reflecting significant mediation were followed by post hoc moderated mediation analyses. RESULTS: Subjective cognitive complaints and objective cognitive performance were significantly associated (ß = -6.49, SE = 2.85, p = .03), but this relationship was mediated by PTSD severity (ß= -2.95, SE = 2.86, p = .30). PTSD mediation was not moderated by either blast or impact mTBI. CONCLUSION: The present results delineate the prominent impact of PTSD symptoms, relative to blast and impact mTBI, on cognition following combat. These findings highlight the importance of assessing for trauma-related psychopathology in those seeking neuropsychological assessment or rehabilitative care for cognitive complaints. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Concussão Encefálica/psicologia , Transtornos Cognitivos/psicologia , Distúrbios de Guerra/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Campanha Afegã de 2001- , Traumatismos por Explosões/psicologia , Concussão Encefálica/complicações , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Transtornos de Estresse Pós-Traumáticos/complicações , Estados Unidos , Adulto Jovem
5.
Health Psychol ; 38(7): 606-612, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31008646

RESUMO

OBJECTIVE: This study aimed to examine the role of combat stress reaction (CSR) in predicting all-cause mortality over a 33-year period following the end of the war. METHOD: Two groups of male veterans from the 1982 Lebanon War participated in this study in 1983 (T1) and 2016 (T2): the CSR group (n = 375) and a matched comparison group (n = 305) consisting of combatants who had participated in combat in the same units as the CSR group but were not identified as having CSR. Participants were assessed for posttraumatic stress disorder symptoms and depressive symptoms in T1 and mortality in T2. RESULTS: The distribution of mortality rates was significantly different between the 2 groups and higher among the CSR group (n = 32, 8.5%) as compared to the comparison group (n = 12, 3.9%; χ2 = 5.89, p = .01). Both posttraumatic stress disorder symptoms and depressive symptoms were controlled for because they have been shown to be risk factors for all-cause mortality. The mortality curve of the CSR group increased steeply around the age of 40 years, whereas in the comparison group, the increase was less substantial. CONCLUSIONS: CSR was found to be a significant predictor of all-cause mortality. The risk for mortality was higher and earlier among the CSR group compared with the comparison group. The findings of this study call attention to the importance of immediately identifying CSR to better care for the individual and minimize long-term negative effects. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Distúrbios de Guerra/mortalidade , Distúrbios de Guerra/psicologia , Transtornos de Estresse Pós-Traumáticos/mortalidade , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Doença Aguda , Adolescente , Adulto , Distúrbios de Guerra/diagnóstico , Humanos , Israel/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Fatores de Risco , Autorrelato , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estresse Psicológico/diagnóstico , Estresse Psicológico/mortalidade , Estresse Psicológico/psicologia , Adulto Jovem
6.
Psychol Aging ; 34(4): 467-474, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30816736

RESUMO

Cross-sectional studies have shown contradictory results concerning the impact of combat exposure on mental health in later life. We examined whether combat exposure influences trajectories of mental health symptoms in older male veterans using longitudinal data collected from 1985 to 1991 in the Veterans Affairs Normative Aging Study (N = 1,105, age range = 40-86 years in 1985). Noncombat veterans showed little systematic change in depressive and anxiety symptoms with age, whereas combat veterans showed U-shaped nonlinear changes, with higher levels in midlife decreasing until the mid-60s and then increasing again in the 70s and 80s. These findings support the notion that military service, and especially combat exposure, is a hidden variable in aging research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Envelhecimento/psicologia , Distúrbios de Guerra/psicologia , Saúde Mental/tendências , Veteranos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
7.
Psychol Trauma ; 11(6): 621-629, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30896225

RESUMO

OBJECTIVE: Among combat veterans, moral injury (i.e., the guilt, shame, inability to forgive one's self and others, and social withdrawal associated with one's involvement in events that occurred during war or other missions) is associated with a host of negative mental health symptoms, including suicide. To better inform and tailor prevention and treatment efforts among veterans, the present study examined several potential risk (i.e., overidentification and self-judgment) and protective (i.e., self-kindness, mindfulness, common humanity, and social connectedness) variables that may moderate the association between moral injury and suicidality. METHOD: Participants were 189 combat wounded veterans (96.8% male; mean age = 43.14 years) who had experienced one or more deployments (defined as 90 days or more). Nearly all participants reported a service-connected disability (n = 176, 93.1%) and many had received a Purple Heart (n = 163, 86.2%). RESULTS: Within a series of moderation models, we found 3 statistically significant moderation effects. Specifically, the association between self-directed moral injury and suicidality strengthened at higher levels of overidentification, that is, a tendency to overidentify with one's failings and shortcomings. In addition, the association between other-directed moral injury and suicidality weakened at higher levels of mindfulness and social connectedness. CONCLUSIONS: These findings provide insight on risk and protective factors that strengthen (risk factor) or weaken (protective factor) the association between moral injury and suicidality in combat-wounded veterans. Taken together, mindfulness, social connectedness, and overidentification are relevant to understand the increased/decreased vulnerability of veterans to exhibit suicidality when experiencing moral injury. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Distúrbios de Guerra/psicologia , Empatia , Princípios Morais , Sistemas de Apoio Psicossocial , Autoimagem , Suicídio/psicologia , Veteranos/psicologia , Lesões Relacionadas à Guerra/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
8.
J Abnorm Psychol ; 128(3): 245-255, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30920234

RESUMO

Posttraumatic stress disorder (PTSD) is prevalent among combat veterans and is associated with intimate relationship difficulties. Few studies have examined the prospective longitudinal course of associations between PTSD and relationship difficulties and whether there are gender differences. In a sample comprised of 202 male and female post 9/11 veterans, this study examined gender differences in the association between PTSD symptoms measured 4 times over the course of 1 year and romantic relationship role impairment measured at the beginning and end of that year, accounting for the association of combat stress and noncombat stressful life events. Increases in PTSD symptoms over time were positively associated with increased relationship impairment; however, relationship impairment was not associated with changes in PTSD over time. Gender did not significantly moderate this relationship. However, allowing model parameters to vary between genders revealed that noncombat life stress was associated with changes in PTSD over time for women, but not men. Conversely, only men exhibited associations of baseline levels of combat stress and noncombat stress with baseline relationship functioning, and between baseline relationship functioning and baseline PTSD symptoms. Findings suggest women veterans in particular may benefit from clinical attention to the influence of general stress on PTSD symptoms, while clinical work to improve couple impairment in the context of PTSD symptoms may be beneficial for veterans of both genders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Relações Interpessoais , Ataques Terroristas de 11 de Setembro/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Distúrbios de Guerra/psicologia , Feminino , Humanos , Amor , Masculino , Estudos Prospectivos , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estresse Psicológico , Estados Unidos , Veteranos/psicologia
9.
Psychiatry Res ; 274: 7-11, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30776710

RESUMO

Suicide rates amongst women veterans are significantly higher than rates for their civilian counterparts. However, risk factors for suicide among women veterans remain unclear. The current study examined the impact of exposure to a number of military stressors (e.g., perceived life threat, killing in combat, military sexual trauma) on suicidal ideation (SI) in women veterans. A total of 403 women veterans responded to mailed self-report surveys, 383 (ages 24-70 years) returned fully completed surveys and were included in analyses, and 16% of those included endorsed current SI. Rates of endorsement for military stressors were as follows: 43% being wounded, 34% loss of someone close, 36% perceived life threat, 30% witnessing a killing or injury, 4% seeing injured or dead bodies, 4% killing in combat, 65% military sexual harassment, and 33% military sexual assault. A logistic regression analysis was conducted with all of the military stressors entered simultaneously to determine the effect on SI. Life threat and sexual harassment had the strongest associations with SI compared to other military stressors. These findings suggest that particular military stressors may play an especially important role in SI in women veterans. Implications and future research considerations are discussed.


Assuntos
Distúrbios de Guerra/psicologia , Trauma Psicológico/psicologia , Delitos Sexuais/psicologia , Assédio Sexual/psicologia , Ideação Suicida , Veteranos/psicologia , Adulto , Idoso , Distúrbios de Guerra/diagnóstico , Distúrbios de Guerra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Militares/psicologia , Trauma Psicológico/diagnóstico , Trauma Psicológico/epidemiologia , Fatores de Risco , Autorrelato , Delitos Sexuais/tendências , Suicídio/psicologia , Suicídio/tendências , Inquéritos e Questionários , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/tendências , Adulto Jovem
10.
J Nerv Ment Dis ; 207(2): 53-58, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30672877

RESUMO

A vast number of veterans with posttraumatic stress disorder (PTSD) have chronic somatic comorbidities. However, their relationship with quality of life (QoL) has received little attention. We aimed to compare QoL of veterans with similar intensity of PTSD but different number of chronic somatic disorders. Of 129 veterans, 78% had at least one somatic disorder, and they reported lower QoL across all domains than veterans without somatic comorbidities. The greatest effect size was observed on social relationship (d = 0.65), it was notable on environment (d = 0.4) and psychological health (d = 0.38), and it was not relevant on physical health (d = 0.05). There was a negative correlation between the number of somatic disorders and scores on psychological health (rs = -0.217, p = 0.014), social relationships (rs = -0.248, p = 0.005), and environment (rs = -0.279, p = 0.001). The QoL of war veterans decreases significantly with the number of comorbid somatic conditions, particularly on the nonphysical domains of QoL.


Assuntos
Distúrbios de Guerra/psicologia , Relações Interpessoais , Doenças não Transmissíveis/psicologia , Qualidade de Vida/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adulto , Distúrbios de Guerra/epidemiologia , Comorbidade , Croácia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos
11.
Nat Neurosci ; 22(3): 470-476, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30664770

RESUMO

By combining computational, morphological, and functional analyses, this study relates latent markers of associative threat learning to overt post-traumatic stress disorder (PTSD) symptoms in combat veterans. Using reversal learning, we found that symptomatic veterans showed greater physiological adjustment to cues that did not predict what they had expected, indicating greater sensitivity to prediction errors for negative outcomes. This exaggerated weighting of prediction errors shapes the dynamic learning rate (associability) and value of threat predictive cues. The degree to which the striatum tracked the associability partially mediated the positive correlation between prediction-error weights and PTSD symptoms, suggesting that both increased prediction-error weights and decreased striatal tracking of associability independently contribute to PTSD symptoms. Furthermore, decreased neural tracking of value in the amygdala, in addition to smaller amygdala volume, independently corresponded to higher PTSD symptom severity. These results provide evidence for distinct neurocomputational contributions to PTSD symptoms.


Assuntos
Aprendizagem por Associação/fisiologia , Encéfalo/fisiopatologia , Distúrbios de Guerra/fisiopatologia , Distúrbios de Guerra/psicologia , Medo , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Tonsila do Cerebelo/fisiopatologia , Distúrbios de Guerra/complicações , Corpo Estriado/fisiopatologia , Eletrochoque , Feminino , Giro do Cíngulo/fisiopatologia , Hipocampo/fisiopatologia , Humanos , Masculino , Modelos Neurológicos , Motivação , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto Jovem
12.
Psychol Trauma ; 11(4): 379-382, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29963891

RESUMO

OBJECTIVE: Although killing in combat is associated with negative mental health outcomes and hazardous alcohol use, mechanisms that underlie this risk are not well understood. To our knowledge, this present brief report is the first to use mediation analysis to examine associations between killing in combat, distinct facets of rumination (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts), and negative mental health outcomes (i.e., depression, anxiety, PTSD, suicidality) and hazardous alcohol use. METHOD: Participants were a community sample of 283 military personnel (158 males [60.31%]; mean age = 32.61 [SD = 7.11]) who had deployed in support of recent wars in Iraq or Afghanistan. Participants completed an online self-report survey. RESULTS: Three rumination facets (i.e., problem-focused thoughts, counterfactual thinking, and anticipatory thoughts) uniquely (controlling for effects of other rumination facets) mediated the associations between killing in combat and negative mental health outcomes and hazardous alcohol use. Taken together, killing in combat was associated with higher levels of each rumination facet, which in turn were distinctly associated with more negative symptoms of mental health and more hazardous drinking (problem-focused thoughts were the only facet to mediate all effects). Beyond these significant mediation effects, killing in combat still had a significant direct effect on every outcome. CONCLUSION: These findings provide preliminary support for associations between killing in combat and negative mental health outcomes and hazardous alcohol use. Furthermore, rumination (particularly problem-focused thoughts) may be an important consideration in the evaluation and care of recent-era combat veterans. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Alcoolismo/psicologia , Homicídio/psicologia , Saúde Mental , Militares/psicologia , Ruminação Cognitiva , Exposição à Guerra , Adulto , Campanha Afegã de 2001- , Alcoolismo/epidemiologia , Distúrbios de Guerra/epidemiologia , Distúrbios de Guerra/psicologia , Estudos Transversais , Feminino , Humanos , Guerra do Iraque 2003-2011 , Masculino , Risco
13.
Mil Med ; 184(3-4): e263-e270, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30215768

RESUMO

INTRODUCTION: Post-traumatic stress disorder (PTSD) has been linked to a variety of adverse mental and physical health outcomes including distressed relationships. Involving romantic partners in PTSD treatment appears to be a promising new avenue for PTSD treatment; however, additional research is necessary to clarify veteran preferences for inclusion of significant others in treatment and relationship characteristics that may influence such preferences. Accordingly, the present study was designed to evaluate Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans' desire to include romantic partners in trauma-focused care (n = 74) and to explore psychological and relationship variables associated with preference for partner inclusion in PTSD treatment. MATERIALS AND METHODS: This study surveyed male (N = 74) OEF/OIF/OND combat veterans seeking mental health services at a Veterans Health Administration PTSD treatment program. Relationships between PTSD symptoms, romantic relationship functioning, and interest in including their romantic partner in PTSD treatment were examined. RESULTS: Consistent with previous research, OEF/OIF/OND veterans seeking treatment at a specialty PTSD program report low relationship satisfaction. The majority of participants reported that PTSD symptoms interfere with relationship functioning; specifically, numbing symptoms were a significant predictor of PTSD-related relationship impairment. A minority (26%) of participants reported a desire to include their romantic partner in PTSD treatment. Greater behavioral avoidance and communication difficulties were associated with increased interest in including a romantic partner in PTSD treatment. CONCLUSION: We confirmed that OEF/OIF/OND veterans seeking PTSD treatment experience PTSD-related problems in romantic relationships, low-relationship satisfaction, and relationship satisfaction was positively associated with perceived communication and problem-solving skills. A minority of veterans were interested in involving significant others in their PTSD treatment; however, in the present study, veterans were not given information about the various ways that a romantic partner might be involved in treatment, and they were not presented with specific conjoint therapies (e.g., Cognitive-Behavioral Conjoint Therapy for PTSD, Strategic Approach Therapy). For veterans with PTSD, relationship distress, and communication difficulties, conjoint psychotherapies may offer a way of increasing engagement in PTSD treatment by parsimoniously addressing multiple treatment targets at once (PTSD symptoms, relationship distress, communication problems) and providing veteran-centered care.


Assuntos
Percepção , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia , Adulto , Campanha Afegã de 2001- , Distúrbios de Guerra/psicologia , Distúrbios de Guerra/terapia , Humanos , Relações Interpessoais , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Cônjuges/psicologia , Cônjuges/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/estatística & dados numéricos
14.
Mil Med ; 184(5-6): e218-e226, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30252077

RESUMO

INTRODUCTION: Driven by the need to share data, sufficiently power studies, and allow for cross-study comparisons of medical and psychiatric diseases, the President's National Research Action Plan issued in 2013 called for the use of state-of-the-art common data elements (CDEs) for research studies. CDEs are variables measured across independent studies that facilitate methodologically sound data aggregation and study replication. Researchers in the field of military-related post-traumatic stress disorder (PTSD) have suggested applicable CDEs; however, to date, these recommendations have been conceptual and not field-tested. The Consortium to Alleviate PTSD (CAP) - an interdisciplinary and multi-institutional, military-related PTSD research consortium funded by the Departments of Defense and Veterans Affairs - generated and applied CDEs that can be used to combine data from disparate studies to improve the methodological and statistical capabilities of study findings. We provide a description and rationale for the CAP CDEs and details about administration with two main goals: (1) to encourage military-related PTSD researchers to use these measures in future studies and (2) to facilitate comparison, replication, and data aggregation. MATERIALS AND METHODS: The CAP compiled mandated (core) and optional CDEs based on the following criteria: (1) construct applicability to military-related PTSD; (2) precedence (use) in prior, related research; (3) published and strong psychometric evidence; (4) no cost (public domain); and (5) brevity, to limit participant burden. We provided descriptive statistics and internal consistency reliabilities for mandated measures from an initial cohort of around 400 participants enrolled in CAP studies. RESULTS: Mandated CDEs in the CAP were found to have very good internal consistency reliability. CONCLUSION: Although further research is needed to determine the incremental validity of these CDEs, preliminary analyses indicated that each mandated measure has very good internal consistency reliability. Investigators designing military-related PTSD research should consider using these field-tested CDEs to facilitate future data aggregation. Feedback based on empirical evidence or practical concerns to improve these CDEs is welcome.


Assuntos
Elementos de Dados Comuns , Psicometria/normas , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Distúrbios de Guerra/diagnóstico , Distúrbios de Guerra/psicologia , Humanos , Militares/psicologia , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
16.
Psychosomatics ; 60(2): 121-128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30580807

RESUMO

BACKGROUND: Post-September 11, 2001 combat veterans represent a growing cohort of patients with unique mental health needs, particularly around post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). The United States (US) remains engaged in conflicts around the globe, so this patient cohort will continue to grow in number. With around 40% of American combat veterans from Iraq and Afghanistan seeking mental health care outside of the Veterans Affairs, understanding the psychiatric needs of the post-September 11 combat veteran is an important goal for all psychiatrists. These patients are relevant to consultation-liaison (C-L) psychiatrists because of their high comorbidity of conditions such as TBI, obstructive sleep apnea, insomnia, and chronic pain. This article reviews the current literature on mental health care for the post-September 11 combat veteran, emphasizing PTSD and TBI treatment, and culling evidence-based recommendations from randomized controlled trials of combat veterans. Emphasis is also placed on the Veterans Affairs/Department of Defense Clinical Practice Guidelines. The authors also bring unique clinical expertise of having served on active duty as psychiatrists for the US Army, including in a combat zone, and both currently work in a Veterans Affairs Iraq and Afghanistan combat veteran mental health clinic. OBJECTIVE: This review outlines useful treatment approaches for PTSD and TBI and briefly covers the comorbid conditions of major depression, chronic pain, and substance use disorders. This review will prepare C-L psychiatrists to care for this challenging patient cohort.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Distúrbios de Guerra/terapia , Transtorno Depressivo Maior/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Veteranos/psicologia , Campanha Afegã de 2001- , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/psicologia , Dor Crônica/epidemiologia , Dor Crônica/psicologia , Distúrbios de Guerra/epidemiologia , Distúrbios de Guerra/psicologia , Comorbidade , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Humanos , Guerra do Iraque 2003-2011 , Psiquiatria , Delitos Sexuais/psicologia , Delitos Sexuais/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos
17.
Sleep ; 42(3)2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30561746

RESUMO

STUDY OBJECTIVES: Aggression, substance misuse, and other health risk behaviors are common among combat veterans. We examined whether sleep quality and quantity predict the association between combat exposure, post-traumatic stress symptoms, and adverse health-related behaviors. METHODS: Soldiers (N = 2420) from a brigade combat team completed surveys assessing combat experiences, and psychological and behavioral health factors, approximately 3 months following deployment to Afghanistan in 2011. RESULTS: Respondents were 93.5% male; 73% were age 18-29 years old. The response rate was 80% (3076/3832); 94% (2876/3076) of the soldiers who attended the recruitment briefings consented to participate in this research. Complete data were available across the variables used in this study for up to 2420 soldiers. Sleep continuity disturbance accounted for the association of combat exposure with post-traumatic stress symptoms and aggression, alcohol use, and risky behavior. Moreover, for soldiers who reported sleep duration of <6 hr per day, the indirect association of combat exposure and post-traumatic stress on aggression, alcohol use, risky behavior, and opioid use was strongest. CONCLUSIONS: This study is the first to model sleep problems as a predictor of the association between combat exposure and post-traumatic stress symptoms and frequently reported health-related behavior problems. Sleep disturbance is highly prevalent among Warfighters. While not fully preventable in operational contexts, these problems can be effectively mitigated postdeployment with appropriate policy and intervention resources. Improving the sleep characteristics of combat-exposed soldiers following deployment should reduce subsequent post-traumatic stress and related health compromising behavior, thereby enhancing force readiness.


Assuntos
Campanha Afegã de 2001- , Distúrbios de Guerra/psicologia , Comportamentos Relacionados com a Saúde/fisiologia , Militares/psicologia , Sono/fisiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adolescente , Adulto , Distúrbios de Guerra/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Assunção de Riscos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Inquéritos e Questionários , Veteranos/psicologia , Adulto Jovem
18.
Behav Res Ther ; 113: 1-8, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30553859

RESUMO

Resilience following traumatic events has been studied using numerous methodologies. One approach involves quantifying lower-than-expected levels of a negative outcome following trauma exposure. Resilience research has examined personality and coping-related factors. One malleable factor is psychological flexibility, or the context-dependent ability/willingness to contact the present moment, including emotional distress, in order to engage in valued actions. Among 254 war Veterans who participated in a longitudinal study, we operationalized resilience as lower-than-expected PTSD symptoms and PTSD-related functional impairment one-year following an initial post-deployment assessment based on lifetime exposure to childhood trauma, combat trauma, and sexual trauma during military service. We evaluated the contribution of personality factors, self-reported trait resilience, and psychological flexibility, measured using the Acceptance and Action Questionnaire-II, to PTSD-related resilience after accounting for lifetime and current PTSD symptom severity and depression symptom severity. In hierarchical regression analyses, neither specific personality factors nor self-reported resilience predicted PTSD-related resilience at follow-up after accounting for PTSD and depression symptoms. In the final step, psychological flexibility predicted unique variance and was the only significant predictor of PTSD-related resilience aside from baseline PTSD symptom severity. Findings indicate that psychological flexibility is a predictor of resilience that is distinct from psychiatric symptoms, personality, and self-reported resilience. Trauma survivors may benefit from interventions that bolster psychological flexibility.


Assuntos
Resiliência Psicológica , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos/psicologia , Adaptação Psicológica/fisiologia , Adulto , Campanha Afegã de 2001- , Distúrbios de Guerra/psicologia , Depressão/psicologia , Feminino , Humanos , Guerra do Iraque 2003-2011 , Estudos Longitudinais , Masculino , Personalidade , Autorrelato , Delitos Sexuais/psicologia , Exposição à Guerra
19.
Mil Med ; 184(1-2): e133-e142, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29931192

RESUMO

Introduction: Limited research has been conducted on the impact of deployment-related trauma exposure on post-traumatic stress symptoms in military medical personnel. This study evaluated the association between exposure to both combat experiences and medical duty stressors and post-traumatic stress symptoms in deployed military medical personnel. Materials and Methods: U.S. military medical personnel (N = 1,138; 51% male) deployed to Iraq between 2004 and 2011 were surveyed about their exposure to combat stressors, healthcare stressors, and symptoms of post-traumatic stress disorder (PTSD). All participants were volunteers, and the surveys were completed anonymously approximately halfway into their deployment. The Combat Experiences Scale was used as a measure of exposure to and impact of various combat-related stressors such as being attacked or ambushed, being shot at, and knowing someone seriously injured or killed. The Military Healthcare Stressor Scale (MHSS) was modeled after the Combat Experiences Scale and developed for this study to assess the impact of combat-related healthcare stressors such as exposure to patients with traumatic amputations, gaping wounds, and severe burns. The Post-traumatic Stress Disorder Checklist-Military Version (PCL-M) was used to measure the symptoms of PTSD. Results: Eighteen percent of the military medical personnel reported exposure to combat experiences that had a significant impact on them. In contrast, more than three times as many medical personnel (67%) reported exposure to medical-specific stressors that had a significant impact on them. Statistically significant differences were found in self-reported exposure to healthcare stressors based on military grade, education level, and gender. Approximately 10% of the deployed medical personnel screened positive for PTSD. Approximately 5% of the sample were positive for PTSD according to a stringent definition of caseness (at least moderate scores on requisite Diagnostic and Statistical Manual for Mental Disorders criteria and a total PCL-M score ≥ 50). Both the MHSS scores (r(1,127) = 0.49, p < 0.0001) and the Combat Experiences Scale scores (r(1,127) = 0.34, p < 0.0001) were significantly associated with PCL-M scores. However, the MHSS scores had statistically larger associations with PCL-M scores than the Combat Experiences Scale scores (z = 5.57, p < 0.0001). The same was true for both the minimum criteria for scoring positive for PTSD (z = 3.83, p < 0.0001) and the strict criteria PTSD (z = 1.95, p = 0.05). Conclusions: The U.S. military has provided significant investments for the funding of research on the prevention and treatment of combat-related PTSD, and military medical personnel may benefit from many of these treatment programs. Although exposure to combat stressors places all service members at risk of developing PTSD, military medical personnel are also exposed to many significant, high-magnitude medical stressors. The present study shows that medical stressors appear to be more impactful on military medical personnel than combat stressors, with approximately 5-10% of deployed medical personnel appearing to be at risk for clinically significant levels of PTSD.


Assuntos
Distúrbios de Guerra/etiologia , Pessoal de Saúde/psicologia , Análise de Variância , Distúrbios de Guerra/complicações , Distúrbios de Guerra/psicologia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Guerra do Iraque 2003-2011 , Modelos Lineares , Masculino , Medicina Militar/métodos , Medicina Militar/normas , Militares/psicologia , Militares/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , Fatores de Risco , Inquéritos e Questionários , Estados Unidos
20.
Occup Med (Lond) ; 68(9): 617-625, 2018 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-30590773

RESUMO

Background: Military service can be a traumatic experience and cause mental health problems in a minority of personnel, such as post-traumatic stress disorder (PTSD), which is linked to negative long-term outcomes. As a result, PTSD has received significant research attention. However, post-traumatic growth (PTG) is a newer construct, with comparatively little known about its presentation and development. Aims: To qualitatively examine the experience of (PTG) in military and ex-military personnel. Methods: A qualitative systematic search of electronic databases was conducted, with studies assessed for methodological quality and data analysed using thematic analysis. Nine qualitative studies, carried out between 2011 and 2016, met the inclusion criteria with 195 participants in total, including both military and ex-military personnel. Results: Six themes were identified: appreciation for life, re-evaluating sense of purpose, improvement of personal human traits, bonding and connecting with others, integrating into society, and being proud of heritage and feeling valuable to society. Conclusions: The results of this review illustrate that military personnel may experience PTG due to deployment-related trauma exposure, and the presentation of PTG in this population is not dissimilar to that of civilians. This study highlights the need for additional research to quantify the long-term psychological impact of PTG and whether a focus on PTG may be helpful in psychological treatment for (ex-) military personnel.


Assuntos
Distúrbios de Guerra/complicações , Transtornos Mentais/etiologia , Crescimento Psicológico Pós-Traumático , Adaptação Psicológica , Adulto , Distúrbios de Guerra/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Militares/psicologia , Militares/estatística & dados numéricos , Pesquisa Qualitativa , Veteranos/psicologia , Veteranos/estatística & dados numéricos
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