Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: perspectives from cognitive neuroscience.

A significant proportion of military personnel deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has been exposed to war-zone events potentially associated with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). There has been significant controversy regarding healthcare policy for those service members and military veterans who returned from OEF/OIF deployments with both mild TBI and PTSD. There is currently little empirical evidence available to address these controversies.

Sexual dysfunction in male Operation Enduring Freedom/Operation Iraqi Freedom patients with severe post-traumatic stress disorder.

The medical records of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans who entered the post-traumatic stress disorder (PTSD) residential recovery program were retrospectively reviewed for presence of diminished libido, erectile dysfunction, and ejaculatory delay. Of 53 patients, 39 reported diminished libido, 26 reported erectile dysfunction, and 8 reported ejaculatory dysfunction. This rate of prevalence is comparable to that observed in prior studies of patients with chronic PTSD of many years duration, suggesting that the mechanism underlying such dysfunction is directly related to PTSD rather than age, other health concerns, chronicity of PTSD symptoms, or lifestyle.

Do older rural and urban veterans experience different rates of unplanned readmission to VA and non-VA hospitals?

Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality.

Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts.

Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non-VA hospitals between 1997 and 2004.

Auditory brainstem response differences in diabetic and non-diabetic veterans.

A number of studies have found statistically significant delays in auditory brainstem latencies of patients with diabetes compared with non-diabetic controls. However, the mechanisms ascribed as responsible for the latency differences between diabetic and non-diabetic patients vary among studies, and the latency differences, while significant, are small. In this 5-year prospective study, auditory brainstem response testing was conducted with 416 non-diabetic and 375 diabetic veterans from the Portland Veterans Affairs Medical Center as part of a larger study.

Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system.

Background: Adverse drug events (ADEs) account for considerable patient morbidity and mortality as well as legal, operational and patient care costs. In Veterans Affairs (VA) hospitals in the USA, all serious adverse events and "potential" adverse events are reviewed using root cause analysis (RCA). This study characterised RCA reports associated with ADEs to determine what actions VA RCA teams took to reduce the number or severity of ADEs, and to evaluate which actions were effective in doing so.

Domains of quality of life and symptoms in male veterans treated for posttraumatic stress disorder.

This study examined the relationship between domains of quality of life and posttraumatic stress disorder (PTSD) symptoms in 319 male veterans in a randomized trial of group psychotherapy. Confirmatory factor analyses suggested a 4-factor model of quality of life (achievement, self-expression, relationships, and surroundings) fit better than a unidimensional model. Clinically meaningful symptom change was associated with greater change in all quality of life domains.

Randomized clinical trial: group counseling based on tinnitus retraining therapy.

The main component of tinnitus retraining therapy (TRT) is structured counseling. We conducted a randomized clinical trial to test the hypothesis that group educational counseling based on TRT principles would effectively treat veterans who have clinically significant tinnitus. Veterans with clinically significant tinnitus were randomized into one of three groups: educational counseling, traditional support, and no treatment.

Electroconvulsive therapy for comorbid major depressive disorder and posttraumatic stress disorder.

Objective: Posttraumatic stress disorder (PTSD) and major depressive disorder frequently co-occur. Electroconvulsive therapy (ECT) is the most effective treatment for refractory major depressive disorder. We examined the effect of ECT in patients with co-occurring major depression and PTSD.

Frequency-modulation (FM) technology as a method for improving speech perception in noise for individuals with multiple sclerosis.

Almost half of the population with multiple sclerosis (MS) complains of difficulty hearing, despite having essentially normal pure-tone thresholds. The purpose of the present investigation was to evaluate the effects of frequency-modulation (FM) technology utilization on speech perception in noise for adults with and without MS. Sentence material was presented at a constant level of 65 dBA Leq from a loudspeaker located at 0 degrees azimuth.

Some effects of multiple sclerosis on speech perception in noise: Preliminary findings.

The present investigation examined speech perception in noise of adults with and without multiple sclerosis (MS). Institute of Electrical and Electronic Engineers (IEEE) sentences were presented at a constant level of 65 dBA L(eq) (equivalent continuous noise level [4 dB exchange rate]) from a loudspeaker located at 0-degree horizontal azimuth and 1.2 m from the study participant.

A decrease in the plasma DHEA to cortisol ratio during smoking abstinence may predict relapse: a preliminary study.

Rationale: Increases in depressive symptoms during smoking cessation have been associated with risk for relapse. Several studies have linked plasma levels of cortisol and dehydroepiandrosterone (DHEA) or DHEA-sulfate (DHEAS) to depressive symptoms.

Objectives: To determine whether changes in plasma cortisol, DHEA, or DHEAS levels and emergence of depressive symptoms during smoking cessation are associated with smoking relapse.

Mental distress among younger veterans before, during, and after the invasion of Iraq.

Objective: The purpose of this study was to determine whether patients receiving care from the Department of Veterans Affairs (VA) reported more mental distress as the war in Iraq began or reintensified compared with other respondents to national health surveys.

Methods: Data from the 2000 and 2003 Behavioral Risk Factor Surveillance System (BRFSS) health surveys were analyzed. Unlike in other years, these particular surveys asked respondents whether they were military veterans.

Chronic PTSD patients' functioning before and after the September 11 attacks.

This study examined how treatment-seeking veterans with preexisting posttraumatic stress disorder (PTSD) (n = 178) were affected by vicarious exposure to the September 11 terrorist attacks. Participants were surveyed 0 to 5 months prior to 9/11 and resurveyed 6 months after the attacks. Half the patients reported that thoughts and feelings about 9/11 impaired their functioning some (37%) or most or all of the time (13%).

The role of loss of meaning in the pursuit of treatment for posttraumatic stress disorder.

Clinical observation and theory suggest that people who have difficulty coping with their exposure to traumatic events often experience a loss of meaning to their lives. This article examines the contribution of loss of meaning to seeking help from clergy and/or mental health providers. Results support the hypotheses that veterans who have suffered a greater loss of meaning are more likely to seek help from clergy and from VA mental health professionals.

Issues in the design of multisite clinical trials of psychotherapy: VA Cooperative Study No. 494 as an example.

This article describes issues in the design of an ongoing multisite randomized clinical trial of psychotherapy for treating posttraumatic stress disorder (PTSD) in female veterans and active duty personnel. Research aimed at testing treatments for PTSD in women who have served in the military is especially important due to the high prevalence of PTSD in this population. VA Cooperative Study 494 was designed to enroll 384 participants across 12 sites.

The role of emotional functioning in military-related PTSD and its treatment.

This two-part study investigated the cross-sectional and across-treatment relationships among measures of emotional functioning and posttraumatic stress disorder (PTSD) symptomatology for veterans receiving specialized treatment for military-related PTSD. Cross-sectional analyses revealed overlap among emotion regulation, affective control, depressive symptoms, and PTSD symptoms at pre-treatment. In regression analyses, fear of losing affective control was most predictive of PTSD symptoms.

One-year follow-up after a collaborative breakthrough series on reducing falls and fall-related injuries.

Background: Multisite facilitated quality improvement (QI) projects, called collaborative Breakthrough Series (BTS), have been shown to improve care, but it is also important to evaluate the lasting effects and spread of changes of BTSs. A project focused on fall and injury-related prevention started in Spring 2001; after the project's end, support was provided through e-mail and periodic conference calls.

Methods: One year after project completion, team contacts were interviewed to determine if they had maintained gains or made further improvements.

The role of war-zone trauma and PTSD in the etiology of antisocial behavior.

Historically, successful reintegration of war veterans into civilized society has been an enduring concern of nations. Data from the National Vietnam Veterans Readjustment Study were used to develop and evaluate an etiological model of postwar antisocial behavior. Two initial models specified causal paths among five sets of variables, ordered according to their historical occurrence: (a) premilitary risk factors, (b) military traumas and disciplinary actions, (c) the homecoming reception, (d) postmilitary PTSD and substance abuse, and (e) postmilitary antisocial behavior.

Using aggregate root cause analysis to reduce falls.

Background: In certain categories of adverse events, Department of Veterans Affairs (VA) facilities may combine data to produce an aggregate review of the data. Individual root cause analyses are still required for the more serious adverse events. About 100 of the VA acute and long term care facilities contributed data to an analysis of results of 176 root cause analyses (RCAs) for patient falls occurring in the VA system.

Cognitive-behavioral therapy for PTSD in the real world: do interpersonal relationships make a real difference?

The goal of this effectiveness study was to investigate the role of pre-treatment interpersonal relationship functioning in two forms of group cognitive-behavioral treatment (CBT) for veterans with PTSD. Analysis of data from 45 veterans who completed either trauma- or skills-focused CBT indicated no overall differences between the two treatments in PTSD symptomatology, alcohol abuse, or violence perpetration at four months post-treatment. However, there was a stronger inverse relationship between intimate relationship functioning and violence outcomes in the trauma-focused group versus the skills-focused group.

A cognitive aid for cardiac arrest: you can't use it if you don't know about it.

Background: A cognitive aid developed by the Department of Veterans Affairs (VA) and distributed to all VA facilities provides caregivers with information to minimize omission of critical steps when diagnosing and treating cardiac arrest. In 2002, caregivers were surveyed about the usefulness of the cognitive aid and the success of its dissemination throughout the VA.

Methods: Fifty randomly selected VA hospitals were sent a letter to alert them of the upcoming survey.

Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD.

One of the most pervasive effects of traumatic exposure is the challenge that people experience to their existential beliefs concerning the meaning and purpose of life. Particularly at risk is the strength of their religious faith and the comfort that they derive from it. The purpose of this study is to examine a model of the interrelationships among veterans' traumatic exposure, posttraumatic stress disorder (PTSD), guilt, social functioning, change in religious faith, and continued use of mental health services.

Emotional deficits in military-related PTSD: an investigation of content and process disturbances.

To expound on the nature of emotional deficits in PTSD, the current study investigated the relationships among emotion content and process variables and PTSD symptomatology in a sample of 85 veterans with military-related trauma. Alexithymic externally oriented thinking and negative affectivity emerged as the most consistent predictors of PTSD symptoms; however, depression was the only variable associated with emotional numbing. Theoretical and clinical implications of these findings are discussed, as well as future research directions including the collateral and clinician assessment of emotional functioning, use of other process measures, and inclusion of various control groups.