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- PTSD Update 100
- PTSD Update 101
- Dr. Matthew Friedman ********************************* PTSD Update 102
- PTSD Update 103
PTSD Update 99: Maj. Gary H. Wynn, a research psychiatrist at Walter Reed Army Institute of Research, presented new analysis at American Psychiatric Association’s annual meeting on 5MAY about why the soldiers don’t seek care or drop out of treatment early. Roughly half of the soldiers who return from war with post-traumatic stress disorder don’t seek treatment, and many more drop out of therapy early, according to military research presented at last week’s American Psychiatric Association’s annual meeting. “Fewer than half of the soldiers who report symptoms of combat-related PTSD receive the care they need,” Maj. Gary H. Wynn, a research psychiatrist at Walter Reed Army Institute of Research, said during a presentation to the association. “And of those soldiers who do start treatment, between 20 percent and 50 percent walk away before its completion.” Army analysis of multiple studies suggests that most servicemembers have at least one experience during deployment that could lead to PTSD, and 15 percent of U.S. infantrymen who have deployed to Iraq or Afghanistan have returned with the disorder, a condition characterized with such symptoms as depression, anger, mistrust, panic, guilt and violent behavior, physical pain, dizziness and trouble sleeping, Wynn said. Experiences that can lead to PTSD include receiving incoming artillery, rocket or mortar fire, being attacked or ambushed or knowing someone seriously injured or killed, he said. Despite these alarming findings, few servicemembers seek help, research shows. And there’s a common misperception that the military can simply order a servicemember to report for PTSD treatment, Wynn said in a phone interview. Military members retain the right to refuse psychiatric treatment or medication, unless they are a risk to themselves or others, he said, adding that it wouldn’t be good therapy to order people into care. “You want them to be engaged and not feel forced,” he said. The fact that today’s soldiers are professionals, rather than draftees, might also be a factor in their reluctance to engage in PTSD therapy, said retired U.S. Army Lt. Col. David Johnson, now executive director of the Center for Advanced Defense Studies in Washington, D.C. Soldiers in an all-volunteer force want to be selected for combat missions and they are afraid that psychological testing will prevent them from deploying,” Johnson said. The Army needs to reduce the stigma associated with PTSD and, “let people know it doesn’t harm your career,” he said, adding that recent rule changes mean soldiers can’t be denied a security clearance simply because they’ve been diagnosed with PTSD. Getting soldiers to seek treatment is only half the battle; doctors must also find ways to keep them in treatment. A soldier might drop out of PTSD therapy for a variety of reasons, including a lack of trust for mental health professionals, a belief that psychological problems tend to work themselves out or a perception that seeking mental health treatment should be a last resort, Johnson said. While it’s possible to see a physical wound heal, it’s not obvious when somebody has overcome PTSD. “Soldiers don’t like the idea of open-ended therapy,” Johnson said, adding that psychiatrists and psychologists could be motivated to keep troops in therapy longer than necessary since they get paid based on how much therapy they provide. “I don’t think soldiers are dropping out of treatment because they don’t think it works. Perhaps they think it works and nobody can tell them when it is done.” Regardless of the reasons, Wynn said it’s important that troops get the help they need. “We’ve learned that keeping soldiers who are already enrolled in PTSD treatment from dropping out is the most important strategy for improving outcomes,” he said. The key, Wynn said, is to keep the troops interested. Treatments that include video games, alternative medicine and outdoor activities, such as fly fishing, are common methods. “We want guys to continue these things after they finish treatment,” he said. [Source: Stars and Stripes Seth Robson article 15 May 2012 ++] ********************************* PTSD Update 100: The Army on 16 MAY launched a review of its handling of post-traumatic stress disorder and other behavioral health evaluations at all of its medical facilities since 2001, in response to fears that some soldiers had their diagnoses reversed because of concerns about the cost of treating them. The announcement follows disclosures that some soldiers diagnosed as suffering from post-traumatic stress disorder had that finding rejected during subsequent evaluations at Joint Base Lewis-McChord in Washington state. In reviewing those evaluations this year, Army investigators have found cases where “the original PTSD diagnoses were more accurate,” according to an Army statement. The Army will now review diagnoses and evaluations made at all of its other medical facilities. Army leaders also have ordered an independent review by the Army inspector general into whether the disability evaluation system affects the behavioral health diagnoses given to soldiers, and whether the command climate or other non-medical factors affect the diagnoses, according to information given Wednesday to members of Congress. The diagnoses are the first step in evaluating the amount of disability benefits a soldier receives. In addition, the Army auditor general has been ordered to audit the U.S. Army Medical Command Ombudsman Program, which was set up as a mediator for soldiers and family members in the wake of the scandal over conditions at the former Walter Reed Army Medical Center. “The Army clearly realizes they have a nationwide, systematic problem on their hands,” said Sen. Patty Murray, (D-WA) the chairman of the Senate Veterans’ Affairs Committee, who requested the Army review at Lewis-McChord. “I credit them with taking action, but it will be essential that this vast and truly historic review is done the right way.”The Army’s review of 400 cases at Lewis-McChord has so far led to more than 100 service members having their PTSD diagnoses restored. “Reviewing our processes and policies will ensure that we apply an appropriate standard at every installation - one that is influenced only by the opinion and expertise of our medical professionals,” Secretary of the Army John M. McHugh and Army Chief of Staff Raymond T. Odierno said in a joint statement. Joint Base Lewis-McChord, one of the largest military installations in the nation, has attracted attention in recent months because of several high-profile incidents. It is the home base for Army Staff Sgt. Robert Bales, accused of massacring 17 Afghan villagers in March, as well as five soldiers who were found guilty in 2010 of charges relating to the killings of three unarmed Afghan civilians. The Army review is to be led by Gen. Lloyd Austin, the Army vice chief of staff, and Undersecretary of the Army Joseph Westphal. The review is meant to identify and correct problems in the Army’s approach to behavioral health diagnoses and disability evaluations. Austin called Murray Wednesday to brief her on the Army review. [Source: Stars & Stripes Steve Vogel article 16 May 2012 ++] ********************************* PTSD Update 101: A key leader in the psychiatric community has rejected the idea of altering the name of a traumatic condition affecting estimated tens-of-thousands of U.S. combat veterans -- a move that effectively blocks growing efforts by a small group of psychiatrists and military brass concerned about reducing patient stigma. Dr. Matthew Friedman, who is chairing the committee that is updating the trauma section of the dictionary of mental, said changing the name of the condition could have "unintended negative consequences" because "it would confuse the issue and set up diagnostic distinctions for which there is no scientific evidence." The dictionary, known as the Diagnostic and Statistical Manual of Mental Disorders, is considered the bible by the psychiatric association. Last year, then-Army Vice Chief of Staff Peter Chiarelli asked the American Psychiatric Association to modify the name of Post-Traumatic Stress Disorder (PTSD) to Post-Traumatic Stress Injury (PTSI). The four star general says calling the condition a "disorder" perpetuates a bias against the mental health illness and is a barrier to veterans getting the care they need. More recently, two leading trauma psychiatrists similarly asked the Association, which is updating its dictionary of mental health illness, to change the word "disorder" to "injury," calling the condition PTSI instead. But at the psychiatric association annual conference on 14 MAY, Friedman said the net effect of such a modification would be to tinker with a psychiatric diagnosis rather than help patients. "To change to PTSI without anything else would accomplish nothing positive," Friedman said. For a more in-depth article on the issue refer to http://www.pbs.org/newshour/rundown/2012/05/key-psychiatric-doctor-rejects-name-change-for-ptsd.html. [Source: PBS News Hour Daniel Sagalyn article 10 May 2012 ++] 
Dr. Matthew Friedman ********************************* PTSD Update 102: Doctors at the Ralph H. Johnson VA Medical Center are experimenting with new approaches to help soldiers who are battling Post-Traumatic Stress Disorder. "We want something that's quicker and more effective," says Dr. Christopher Pelic of the VA Medical Center. "Sort of in combining treatments with the short burst of therapy." This new form of PTSD therapy, called Transcranial Magnetic Stimulation, uses electrical pulses. A veteran sits in a chair and they think about the event that made them feel so out of control while in the war zone. While that is happening, electrical pulses trigger feelings of control inside the veteran's brain. This type of therapy is in its early stages, but doctors at the VA Medical Center say the results are encouraging. "We've seen some folks have a nice turn around early on," says Dr. Pelic. "We haven't had a large number of subjects, but we've seen some nice results." 
Veterans with PTSD are also re-living whatever trauma they experienced through a custom designed video game that puts them back in war zone. You wear a set of goggles and you're back in that situation, and we think that helps people who can't really keep those memories and imagination for whatever reason," says Dr. Ron Acierno. And the theme of using technology to assist in PTSD therapy continues outside of the research facility. "Another intervention we're doing is handing out iPads so that veterans who would rather get treatment at home, or if for example they have child care responsibilities or work or if they live far away from the VA centers, they can still get the same treatment," explains Dr. Acierno. All this new technology may one day replace the way veterans have been coping with PTSD for decades, which is the use of a counselor and exposure therapy. Dr. Acierno says that in exposure therapy, "we have people engage in those traumatic memories, things that bother the most, over and over again until they're no longer overwhelming." And while this type of therapy has been helpful for many, doctors are hoping their new high tech forms of therapy will mean quicker relief for veterans who are still battling with stress-inducing memories. ********************************* PTSD Update 103: John Huston’s controversial World War II documentary about soldiers suffering from combat stress has been restored by the National Archives and put online at http://www.filmpreservation.org/preserved-films/screening-room/let-there-be-light-1946 to mark Memorial Day. The film, “Let There Be Light,” was suppressed by the Army and not shown to the public until 1980. The restoration has repaired the soundtrack, allowing viewers to hear once-inaudible conversations between the soldiers and the Army doctors treating them for what was then called shell shock and is now known as post-traumatic stress disorder. “We hope that by making ‘Let There Be Light’ freely available — and by drawing attention to it — that the courageous documentary will find the audience it was intended to serve,” said Annette Melville, director of the National Film Preservation Foundation, which funded the restoration. The film will be available on the foundation’s Web site through August 2012. [Source: Washington Post Steve Vogel article 24 May 2012 ++] 
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