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 >

Psychopharmacology in Treating Posttraumatic Stress Disorder with Co-occuring Mild Traumatic Brain Injury

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 >

A small number of older studies have demonstrated efficacy for a few antidepressants in cancer care – namely mianserin, fluoxetine and paroxetine – but we lack an evidence base for most of the currently used antidepressants. In their systematic review and meta-analysis in this issue of the role of antidepressants in the treatment of cancer-related depression, Riblet, Larson, Watts and Holtzheimer call for high quality randomized clinical trials that properly examine the efficacy, tolerability and safety of modern day antidepressants .

Read >

Importance Few studies have examined the curtailment of reproduction (ie, stoppage) after the diagnosis of a child with autism spectrum disorder (ASD). Objective To examine stoppage in a large, population-based cohort of families in which a child has received a diagnosis of ASD. Design, Setting, and Participants Individuals with ASD born from January 1, 1990, through December 31, 2003, were identified in the California Department of Developmental Services records, which were then linked to state birth certificates to identify full sibs and half-sibs and to obtain information on birth order and demographics

Read >

Abstract: Objective: NICE recommends the use of structured tools to improve holistic care for patients with cancer. The Distress Thermometer and Problem Checklist (DT) is commonly used for screening in physical health settings. However, it has not been integrated into the clinical pathway within specialist psycho-oncology services

Read >

Abstract: A series of case reports and neuroimaging research points to the underlying neuropathological substrate for obsessive–compulsive disorder (OCD) and the underlying associations between OCD and areas of the frontal lobe. We report a patient wherein the onset of OCD occurred after resection of meningioma of the right frontal lobe and who was treated successfully with paroxetine hydrochloride. We suggest that the onset of secondary (organic) OCD is associated with the frontal lobe, and we propose that the origin of obsessions is located in the right frontal lobe.

Read >

Abstract: Objective: Eating disorder (ED) symptoms have gone mostly unexamined among veterans. The current study assessed rates of bulimia nervosa (BN) and binge eating disorder (BED) symptoms and diagnoses and their associations with common comorbidities among male and female veterans.Method: Participants were US military veterans who screened positive for trauma histories and/or a probable Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD) diagnosis (n=499). Symptoms of PTSD were assessed using the Clinician-Administered PTSD Scale, and symptoms of EDs, mood, and substance use disorders were assessed using the Structured Clinical Interview for the DSM-IV.Results: Lifetime rates of BN and BED diagnoses were comparable to civilian populations, and a considerable range of lifetime and current BN and BED symptoms were identified

Read >

Director’s Blog Conventional wisdom says that there is a long delay between a research finding and putting that finding into practice. Based on treatments for hypertension, that delay is usually described as 17 years. So it is especially worth noting an announcement last week from the Substance Abuse and Mental Health Services Administration (SAMHSA) that 5 percent of the Mental Health Block Grant allocation would be used to implement evidence-based treatments for first episode psychosis (FEP)

Read >