Posts Tagged ‘PTSD’


Posted: July 15, 2012 in Uncategorized

Retired Army Maj. James LaCaria said he was afraid to leave his apartment before he got Kaeci, his 5-year-old service dog. LaCaria, 36, from El Paso, Texas, was diagnosed in 2010 with post-traumatic stress disorder after combat tours in Iraq and Afghanistan. He had been in and out of inpatient psychiatric treatment facilities before his psychiatrist recommended he get a service dog to help him cope with his anxiety and nightmares. But an Army policy implemented in JAN 2012, critics say, has made it harder for soldiers such as LaCaria who are suffering from PTSD and traumatic brain injuries to have specialized psychiatric service dogs on military posts. Matt Kuntz, executive director of the Montana chapter of the National Alliance on Mental Illness, launched an online petition last month calling on Army Secretary John McHugh to revise it. “In our point of view, the need for basic regulation turned into a mountain of red tape,” Kuntz said. The policy was implemented shortly after a 6-year-old boy in Kentucky was fatally mauled by a German shepherd trained to help a soldier at Fort Campbell cope with PTSD. The incident happened away from the post. Before January, service dogs were allowed on Army posts under the Americans with Disabilities Act.
Now, service dogs must be provided by groups approved by Assistance Dogs International. ADI does not have chapters in 18 states, making the process of acquiring one in those states more difficult. The new policy also requires service members to get approval of a care plan from their commander. “Our policy is supportive of the use of service animals in treating physical disabilities, as well as PTSD,” said Maria Tolleson, a spokeswoman for the U.S. Army Medical Command. Kuntz’s petition at calls on the Army to make it clear that soldiers do not need to exhaust all other treatment methods before they can qualify for a service dog, and to ensure that soldiers with service dogs can have living quarters where they can keep their service dogs, and to broaden the definition of an accredited service animal provider beyond ADI. Sen. Jon Tester (D-MT) last month sent a letter to McHugh urging the Army to change its new policy. Lt. Gen. Patricia Horoho, surgeon general and commanding general of MEDCOM, responded in a letter that the Army “is committed to providing the highest level of care to all soldiers” but “has no studies underway to determine the efficacy of service dog use in the treatment of traumatic brain injury.” [Source: USA Today article 7 Jun 2012 ++]



Posted: May 11, 2012 in Uncategorized

The Army Surgeon General's Office has issued new guidelines for diagnosing PTSD that criticize an approach once routinely used at Madigan Army Medical Center. The policy, obtained by The Seattle Times, specifically discounts tests used to determine whether soldiers are faking symptoms of post-traumatic stress disorder. It says that poor test results do not constitute malingering. The written tests often were part of the Madigan screening process that overturned the PTSD diagnoses of more than 300 patients during the past five years. Madigan medical-team members cited studies that said fabricated PTSD symptoms were a significant — and often undetected — phenomenon. They offered the tests as an objective way to help identity "PTSD simulators" among the patients under consideration for a medical retirement that offers a pension and other benefits. The team's approach once was called a "best practice" by Madigan leaders, including Lt. Gen. Patricia Horoho, a former commander who now serves as the Army's surgeon general. But earlier this year, amid patient protests about overturned diagnoses, the team was shut down as the Army launched several investigations.
Though none of the Army findings have been publicly released, the April 10 "policy guidance" from the surgeon general charts new directions for PTSD screening at Madigan and elsewhere in the Army medical system. The new policy downplays the frequency of soldiers faking symptoms to gain benefits, citing studies indicating it is rare. It also rejects the view a patient's response to the hundreds of written test questions can determine if a soldier is faking symptoms for financial gain, and it declares that a poor test result "does not equate to malingering, which requires proof of intent… " The new policy offers broad guidance on how the Army medical staff should evaluate and treat patients for PTSD, a condition affecting 5 to 25 percent of soldiers returning from combat zones. The 17-page document was distributed to commanders throughout the Army medical system. The surgeon general's policy document says:
 PTSD is being under — not over — diagnosed. It states that most combat veterans with PTSD do not seek help, and as a result their conditions are not recognized and identified.
 The policy also questions the use of a class of drugs in treating anxiety in troops with PTSD and other mental conditions. The document found "no benefit" from the use of Xanax, Librium, Valium and other drugs known as benzodiazepines in the treatment of PTSD among combat veterans. Moreover, use of those drugs can cause harm, the Surgeon General's Office said. The drugs may increase fear and anxiety responses in these patients. And, once prescribed, they "can be very difficult, if not impossible, to discontinue," due to significant withdrawal symptoms compounded by PTSD, the document states.
 The policy also said the harm outweighs the benefits from the use of some antipsychotics, such as Risperidone, which have shown "disappointing results" in clinical trials involving PTSD.
 PTSD patients may frequently have other physical and mental-health problems. The new memorandum encourages a range of treatment options, including yoga, biofeedback, massage, acupuncture and hypnosis.
In 2008, Congress approved an overhaul of the disability system, saying a soldier rendered unfit for duty by PTSD qualified for a medical retirement. Since then, the number of Army personnel with PTSD receiving a temporary disability (the first step in the retirement process) has escalated sharply. More than 2,790 soldiers were given a PTSD-related temporary disability in 2011, more than a fivefold increase since passage of the congressional overhaul. The pensions, health insurance and other retirement benefits are financed through the Defense Department, which is facing significant budget cuts as Congress struggles to trim federal spending. In a controversial presentation to colleagues last fall, Dr. William Keppler, then the leader of the Madigan screening team, said a PTSD diagnosis could cost as much as $1.5 million over the lifetime of a soldier, and he urged staff to be good stewards of taxpayer dollars. Keppler is a forensic psychiatrist whose work had helped Madigan gain a national reputation for innovative screening for PTSD before questions were raised about the accuracy of his team's diagnoses.
Soldiers evaluated by the screening team often took the Minnesota Multiphasic Personality Test, which consists of more than 500 true-or-false questions. Some are relatively straightforward, such as questions about sleep and anxiety. Others are designed to detect patterns of exaggeration, such as answers that reflect what people think mental illness is like rather than what it is actually like. Most of the screenings also included patient interviews. But some of the soldiers who went through the process told The Seattle Times the interviews often felt confrontational, at times hostile. More than 300 patients screened by Keppler's team are now being offered re-evaluations by new screening teams established at Madigan. The results of the new examinations have not been announced. All this has spurred plenty of debate at Madigan and in the broader Army medical community. One forensic team member, Dr. Juliana Ellis-Billingsley, quit in February, and in a letter of resignation blasted the Madigan investigations as a charade. The surgeon general's policy memorandum notes that many soldiers have become wary of the Army's mental-health care providers. It calls for a "culture of trust" that will give more soldiers confidence to seek help. [Source: The Seattle Times Hal Bernton article 22 Apr 2012 ++]


Posted: September 14, 2011 in Uncategorized

Despite its widespread use in veterans‘ facilities, risperidone (Risperdal) appears to be ineffective in the treatment of posttraumatic stress disorder (PTSD) in veterans, according to a new study. Risperdal has not been approved by the U.S. Food and Drug Administration (FDA) to treat PTSD, but doctors often prescribe medications for ailments that have not undergone government approval. John Krystal, M.D., of the VA Connecticut Healthcare System, and colleagues conducted the six-month, randomized, placebo-controlled multicenter study at 23 different Veterans Administration outpatient medical centers. Of the 367 patients screened, 296 were diagnosed with military-related PTSD and had ongoing symptoms despite at least two adequate antidepressant treatments with selective serotonin reuptake inhibitors (SSRIs), and 247 contributed to analysis of the primary outcome measure. Patients in the study received risperidone (up to 4 mg, once daily) or placebo combined with other therapy. Symptoms of PTSD, depression, anxiety and other health outcomes were gauged via various scales and surveys. After analysis of the data, the researchers found no statistically significant difference between risperidone and placebo in reducing measures of PTSD symptoms after six months of treatment.
Posttraumatic stress disorder is among the most common and disabling psychiatric disorders among military personnel serving in combat. No psychiatric medication is approved by the FDA to treat it. However, antidepressants are commonly prescribed for some symptoms of PTSD. Within the U.S. Department of Veterans Affairs (VA), 89 percent of veterans diagnosed with PTSD and treated with pharmacotherapy are prescribed SSRIs, the most common type of antidepressant. ―However, [S]SRIs appear to be less effective in men than in women and less effective in chronic PTSD than in acute PTSD. Thus, it may not be surprising that an SRI study in veterans produced negative results. Second-generation antipsychotics (SGAs) are commonly used medications for SRI-resistant PTSD symptoms, despite limited evidence supporting this practice,‖ the authors write. Researchers wondered whether risperidone (Risperdal) added to an ongoing pharmacotherapy regimen would be more effective than placebo for reducing chronic military-related PTSD symptoms among veterans whose symptoms did not respond to at least two adequate SSRI treatments. The researchers also discovered that risperidone was not statistically superior to placebo on any of the other outcomes, including improvement on measures of quality of life, depression, anxiety, or paranoia/psychosis. Overall, the rate of adverse events during treatment was low but appeared related to dosing of risperidone.
―In summary, risperidone, the second most widely prescribed second-generation antipsychotic within VA for PTSD and the best data-supported adjunctive pharmacotherapy for PTSD, did not reduce overall PTSD severity, produce global improvement, or increase quality of life in patients with chronic SRI-resistant military-related PTSD symptoms. ―Overall, the data do not provide strong support for the current widespread prescription of risperidone to patients with chronic [S]SRI-resistant military-related PTSD symptoms, and these findings should stimulate careful review of the benefits of these medications in patients with chronic PTSD,‖ the authors conclude. In treating military-related PTSD, Charles W. Hoge, M.D., of the Walter Reed Army Medical Center, writes that ―significant improvements in population care for war veterans will require innovative approaches to increase treatment reach.‖ ―Research is required to better understand the perceptions war veterans have concerning mental health care, acceptability of care, willingness to continue with treatment, and ways to communicate with veterans that validate their experiences as warriors.‖ The study appears in the August 3 issue of the Journal of the American Medical Association. [Source: Psych Central News Editor article 2 Aug 2011 ++]