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Other Psychiatric Disorders, Substance Abuse, and Brain Injury

2. Other Traumatic Stress Syndromes. Depressive DisordersOther Anxiety DisordersDissociative DisordersSomatization DisordersFibromyalgia and Chronic FatigueDisorders of Extreme Stress. 3. Mental Health Problems Among Iraq and Afghanistan Veterans. 400,304 accessed VA services as of Sept 200

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Other Psychiatric Disorders, Substance Abuse, and Brain Injury

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    1. 1 Other Psychiatric Disorders, Substance Abuse, and Brain Injury

    2. 2 Other Traumatic Stress Syndromes Depressive Disorders Other Anxiety Disorders Dissociative Disorders Somatization Disorders Fibromyalgia and Chronic Fatigue Disorders of Extreme Stress

    3. 3 Mental Health Problems Among Iraq and Afghanistan Veterans 400,304 accessed VA services as of Sept 2008 178,483 mental health diagnoses (44%) 92,998 PTSD (23%) 63,009 depressive disorders (16%) 50,569 neurotic disorders 35,937 affective psychoses 27,246 nondependent abuse of drugs 16,217 alcohol dependence 1.7 million deployed 945,423 eligible for VA health care VHA Office of Public Health and Environmental Hazards - January 2009 report1.7 million deployed 945,423 eligible for VA health care VHA Office of Public Health and Environmental Hazards - January 2009 report

    4. 4 Increased Suicide Rate in Veterans Prospective data from 1986-1994 National Health Interview Survey (Kaplan et al. 2007) 320,890 men tracked, of whom 104,026 had served in military between 1917 and 1994 Veterans were twice as likely to die of suicide as non-veterans in general population Soldiers who have diagnosable PTSD or who are taking psychiatric medications are being redeployed. Some troops are being redeployed 3 and 4 times.Soldiers who have diagnosable PTSD or who are taking psychiatric medications are being redeployed. Some troops are being redeployed 3 and 4 times.

    5. 5 Active Duty Suicide Record U.S. Army suicide rates in 2006 and 2007 May surpass general population rate in 2008 Attributed by Army to increased pace of combat operations, number of deployments, financial and family troubles connected with deployments Significant relationship between suicide attempts and length of deployment Suicides not counted as “primary battlefield deaths” Age/sex-matched general population rate: 19.5 per 100,000 115 suicides in 2007 Record high suicide rates also in Iraq/Afghanistan veterans in VA populationAge/sex-matched general population rate: 19.5 per 100,000 115 suicides in 2007 Record high suicide rates also in Iraq/Afghanistan veterans in VA population

    6. 6 Substance Abuse and PTSD Substance-use disorders very common in returning veterans Present in 50-85% of those with PTSD Association is thought to represent self-medication in attempt to control highly distressing symptoms.

    7. 7 Alcohol and Drug Abuse

    8. 8 Chronic Pain Chronic pain syndromes highly prevalent in veteran populations. Musculoskeletal injuries are among the most common service-connected disabilities. Complex interactions between musculoskeletal injuries and psychiatric conditions result in high utilization of health care services. Chronic pain in veterans is challenging and costly to treat.

    9. 9 Blast Injuries Primary Blast wave-induced changes in atmospheric pressure Secondary Objects put into motion by blast hit people Tertiary People put into motion by blast hit something

    10. 10 Traumatic Brain Injury Up to 30% of injured – “signature wound” Penetrating or closed - helmets protect from projectiles, not blast wave Mild, moderate, or severe duration of loss of consciousness length of posttraumatic amnesia Pathology of primary blast wave injury to brain poorly understood

    11. 11 Traumatic Brain Injury Need to test actual cognitive functioning with standardized neuropsychological testing Severe TBI – profound disability Mild TBI – another hidden wound Physical symptoms such as headache and dizziness, cognitive deficits, behavioral problems Symptom overlap with PTSD - impaired concentration, anger outbursts, anxiety, depression Multiple mild TBIs can accumulate

    12. 12 Institute of Medicine Report 12/08 Review of 1900 studies for long-term health effects Moderate to Severe TBI Neurocognitive deficits Alzheimer type dementia Parkinsonism Endocrine dysfunction Unemployment Diminished social relationships Mild TBI Depression Aggressive behaviors Postconcussive syndrome (Memory problems, dizziness, irritability)

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    16. 16 Blast Injuries and Polytrauma Most combat injuries from IEDs and roadside bombs Multiple, severe traumatic injuries Brain and spinal column injuries Amputation of one or more limbs Blindness Hearing loss Burns Fractures

    17. 17 High Ratio of Wounded to Killed Iraq 8:1 Vietnam 3:1 World War II 2:1 Many who previously would have died surviving with grievous injuries Advances in body armor and battlefield medicine Increased explosive force Percentage of wounded requiring amputation highest since U.S. Civil War

    18. 18 “This is a particularly brutal and violent fight and that ferocity needed a new more violent name. ‘Polytrauma,’ in its straightforwardness and simplicity, is precisely that word. Today’s survivors are more damaged — and damaged in more and different ways than anyone had expected — nor had ever seen before.”

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