Abstract: Objective: The aims of this study were 1) to assess the long-term effects of a collaborative care intervention for patients with depression on process of care outcomes, and 2) to describe whether case management was continued after the end of the original one-year intervention.Methods: This 24-month follow-up of a randomized controlled trial took place 12months after the end of the 1-year intervention. Data collection occurred by means of self-rating questionnaires and from medical records.

Read >

Abstract: Objective: Previous epidemiologic studies have documented a link between anxiety disorders and ulcer among adults. Few studies have examined these associations over time and little is understood about the pathways underlying these relationships.Method: Data were drawn from n=2,101 adult participants in the Midlife Development in the United States (MIDUS) I and II.

Read >

Abstract: Objective: Pain and depression are prevalent and treatable symptoms among patients with cancer yet they are often undetected and undertreated. The Indiana Cancer Pain and Depression (INCPAD) trial demonstrated that telecare management can improve pain and depression outcomes.

Read >

Abstract: Objective: Thyroid dysfunction is common during pregnancy and the postpartum period and is known to cause psychiatric disturbances. A woman with Graves’ disease and psychosis in the postpartum period is described.Methods: A 22 year woman with Graves’ disease developed fluctuating orientation, catatonia, delusions of persecution and auditory hallucinations three days following childbirth.Results: The report discusses the clinical presentation.

Read >

Jayashri Kulkarni, MBBS, MPM, FRANZCP, PhD
Director, Monash Alfred Psychiatry Research Centre, Melbourne, Australia
Read >

Importance A proportion of patients experience long-lasting symptoms following mild traumatic brain injury (MTBI). The postconcussion syndrome (PCS), included in the DSM-IV , has been proposed to describe this condition. Because these symptoms are subjective and common to other conditions, there is controversy whether PCS deserves to be identified as a diagnostic syndrome

Read >

Importance In 2011, an estimated 26.8 million US adults used prescription medications for mental illness. Objective To estimate the numbers and rates of adverse drug event (ADE) emergency department (ED) visits involving psychiatric medications among US adults between January 1, 2009, and December 31, 2011.

Read >

Paul S. Hammer, MD
Captain, Medical Corps, US Navy; Navy Medicine
Information Systems Support Activity, San Antonio, TX

William M. Sauvé, MD
Medical Director, TMS NeuroHealth Centers of Richmond, VA

Disclosure: This article discusses off-label medication use. Dr. Hammer reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest. Dr. Sauvé has received speaker fees from Sunovion; and has served on the advisory board of Avanir.


 

This article reviews the unique therapeutic challenges associated with treating military-related brain injury with and without comorbid posttraumatic stress disorder. Specific symptoms, including anxiety symptoms, re-experiencing symptoms, sleep disturbance, and affective symptoms may be targeted discretely.

INTRODUCTION

Healthcare providers face unique challenges when treating service members wounded in Operations Iraqi Freedom and Enduring Freedom. The predominant enemy tactic of improvised explosive devices (IED) and a long war have presented the military healthcare system with large numbers of patients with the two “signature wounds” of the war: mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD).1 These disorders often co-occur and require awareness of the subtleties and comorbidities of both diagnoses in order to appropriately identify, diagnose, and treat the service member. Furthermore, the unpredictable nature of IED attacks not only lead to chronic, sub-acute combat stress but can also result in numerous bodily injuries, sometimes resulting in physical disability and chronic pain. Wounded service members will often see numerous specialists and receive treatment with numerous classes of drugs meant to address chronic pain, sleep difficulty, and affective and anxiety symptoms related to multiple comorbidities. The potential of such medications to work at cross purposes with each other makes it all the more important that healthcare providers become experts in the psychopharmacology involved in both PTSD and mTBI. In addition, the high utilization of National Guard and Reserve forces in active combat ensure that many service members who need or seek care may not be seen in the Veterans Affairs (VA) or Department of Defense (DoD) medical systems. It is therefore imperative that all clinicians, and especially psychiatrists, military and civilian, maintain an awareness of combat-related PTSD, its co-occurrence with mTBI, and an understanding of the principles of medication management available to effectively treat this population.

Read >

Abstract: Objective: To estimate 1-year mortality risk associated with preoperative serious mental illness (SMI) as defined by the Veterans Health Administration (schizophrenia, bipolar disorder, posttraumatic stress disorder [PTSD], major depression) following nonambulatory cardiac or vascular surgical procedures compared to patients without SMI. Cardiac/vascular operations were selected because patients with SMI are known to be at elevated risk of cardiovascular disease.Method: Retrospective analysis of system-wide data from electronic medical records of patients undergoing nonambulatory surgery (inpatient or day-of-surgery admission) October 2005–September 2009 with 1-year follow-up (N=55,864; 99% male;

Read >

Importance There is a paucity of controlled treatment trials for the treatment of conversion disorder, seizures type, also known as psychogenic nonepileptic seizures (PNES). Psychogenic nonepileptic seizures, the most common conversion disorder, are as disabling as epilepsy and are not adequately addressed or treated by mental health clinicians.

Read >