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Leshen G, Johnston S, Ries A, Ziajko L, Van Dell L, Nissan D. Establishing an Embedded Psychiatry Rotation with Naval Special Warfare: A Win for Both the Education of Military Psychiatry Residents and the Operational Forces. Acad Psychiatry 2023; 47:402-405. [PMID: 37466888 PMCID: PMC10447586 DOI: 10.1007/s40596-023-01823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/28/2023] [Indexed: 07/20/2023]
Affiliation(s)
| | | | - Amanda Ries
- Naval Medical Center San Diego, San Diego, CA, USA
| | | | | | - David Nissan
- Naval Medical Center San Diego, San Diego, CA, USA
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Shin JH, Yim SV. A Foundation for a "Cheerful Society": The Korean War and the Rise of Psychiatry. Uisahak 2023; 32:553-591. [PMID: 37718562 PMCID: PMC10556413 DOI: 10.13081/kjmh.2023.32.553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/03/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
One of the most remarkable medical achievements of the Korean War was the development of psychiatry. During the Korean War, soldiers and prisoners of war (POWs) experienced "gross stress reaction" and manifested poor concentration and memory as well as clinical depression and social alienation. Rest and relaxation rotations served as the primary treatment for their conditions. Civilians also bore the brunt of the war's effects. Delusions of grandeur and megalomania appear to have been common among Koreans, but there were few mental health facilities to provide treatment and care. Out of the furnace of war, psychiatry emerged as a newly specialized field, and in the 1950s, Korea became the very place where military psychiatry training under the U.S. military laid the groundwork for civilian psychiatry. This essay aims to enrich the study of mental illness during and after the Korean War by providing a more detailed picture of the mental problems experienced not only by veterans and POWs, but also by civilians in Korea. Examining mental health issues from this period is challenging due to the scarcity of resources for delving into the minds of the civilians involved. Taking military psychiatry as a starting point, this essay goes beyond existing scholarship to discuss psychiatry-related responses to the Korean War, including the influence of military psychiatry on civilian psychiatry, the endeavors of medical professionals and government policies, and contemporary expressions of mental distress during and after the war.
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Affiliation(s)
- Ji-Hye Shin
- Assistant Professor, Department of History Education, Chonnam National University
| | - Sung-Vin Yim
- Professor, College of of Medicine, Kyung Hee University
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Ginat K, Fruchter E, Lubin G, Knobler HY. [ISRAELI MILITARY PSYCHIATRY: CHALLENGES AND ACHIEVEMENTS]. Harefuah 2019; 158:473-477. [PMID: 31339249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this article, we have attempted to summarize the achievements and the challenges of the mental health department (MHD) of the IDF Medical Core from the past four decades, since its initiation. We approach this wide scope question through the investigation of the MHD according to the perspective of its main fields of endeavor. These domains are widely arrayed. In this paper, we chose to focus on the following: the unique training of the mental health officers; the initial psychological screening of soldiers - from recruitment to discharge; the mental health treatment of soldiers and officers, and the life-time treatment of combat post traumatic (PTSD) patients; the development of combat PTSD diagnosis, treatment and prevention; the continuous prevention of soldiers' suicides; the prevention of psychiatric hospitalizations; and the participation of the MHD in research and in the development of new treatment modalities. In the writing of this paper we relied on the accumulative experience of the MHD and the historic perspective of the last four commanders of the Mental Health Department of the IDF.
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Affiliation(s)
| | - Eyal Fruchter
- Psychiatric Division, Rambam Health Care Center, Haifa
| | - Gad Lubin
- The Jerusalem Mental Health Center, Eitanim-Kfar Shaul
| | - Haim Y Knobler
- Peres Academic Center
- Jerusalem Hebrew University Hadassah Medical School
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Trautmann S, Goodwin L, Höfler M, Jacobi F, Strehle J, Zimmermann P, Wittchen HU. Prevalence and severity of mental disorders in military personnel: a standardised comparison with civilians. Epidemiol Psychiatr Sci 2017; 26:199-208. [PMID: 27086743 PMCID: PMC6998688 DOI: 10.1017/s204579601600024x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/22/2016] [Indexed: 11/06/2022] Open
Abstract
AIMS Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders. METHOD 1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples. RESULTS Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5-0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1-0.6; NS: OR: 0.2, 95% CI: 0.1-0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3-0.6; NS: OR: 0.5, 95% CI: 0.3-0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4-5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3-8.0) were observed in DS with high combat exposure compared with civilians. CONCLUSIONS Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.
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Affiliation(s)
- S. Trautmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - L. Goodwin
- Department of Psychological Medicine, King's Centre for Military Health Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M. Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - F. Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J. Strehle
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - P. Zimmermann
- Centre for Psychiatry and Posttraumatic Stress, Federal Armed Forces Hospital Berlin, Berlin, Germany
| | - H.-U. Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Kobayashi T. [Effects of sense of coherence on depressive symptoms after employment in the Japan Self-Defense Force among male young adults]. Nihon Koshu Eisei Zasshi 2017; 64:150-155. [PMID: 28367936 DOI: 10.11236/jph.64.3_150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective The present study aimed to explore the effects of sense of coherence (SOC) on depressive symptoms after employment in the Japan Self-Defense Force among male young adults.Methods In April 2013, 953 new male members of the Japan Ground Self-Defense Force (JGSDF; age range: 18-24 years) participated in this study. Depressive symptoms were assessed using the 20-item version of the Center for Epidemiologic Studies Depression scale (CES-D), which defines a score of 16 or greater as indicating the presence of depressive symptoms. The SOC score was assessed using a 13-item version (SOC-13), in which a score of 59 or greater is as assigned to the high score group. A second survey was conducted two months later, in June of 2013. For the analysis, we selected participants without depressive symptoms at the baseline survey. The association between SOC scores at baseline and the onset of depressive symptoms was examined using a logistic regression analysis.Results The final analysis was conducted on data on 389 new male members of the JGSDF. The logistic regression analysis showed a significant reduction in the onset of depressive symptoms among the group with high SOC scores (odds ratios: 0.59, 95% confidence interval=0.35-0.98) as compared with that observed in the group with low SOC scores.Conclusions The present study clarified that SOC among male young adults has a buffering effect on the risk of developing depressive symptoms after employment in the Japan Self-Defense Force. Our results may be useful for improving the mental health of new employees.
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Affiliation(s)
- Tohru Kobayashi
- Department of Food Science and Human Wellness, Rakuno Gakuen University
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Rona RJ, Jones M, French C, Hooper R, Wessely S. Screening for physical and psychological illness in the British Armed Forces: I: The acceptability of the programme. J Med Screen 2016; 11:148-52. [PMID: 15333274 DOI: 10.1258/0969141041732193] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: To assess the response to a self-administered questionnaire and attendance of a medical centre for physical and psychological health screening. Methods: 4500 men and women from the three services were randomly selected to receive either a full or abridged screening questionnaire. The full questionnaire included the General Health Questionnaire-12 (GHQ-12) and Post-traumatic Stress Disorder (PTSD) checklist, 15 symptoms, a self-assessed health status question and three questions on alcohol behaviour (WHO Audit). The abridged questionnaire included GHQ-4, a slightly shortened PTSD checklist and five symptoms, but excluded questions on alcohol behaviour. All 'screen-positive' and a random 'screen-negative' sample were invited to attend a medical centre. Results: 67.1% of the servicemen completed a questionnaire; slightly but significantly more the abridged than the full questionnaire (4.9%, 95% confidence interval 2.3–7.4%). Of those receiving a full or abridged questionnaire, 32% and 22.5% respectively were 'screen-positives', most of the difference (7.5%) attributable to alcohol behaviour. Less than 30% of the servicemen invited to attend a medical centre accepted the invitation, even fewer during the preparation for deployment to Iraq. Those who fulfilled the criteria for PTSD, alcohol behaviour or multi-criteria 'screen-positive' were more reluctant than controls to attend. Conclusions: Screening for psychological illness has little support among servicemen, perhaps because they may not wish to share concerns with a military doctor. Avoidance behaviour among those with a psychological condition may also selectively reduce willingness to attend a medical centre. Screening during pre-deployment periods has even less support than at other times.
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Affiliation(s)
- R J Rona
- Department of Public Health Sciences, Guy's, King's and St Thomas' School Medicine, London.
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Rona RJ, Hooper R, Jones M, French C, Wessely S. Screening for physical and psychological illness in the British Armed Forces: III: The value of a questionnaire to assist a Medical Officer to decide who needs help. J Med Screen 2016; 11:158-61. [PMID: 15333276 DOI: 10.1258/0969141041732210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: To estimate the positive and negative predictive values (PPVT and NPVT), sensitivity and specificity of a full and abridged screening questionnaire of physical and psychological health, using primary care doctors' (medical officers [MOs]) assessments as to whether the servicemen needed medical help as a gold standard. Methods: From a tri-service random sample of those who completed a questionnaire, all 'screen-positive' and an equal random sample of 'screen-negative' were selected to attend their medical centre. MOs were aware that the screening was aimed at detecting psychological illness, but were blind as to the 'screen-positivity' of any serviceman. The MO completed a questionnaire that asked whether the patient needed medical help and whether s/he was previously aware of this need. Results: 314 subjects were available for analysis. The PPVT was 47% (95% confidence interval [CI] 36–59%) for the full questionnaire and 48% (95% CI 36–60%) for the abridged questionnaire. Of those 'screen-positive' subjects whom the MO rated as needing help, one third had problems already known to the MO, regardless of the length of the questionnaire. The sensitivity and specificity of the full and abridge questionnaires were 43% and 74%, and 36% and 83% respectively. The PPVT did not vary greatly between health dimensions nor did selection of servicemen with very high scores. Conclusions: The use of MOs as a gold standard is important because of their central role in initiating the management of any condition uncovered by a screening programme. Using MOs as a gold standard, the validity of the screening questionnaires for physical and psychological health in the military was mediocre.
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Affiliation(s)
- R J Rona
- Department of Public Health Sciences, Guy's, King's and St Thomas' School Medicine, London.
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Schnitzlein CW, Lee DJ, Wise JE, Warner CH. Both Feet In: Maintaining an Academic Focus During the Transition from Residency to a First Military Assignment. Acad Psychiatry 2015; 39:372-375. [PMID: 26122348 DOI: 10.1007/s40596-015-0369-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/06/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Maintenance of an academic focus is difficult for military residents transitioning into their first duty assignment. METHOD Building upon previous work on this subject, the authors present an updated and expanded junior faculty development model organized around seven overlapping domains: mentorship, scholarship, research, career planning, openness to experience, networking with other disciplines, and responsibility seeking. Using these seven domains as a platform for discussion, the authors focus on challenges facing early-career military psychiatrists and provide guidance based upon personal experience and limited applicable research. RESULTS The authors believe that highly successful early-career psychiatrists wishing to maintain an academic focus possess a proactive attitude, obtain skillful mentoring, work well with others, and are able to adapt to new environments. CONCLUSION Through conscious planning and goal setting, they are able to capitalize on opportunities as they become available.
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Colas MD. [ Military psychiatry in a theatre of operations: on mission in Mali]. Soins Psychiatr 2015:34-36. [PMID: 25975168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The recent missions of military psychiatrists in the theatres of operation underline the reactivity of the French healthcare system, focused on the expertise of the combat unit doctor. Operation Serval in Mali illustrates in particular the methods of medical-psychological support in exceptional situations, across a vast geographical area and in very difficult climatic conditions. The concept of "forward psychiatry" has a particularly important role to play in the early screening and treatment of psychological disorders in order to preserve the operational capacity of the deployed personnel.
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Rondier JP. [Traumatic psychological combat disorders. Extraordinary experiences]. Soins Psychiatr 2015:9. [PMID: 25975160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Charles B. [Working closely with units to treat war-related psychological trauma]. Soins Psychiatr 2015:13-14. [PMID: 25975162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
French soldiers are carrying out more operational missions than ever and are consequently exposed to potentially traumatic events. At the beginning of 2013, psychologists were posted to four military medical centres. Working as closely as possible to the units, military psychologists can thereby provide early, specific and continuous treatment to soldiers with psychological injuries.
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Le Pape E, de Montleau F. [Psychological impact on French soldiers in the Central African Republic]. Soins Psychiatr 2015:30-33. [PMID: 25975167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The many constraints and psychologically demanding situations to which French soldiers are subjected (living conditions, operational pace, scenes of exaction, hostile crowds, combat situations) have justified a psychiatrist being posted to the theatre of operation Sangaris, in the Central African Republic, soon after the military intervention began. While the psychiatrist's activity is typical of psychiatry in operational situations,.the configuration of the conflict- a civil war - and its impact on the psyche of the soldiers making up the task force have resulted in these practices being adapted and acknowledgement of the need to update skills.
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Gault C, Leduc C. [The "Écoute Défense" helpline, a new care tool within the military health service]. Soins Psychiatr 2015:19-22. [PMID: 25975164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The "Écoute Défense" helpline was launched on 23rd January 2013. This freephone number, available 24/7, is aimed at soldiers, former soldiers and their families. The main objective of the service is to listen, provide information and guide those suffering from psychological traumas which have arisen during service. Carried out by clinical psychologists from the military health service, the mission raises discussion around the challenges of this new channel for accessing care for soldiers.
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Boisseaux H. [The post-traumatic stress of journalists and war reporters]. Soins Psychiatr 2015:41-43. [PMID: 25975170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Just like soldiers, war photojournalists, reporters and technicians are subject to the risks of being exposed to a traumatic event. While a policy of prevention has been implemented within the army, this is not yet really the case with regard to press organisations. However, some professionals seek consultations at military hospitals. While their symptomatology does not present any notable specificities, considerable addictive or depressive comorbidities are observed. Managing their care is difficult, particularly as many are reluctant to undertake treatment programmes.
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Gheorghiev C. [Psychiatry in exceptional situations: the crash of flight AH5017 in Mali]. Soins Psychiatr 2015:37-40. [PMID: 25975169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The practice of the military psychiatrist comprises different perspectives, including a characteristic operational dimension. The unexpected is frequent in overseas missions, as illustrated by the crash of the Air Algeria flight in July 2014 in Mali and the deployment of French forces in the management of this disaster.This article reports on the medical-psychological intervention carried out in this context.
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Daudin M. [Role of a military psychiatrist in Afghanistan]. Soins Psychiatr 2015:27-29. [PMID: 25975166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Operational conditions expose soldiers to situations which are potentially traumatic on a psychological level. The specific and non specific psychological disorders which can result require relatively flexible treatment tools which can be adapted to the circumstances.As the first "link in the chain", the intervention of a psychiatrist in a theatre of operations enables the psychological care to begin at an early stage to be followed by long-term treatment when necessary. This article focuses on a mission in Afghanistan.
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Alexander D. With Doug: an Eastern Orthodox--Gestalt framework for pastoral psychotherapy in the armed forces. J Pastoral Care Counsel 2013; 67:7. [PMID: 24720246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In military behavioral healthcare, a short-term, solutions-focused system often privileges cognitive techniques over existential, affective, or psychodynamic approaches to care. Pastoral psychotherapy, which often privileges existential and person-centered care, has the potential to prove a pivotal complement in treating the whole person. This article offers an existential approach to pastoral psychotherapy in the military using integrated concepts and applications from Gestalt Therapy and Eastern Orthodox pastoral care.
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Muramatsu RS. Re: A mounting need for military cultural competency in civilian behavioral health providers. Mil Med 2013; 178:iv. [PMID: 23495453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
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Fasano MA. Healing at the Merritt Center: holistic nurses volunteer to help returning combat veterans. Beginnings 2012; 32:8-10. [PMID: 23210386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Halderman F. Caring for our troops: an overview of veteran trauma holistic nursing. Beginnings 2012; 32:4-7. [PMID: 23210385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Rapaport R. Holistic nursing takes a big step forward at VA. Beginnings 2012; 32:14-16. [PMID: 23210387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Kurasov ES, Marchenko AA, Krasnov AA, Golovach IG, Kozlova SN. [Comorbide somatic pathology in servicemen with neurotic disorders]. Voen Med Zh 2012; 333:29-34. [PMID: 22712246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Prevalence and structure of comorbidity a somatic pathology in military men with neurotic disorders was studied. It was established that 40,4% of surveyed noted concomitant somatic pathology, the structure of which was dominated by gastro-intestinal tract (26,8%), and pathology of the cardiovascular system (21,6%). It is shown that concomitant somatic pathology provided aggravating effect on clinic neurotic disorders in serviceman, making it difficult to diagnose mental disorders. The greatest risk concomitant a somatic pathology was marked in patients with depressive and somatoform disorders. Indicates the need for specialized standards of care for persons with comorbid mental and somatic disorders.
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Andersen HS. [ Military psychiatry in Denmark]. Ugeskr Laeger 2012; 174:792. [PMID: 22433549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Henrik Steen Andersen
- Krise- og Katastrofepsykiatrisk Center, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark.
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Xenakis SN. Neuropsychiatric evidence of waterboarding and other abusive treatments. Torture 2012; 22 Suppl 1:21-24. [PMID: 22948399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Maznikov IL, Sadchenko SN, Skripal' VN, Minaev AV. [Dysaptation in troops called up for military service to the Northern Fleet]. Voen Med Zh 2011; 332:45-49. [PMID: 22332396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Analyzed the results of the survey and inspection of about 75 000 conscripts who came to the acquisition of forces and troops of the fleet in terms of the Kola Polar region in 2001-2010. Cases of identified mental disorders in the number of young recruits in the period of examination by military medical committee designated as the primary dysaptation, and later--as delayed. The authors concluded that at present time we can expect the total number of recruits 4.45% of persons with mental dysaptation, including 0.52% of the primary and 3.93% with delayed. Over the last 10 years, an average of 4.45% of conscripts who came to the acquisition of forces (troops) of the Northern Fleet, dismissed by reason of mental dysaptation. The main contribution to the structure of the causes of limited recognition of the young recruits fit and unfit for military service were neurotic disorders and personality pathology. The authors suggest a specific position on a number of documents that need proof in order to improve the quality of maintenance training and combat activities of troops and naval forces.
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Merezhkin AM, Zheltyĭ OP, Karanik AR. [Diagnosis of reduction of reserves of mental adaptation in flight personnel and associated psycho-correction of preneurotic violations]. Voen Med Zh 2011; 332:50-54. [PMID: 22332397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The study shows that widespread distribution and low detectability of the early stages of reduction of reserves of mental adaptation in troop echelon of aviation specialists conditions the necessity for outpatient screening and psycho-correction of violations of the state, indicating a decrease in adaptive capacity of the individual. According to the authors, the use of the complex rehabilitation measures of personality-oriented individual and group psychotherapy helps to leveling of manifestations of preneurotic violations, correction of stress-producing reduction of psycho-physiological functions in the system of professionally important qualities for pilots, and has a significant positive impact on the adaptive capacity of individual pilots in general. As a result, digestion of the psycho corrective course by pilots leads to positive dynamics of their mental state, which is confirmed by objective data.
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Affiliation(s)
- Martin Deahl
- South Staffordshire and Shropshire NHS Foundation Trust, Stafford ST16 3AG, UK
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Prochazka H. [Societal support important for soldiers' mental health]. Lakartidningen 2010; 107:2536. [PMID: 21137545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Callahan DJ. Combat-related mental health disorders: the case for resiliency in the long war. J Am Osteopath Assoc 2010; 110:520-527. [PMID: 20876837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
More US military service members have been deployed since 9/11 than in the previous 40 years. A greater number of these deployed service members are surviving, which has increased the incidence of combat-related mental health disorders among veterans of "The Long War." The societal cost of caring for veterans with such disorders is expected to surpass that of the Global War on Terror, which is estimated at $600 billion. Because the prospect of stopping all deployment is remote, standardized prevention and treatment methods must be used to eliminate these "invisible wounds of war." It is imperative that high-quality, evidence-based, and cost-effective treatments--pharmaceutical and nonpharmaceutical--be developed. Although no approved medication currently exists for the prevention of posttraumatic stress disorder, the blood pressure medication propranolol has shown promise in erasing the behavioral expression of fear memory and may be useful for preventing more severe emotional disorders. In addition, a nonpharmaceutical method known as stress inoculation training is ideally suited to military populations and should be incorporated into military training programs. Furthermore, osteopathic physicians can improve resilience in the communities they serve by considering the dynamic of body, mind, and spirit in their patients. Applying these methods, teaching self-regulation traits, and removing barriers to care will build resiliency among service personnel for The Long War.
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Affiliation(s)
- Daryl J Callahan
- Kansas National Guard, Office of the State Surgeon, 2800 SW Topeka Blvd., Topeka, KS 66611-1287, USA.
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Kozminski M. Combat-related posttraumatic headache: diagnosis, mechanisms of injury, and challenges to treatment. J Am Osteopath Assoc 2010; 110:514-519. [PMID: 20876836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
CONTEXT Studies have revealed the rates of posttraumatic stress disorder (PTSD) and concussion among US soldiers returning from combat, but only one study has focused on the subpopulation of soldiers with headache. OBJECTIVES To determine the rate of PTSD among US soldiers with comorbid chronic posttraumatic headache attributed to head injury, to identify common mechanisms of head injury, and to identify the common challenges a healthcare provider must face when treating US soldiers with chronic posttraumatic headache attributed to head injury. METHODS Between July 2007 and December 2008, the author examined 42 US Army soldiers with complaint of chronic headache. In March 2009, the author retrospectively reviewed the outpatient records for diagnoses, mechanisms of injury, and challenges to treatment. RESULTS The rate of concussion, defined by the Defense and Veterans Brain Injury Center Working Group on the Acute Management of Mild Traumatic Brain Injury in Military Operational Settings, was 95%. The rate of PTSD, as determined either with the PTSD Checklist or by confirming a prior diagnosis by another healthcare provider, was 97.9%. Both rates are remarkably higher than rates reported in the literature. The most common mechanisms of injury were proximity to blast (18 [45.2%]) and direct target of blast (15 [35.7%]). The most common treatment challenges were overuse of headache-abortive medications (10 [23.8%]) and poor patient followup (7 [16.7%]). CONCLUSION Physicians should be aware that the rates of PTSD and concussion for US soldiers, most often linked to involvement in or proximity to a blast, are higher for soldiers complaining of chronic headache. Physicians should also be aware of the potential for overuse of medications in this patient population.
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Affiliation(s)
- Matthew Kozminski
- Neurology Clinic, Darnall Army Medical Center, 36000 Darnall Loop, Fort Hood, TX 76544, USA.
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Wieland D, Hursey M, Delgado D. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) military mental health issues. Information on the wars' signature wounds: posttraumatic stress disorder and traumatic brain injury. Pa Nurse 2010; 65:4-13. [PMID: 21061780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This topic can be related to the nursing profession and the need to be better educated on military mental health. Since mood disorder, suicide, alcohol abuse, PTSD and TBI are evident in actively serving and returning service members, it is imperative to educate nurses and healthcare providers about these conditions, the available evidence-based treatments and referrals to programs for these signature OEF/OIF wounds. The authors encourage nurse educators to consider ways to include military mental health and other service-related health issues into nursing curricula and to use Veterans Administration and veterans-related healthcare facilities for clinical courses. As the wars in Afghanistan and Iraq continue into the foreseeable future, many veterans will be seen not only in VA facilities, but they will self-refer to academic and community hospitals, and psychiatric and rehabilitation centers. It is important for all nurses to be aware of the effects of PTSD, depression, suicide, substance abuse and TBI on our patients and to be effective advocates for quality care of veterans in all settings. Nurses need to advocate for screening and provision of mental health services in primary care settings. When such services are offered in primary care settings, it normalizes the care and the service member will more likely allow themselves to receive the care (Jones, 2004). All nurses must understand the price of war experienced by U.S. service members and their families, and in particular, the invisible wounds of war.
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Affiliation(s)
- Diane Wieland
- La Salle University, School of Nursing & Health Sciences, USA
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Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) has been called one of the signature injuries of the Iraq War. In this review prevalence estimates of PTSD are summarized and discrepancies are discussed in relation to methodological differences between studies. METHOD We searched for population-based studies with a minimum sample size of 300. Studies based on help-seeking samples were excluded. We identified 60 possible papers, of which 19 fulfilled the inclusion criteria. Prevalence estimates and study characteristics were examined graphically with forest plots, but because of high levels of heterogeneity between studies, overall estimates of PTSD prevalence were not discussed. RESULTS The prevalence of PTSD in personnel deployed to Iraq varied between 1.4% and 31%. Stratifying studies by PTSD measure only slightly reduced the variability in prevalence. Anonymous surveys of line infantry units reported higher levels of PTSD compared to studies that are representative of the entire deployed population. UK studies tend to report lower prevalence of PTSD compared with many US studies; however, when comparisons are restricted to studies with random samples, prevalences are similar. US studies that have assessed personnel more than once since return from deployment have shown that PTSD prevalence increases over the 12 months following deployment. CONCLUSIONS Differences in methodologies and samples used should be considered when making comparisons of PTSD prevalence between studies. Further studies based on longitudinal samples are needed to understand how the prevalence of PTSD changes over time.
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Affiliation(s)
- J Sundin
- Academic Centre for Defence Mental Health, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
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Richardson JD, Sareen J, Elhai JD. Psychiatric problems in medically evacuated service members. Lancet 2010; 375:257-9. [PMID: 20109931 DOI: 10.1016/s0140-6736(10)60004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Don Richardson
- Operational Stress Injury Clinic, St Joseph's Health Care London-Parkwood Hospital, London, ON, Canada.
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Clark D. Crisis intervention and mental health services in the military. Int J Emerg Ment Health 2010; 12:149. [PMID: 21473364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Shamreĭ VK, Marchenko AA, Abritalin EI, Kurasov ES, Krasnov AA. [Pathomorphism of neurotic disorders among military servicemen]. Voen Med Zh 2010; 331:29-34. [PMID: 20536035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
There were analyzed changes in popularity, structure and clinical peculiarities of neurotic disorders among military servicemen for the period 1986-2006. There were used epidemiological, clinical-archival and clinical-psypathological methods. It was established, that that internosological pathomorphosis of neurosis came out in reduction of their rates in general structure of psychological pathology. Internosological pathomorphosis has found reflection in narrowing of syndromes spectrum and its drift from hypochondriac to anxiety and depressive pole. Dynamic pathomorphosis consisted of less favorable indices of course and outcomes of these disturbances in 1992-1999, and also in reduction of the period of the period from the beginning of illness to hospitalization to a specialized department.
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Maruniak SV, Mosiagin IG, Boĭko IM. [Peculiarities of psychophysiological status of flying staff of fighter aircraft of land basing]. Voen Med Zh 2009; 330:36-40. [PMID: 20201368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
It was investigated the influence of professional activity on psychophysiological peculiarities of fighter pilot of different types of aircraft of land basing and afloat aircraft. As a result of investigation, it was determined that on base of social parameters they are equal. Airmen of the aviation of land basing have a similar personality profile, but different types of interpersonal relations. Station of depletion among airmen of the aviation of land basing was absent. Among airmen of afloat aircraft every third had a forming stage of depletion, characterized by emotional deficit, personal suspension, psychosomatic and psychovegetative disorders.
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Baker DG, Heppner P, Afari N, Nunnink S, Kilmer M, Simmons A, Harder L, Bosse B. Trauma exposure, branch of service, and physical injury in relation to mental health among U.S. veterans returning from Iraq and Afghanistan. Mil Med 2009; 174:773-778. [PMID: 19743729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Significant mental health symptoms are reported in troops deployed to Iraq and Afghanistan (OEF/OIF). Symptomatic troops are more likely to be discharged and become eligible for Department of Veterans Affairs (DVA) care. Prevalence and predictors of mental health symptoms were assessed in 339 OEF/OIF veterans and reservists registering at the San Diego DVA. Participants completed self-report questionnaires assessing combat exposure, posttraumatic stress disorder (PTSD) symptom frequency and severity, depression, and substance and alcohol abuse. A minority of participants (36%) did not screen positive for mental health symptoms; the remainder met threshold for caseness of PTSD, depression, or substance and alcohol abuse. Using a hierarchical logistic regression model, gender, age, race, and rank were not significantly related to PTSD caseness, whereas most recent branch of service and report of injury during combat were. Follow-up analyses revealed that trauma history and combat exposure varied by branch of service. Knowledge of base rates and vulnerability factors can aid in rapid detection of "at risk" individuals.
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Affiliation(s)
- Dewleen G Baker
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Dr., MC 0603 La Jolla, CA 92093-0603, USA
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Coetzee RH. The lion, the doctor, and the omen: the importance of dissociation in the peritraumatic and immediate post-traumatic period in the development of PTSD. Mil Med 2009; 174:viii-x. [PMID: 19743727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Rhead JC. What might psychotherapy have to do with peace? Explore (NY) 2009; 5:186-93. [PMID: 19608104 DOI: 10.1016/j.explore.2009.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Little is known about health and occupational outcomes of male spouse abuse victims. In all, 11,294 male spouse abuse victims with a history of spouse abuse perpetration, 3,277 victims without prior spouse abuse perpetration, and 72,855 nonvictims and nonperpetrators were followed for 12 years to assess army attrition and hospitalization risk. In multivariate Cox models controlling for age, race, education, rank, service time, and dependents, victims were at significantly greater risk for early army discharge and hospitalization than were nonvictims- particularly hospitalizations for depression, alcohol dependence, and mental health-even when the hospitalization occurred years after the abuse event. Victim-perpetrators had greater risk than did victim-nonperpetrators for both attrition (1.13, 95% confidence interval [CI] = 1.08-1.18; 1.05, 95% CI = 1.02-1.08, respectively) and hospitalizations (1.45, 95% CI = 1.38-1.52; 1.38, 95% CI = 1.27-1.49, respectively). College education was protective and deserves further inquiry. Male victims need greater support following spouse abuse.
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Krahl PL, Litow FK. Mental health disorders in a cohort of U.S. Navy and Marine Corps personnel receiving waivers of medical accession standards. Mil Med 2009; 174:232-235. [PMID: 19354084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
To assess risk of disability discharge in U.S. Navy and Marine Corps personnel receiving waivers of medical accession standards for mental health, we retrospectively identified a cohort of 22,960 waiver recipients from February 2001 to November 2005. Relative risk of Medical Evaluation Board (MEB) for any diagnosis was the same in the mental health waiver versus other waiver groups, but risk of MEB specifically for a mental health diagnosis was five times higher in the mental health waiver group. Also, risk of MEB for a musculoskeletal condition was significantly decreased in the mental health waiver group. Because of the high per-case compensation cost for mental health disability, this excess risk represents an estimated 32% higher disability compensation cost. We recommend further analysis of the waiver cohort to identify disqualifying conditions without excess disability risk. Targeting these conditions for policy changes could increase manpower without incurring long-term disability costs.
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Affiliation(s)
- Pamela L Krahl
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Abstract
The association between alcohol use and substantiated incidents of nonmutual and mutual domestic violence between U.S. Army enlisted soldiers and their spouses was examined for the period 1998-2004. Maltreatment was always more severe in nonmutual incidents. Female victims experienced more severe maltreatment than males. Male offenders and victims were more likely to be drinking than females. For victims of both sexes, severity was greater when offenders were drinking. Older males were more likely to be offenders in nonmutual incidents. White males were more likely than Black or Hispanic males to be offenders in nonmutual incidents. There is a need for both domestic violence and alcohol treatment programs to focus on the increased risk of abuse when alcohol is involved.
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Affiliation(s)
- James E McCarroll
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA.
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Myatt CA, Johnson DC. Editorial comment on "Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom". J Spec Oper Med 2009; 9:79. [PMID: 19739481 DOI: 10.55460/yikd-eaop] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Palmer I. A personal view. J ROY ARMY MED CORPS 2008; 154:92-3. [PMID: 19043986 DOI: 10.1136/jramc-154-02-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Korolev SA, Nechiporenko VV. [Transient personality disorders in modern military psychiatry (review of literature)]. Voen Med Zh 2008; 329:61-64. [PMID: 19186527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Di Nola GM. Stressors afflicting families during military deployment. Mil Med 2008; 173:v-vii. [PMID: 18543558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Abstract
The aim of this study was to analyze cognitive dysfunction in PTSD. The testing included 79 Bosnian Army veterans, who participated in Bosnian war from 1992 to 1995. Out of 79 tested war veterans, 45 of developed PTSD while 34 did not. The veterans without PTSD where included in the control group. All the war veterans were of the same education level (secondary education) and between 30 and 50 years of age. Rivermead Behavioral Memory Test - RBMT was applied to all the subjects. The test was originally developed for the purpose of everyday memory problems identification. Clear goal of the 10 RBMT subtests is simulation of everyday life situations. PTSD group achieved significantly lower results than the control group. Results of the total score showed highly significant difference between PTSD and control group. Value of the t-test is t=10,056 with significance level of p<0,001. The same conclusion stands for any RBMT subtest. Numerous psychological studies on PTSD patients show more prominent psychological deficit in war veterans. Our study clearly confirms that finding.
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Affiliation(s)
- Aida Sarac-Hadzihalilović
- Department for Anatomy, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Florkowski A, Gruszczyński W, Gałecki P, Zboralski K. [The range of cooperation between psychiatrist and psychologist during the medical-military certification]. Pol Merkur Lekarski 2008; 25 Suppl 1:59-60. [PMID: 19025055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of certification is to determine the ability to be in the Military Service and to determine the connection between disorders and military service. Military Medical Board that gives certification is obligated to consulate a psychiatrist or a psychologist about soldiers' physical connections. Nowadays the rules that are used in candidates' selection to the military service are not obligatory enough. Regarding the present conditions of health, some changes are needed to be made. It is postulated to estimate candidates' mental health by using a larger frame of psychological examination.
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Barrash J, Denburg NL, Moser DJ, Woolson RF, Schumacher AJ, Doebbeling BN. Credibility of neuropsychological performances of Persian Gulf War veterans and military control subjects participating in clinical epidemiological research. Mil Med 2007; 172:697-707. [PMID: 17691681 DOI: 10.7205/milmed.172.7.697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We investigated whether Persian Gulf War veterans (GWVs) were more likely than Persian Gulf War-era veterans deployed elsewhere (GEVs) to have noncredible neuropsychological examinations. A total of 301 GWVs and 99 GEVs underwent neuropsychological testing. The credibility of 173 examinations showing impairment was evaluated based on test performances, clinical background, psychometric measures, and other self-report data. All 11 examinations judged less than fully credible by one neuropsychologist, plus 19 examinations judged impaired but credible, were then evaluated independently by two more neuropsychologists. Noncredibility was judged with excellent reliability (93% agreement). Seven examinations were judged noncredible. Rates of noncredibility did not differ between GWVs (1%) and GEVs (4%). The pattern of associations of noncredible examinations with cognitive, psychological, and clinical variables generally indicated defective neuropsychological scores, with no coherent pattern, and personality disorder. Findings supported the validity of noncredibility judgments and suggested that noncredible examinations are not a significant problem in neuropsychological investigations of GWVs.
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Affiliation(s)
- Joseph Barrash
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
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