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Bruce Capehart, MD, MBA; Dale Bass, PhD

Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury. Bruce Capehart, MD, MBA; Dale Bass, PhD. Aim Address objectives related to comorbid posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI):

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Bruce Capehart, MD, MBA; Dale Bass, PhD

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  1. Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury Bruce Capehart, MD, MBA; Dale Bass, PhD

  2. Aim • Address objectives related to comorbid posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI): • Cognitive problems among combat veterans. • Blast as TBI injury source. • Diagnosis and management of comorbid PTSD and TBI. • Additional neuropsychiatric comorbidity. • Relevance • Diagnosis and management is challenging, particularly when patient reports blast exposure.

  3. Methods • Searched MEDLINE database for published articles on psychiatric conditions associated with TBI and including blast trauma. • Supplemented by authors’ clinical and laboratory experience.

  4. Results • Treatment recommendations from recently updated Department of Veterans Affairs (VA) and Department of Defense’s (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress are considered from perspective of simultaneously managing comorbid TBI.

  5. Conclusions • Evidence-based therapy is most powerful treatment available for PTSD. • Recent PTSD psychotherapy options may require adaptations for optimal success in TBI setting. • But appear successful among veterans with both PTSD and TBI. • First-line psychopharmacologic options for PTSD are selective serotonin reuptake inhibitor and serotonin-norepinephrine reuptake inhibitor antidepressants. • Not known to cause harm in TBI setting. • Reducing PTSD symptom burden should increase veteran’s ability to benefit from rehabilitation.

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