View topic - PTSD and Brain Trauma... :: Free Dominion - Principled Conservative - Party and Canadian Politics

Posted: 05/ 29/ 07 4:05 pm Post subject: PTSD and Brain Trauma...

Due to the presence of IED's and more heavily armored personnel and vehicles, brain injuries are fast becoming a MAJOR concern in the Iraq theater of war.

PTSD has been an ongoing problem ever since war began. It just wasn't diagnosed as such before the mid 1970's. PTSD can be caused by exposure to Chemical Weapons as well as the life-threatening circumstances of war.

I grouped these two together as they both affect the brain.

Neither is anything to be "ashamed" of, but there is societal pressure on the sufferers nonetheless. Neither is fully "curable", but both can be treated effectively.

I will filter this information to the best of my ability. Please realize these are both areas of modern medicine that are in their infancy.

Both have a tendency to latent symptoms which can take months or even YEARS to surface. Both can stem from a single incident and while related are far from "the same".

Posted: 05/ 29/ 07 4:05 pm Post subject:

Stress disorder affects many vets

Post-traumatic stress disorder and traumatic brain injury have emerged as two signature injuries of the Iraq war, and the nation's mental-health system will be grappling with needs of returning veterans and their families for years to come.

• Symptoms of post-traumatic stress disorder include flashbacks, hyper-vigilance, sleeplessness and depression.

A 2004 New England Journal of Medicine study concluded that from 15 to 17 percent of soldiers returning from Iraq are at risk of the disorder. A recent study by California researchers of Department of Veterans Affairs records found that 25 percent of Afghanistan and Iraq veterans received diagnoses for post-traumatic stress disorder or other mental-health problems.

• Traumatic brain injury includes severe mental impairments from penetrating wounds to the head.

Doctors are documenting much more widespread, milder symptoms of headaches, memory loss, irritability and balance problems from exposure to blasts. In a 22-month study of 13,440 Fort Carson, Colo., soldiers returning from the Middle East, 18 percent suffered from at least a mild form of traumatic brain injury.

Where to go for help

If you or a family member needs help with post-traumatic stress syndrome or other mental-health problems, the following organizations can provide assistance:

VA Puget Sound Health Care System

206-277-4369 in Seattle

253-583-1609 in American Lake

For help with traumatic brain injury: 206-277-6696

Vet Centers

Seattle: 206-553-2706

Tacoma: 253-565-7038

Washington State Department

of Veterans Affairs

This agency contracts with a statewide network of counselors whose services are free to qualified veterans.

For a list of providers:

http://www.dva.wa.gov/

ptsd_contractors.html

You may also leave a message with Thomas Schumacher, state program director, at

360-725-2226; 888-320-0512 (pager)

King County Veterans Program also has a network of providers.

For more information, call:

206-296-7656

www.metrokc.gov/dchs/

csd/veteran

http://seattletimes.nwsource.com/html/localnews/2003723818_adamsside27m.html

Posted: 05/ 29/ 07 4:09 pm Post subject:

Post-traumatic Stress Disorder (PTSD):
Symptoms, Types and Treatment

Traumatic experiences can produce feelings of anxiety, depression, despair, hopelessness, reoccurring anger, self-blame, guilt, and shame, as well as sexual dysfunction, compulsive or aggressive behaviors, sleep disorders, and concentration problems.
Post-traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a medically recognized disorder that occurs in normal individuals under extremely stressful conditions. Its symptoms affect people from all walks of life, including soldiers, victims of natural disasters or serious accidents. PTSD can affect people who provide emergency services for others. Some individuals who survive a traumatic event are affected so strongly by the experience that they are unable to live normal lives.
What are the symptoms of PTSD?

There are four main types of PTSD symptoms. A diagnosis of PTSD requires the presence of all categories of symptomatic responses:

* Re-experiencing the trauma: flashbacks, nightmares, intrusive memories and exaggerated emotional and physical reactions to triggers that remind the person of the trauma.
* Emotional numbing: feeling detached, lack of emotions (especially positive ones), loss of interest in activities
* Avoidance: avoiding activities, people, or places that remind the person of the trauma
* Increased arousal: difficulty sleeping and concentrating, irritability, hypervigilance (being on guard), and exaggerated startle response.

How do animal studies help us understand PTSD and its symptoms?

There is increasing evidence that the symptoms of PTSD are abnormal responses to stress. According to trauma authority Dr. Peter Levine, traumatic symptoms are not caused by the dangerous event itself. These symptoms arise when residual energy from the event is not discharged from the body, but remains trapped in the nervous system where it can wreak havoc on our bodies and minds.

Levine observes that wild prey animals, though threatened routinely, are rarely traumatized. Animals in the wild utilize innate mechanisms to regulate and discharge the high levels of energy arousal associated with defensive survival behaviors. These mechanisms provide animals with a built-in ''immunity'' to trauma that enables them to return to normal in the aftermath of highly ''charged'' life-threatening experiences.

Although humans are born with virtually the same regulatory mechanisms as animals, the function of these instinctive systems is often overridden or inhibited. This restraint prevents the complete discharge of survival energies, and does not allow the nervous system to regain its equilibrium. From this perspective:

* ‘Traumatic panic anxiety’ symptom occurs where normally varied and active defensive responses have been unsuccessful – when a situation, perceived as both dangerous and inescapable, results in a profound failure of innate defenses.
* Un-discharged “survival energy” remains “stuck” in the body and the nervous system – sympathetic and parasympathetic responses are concurrently activated, like brake and accelerator, working against each other.
* Symptoms of trauma result from the body's attempt to ''manage'' and contain this unused energy.
* Healing the symptoms of PTSD is accomplished by normalizing defense responses – by progressively re-establishing the pre-traumatic defensive and orienting responses that were in execution just prior to the initiation of immobility.

In summary, when the normal defensive resources fail to resolve the situation, terror- panic, rage and freezing occur. These emotional anxiety states are evoked when the feelings of danger-orientation and preparedness to flee are blocked or inhibited. It is this “thwarting” that results in freezing and anxiety-panic symptoms associated with PTSD.
What are the consequences of PTSD?

PTSD can have severe and long lasting effects on people's lives. Examples of outcomes of PTSD are:
Consequences of PTSD
Physiological outcomes

* neurobiological changes (alterations in brainwave activity, in size of brain structures, and in functioning of processes such as memory and fear response)
* psychophysiological changes (hyper-arousal of the sympathetic nervous system, increased startle, sleep disturbances, increased neurohormonal changes that result in heightened stress and increased depression)
* physical complaints that are often treated symptomatically, rather than as indications of PTSD (headaches, stomach or digestive problems, immune system problems, asthma or breathing problems, dizziness, chest pain, chronic pain or fibromyalgia)

Psychological outcomes

* depression (major depressive episodes, or pervasive depression)
* other anxiety disorders (such as phobias, panic, and social anxiety)
* conduct disorders
* dissociation ("splitting off" from the present, and into parts of the self)
* eating disorders

Social outcomes

* interpersonal problems
* low self esteem
* alcohol and substance use
* employment problems
* homelessness
* trouble with the law

Self-destructive behaviors

* substance abuse
* suicidal attempts
* risky sexual behaviors leading to unplanned pregnancy or STDs, including HIV
* reckless driving
* self-injury

What is Complex PTSD?

Prolonged, extreme traumatic circumstances — such as childhood sexual abuse, prisoner of war camps, or long-term domestic violence — can cause a form of PTSD called Complex PTSD. As in PTSD, ordinary, healthy persons under severe circumstances can experience changes in how they adapt to stress and how they view themselves. A mental health diagnosis called Borderline Personality Disorder is also highly indicative of a history of trauma, and is increasingly viewed as a type of Complex PTSD.

Possible symptoms of Complex PTSD are:

* severe behavioral difficulties (such as alcohol/drug abuse, aggression, eating disorders)
* difficulty in controlling intense emotions (such as anger, panic, or depression)
* other mental difficulties (such as amnesia or dissociation — a serious condition called Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, which is characterized by "splitting off" parts of oneself).

Why do some people have stronger reactions than others to similar situations?

Anyone exposed to a severely traumatic experience is likely to have symptoms of post-traumatic stress. However, one person's symptoms may appear soon after the event, while another's may not surface for several months or maybe even for years. One person may have relatively minor difficulty adjusting and returning to a fairly normal state, with mild and occasional flare-ups, while another might be debilitated for years to come. Even if two people are exposed to the same situation at the same time, they will have different levels of reaction.

While there is no scientific way to predict or measure the potential effect of a traumatic event on different people, certain variables seem to have the most impact:

* the extent to which the event was unexpected, uncontrollable, and inescapable
* perceived extent of threat or danger, suffering, upset, terror, and fear
* source of the trauma (human-caused is generally more difficult than event of nature)
* sexual victimization, especially when a sense of betrayal is involved
* actual or perceived responsibility
* prior vulnerability factors (such as genetics, early onset and extent of childhood trauma)
* negative social environment (shame, guilt, stigmatization)
* lack of appropriate social or emotional support
* concurrent stressful life events

How is PTSD diagnosed?

A diagnosis of PTSD is made when symptoms in the main clusters (re-experiencing, numbing, avoidance, and arousal) are present for an extended period and are interfering with normal life. The first step in getting treatment is getting a diagnosis. This can be difficult for a number of reasons:

* symptoms may occur months or years after the traumatic event and may not be recognized as being related to the trauma
* beliefs that people "should be able to get over it" or "shouldn't have such a reaction" or "should solve their own problems" may delay treatment being sought
* guilt, blame, embarrassment or pain may interfere with a person seeking help
* avoidance of anything associated with the trauma may result in an inability to recognize the need for treatment

How is PTSD commonly treated?

Symptoms of PTSD are commonly treated by:
Psychotherapy

Because PTSD has so strongly affected the brain itself, treatment often takes longer and progresses more slowly than with other types of anxiety disorders, and is most effective with a specialist in trauma recovery. It is most important to feel comfortable and safe with the therapist, so there is no additional fear or anxiety about the treatment itself. Depending on the extent of the symptoms, it may be more effective to see the therapist several times a week, if possible.

* Cognitive-Behavioral Therapy (CBT), often including exploring personal history as well as history of the event, challenging beliefs and thoughts that lead to distress, learning to recognize and manage "triggering" episodes, and exposure or desensitization (gradual re-introduction to the event that caused the trauma)
* Psychotherapy may include relaxation techniques (deep breathing, muscle relaxation, positive imagery, meditation, neurofeedback, prayer, etc.) There are documented instances where relaxation was counterproductive—triggering rather than relieving symptoms. See Panic, Biology, and Reason: Giving the Body Its Due in the online resources below.
* Psychotherapy may take place in a group setting.

Medications

* anti-anxiety medications or anti-depressants to calm anxiety and stabilize mood while other self-care tools are learned

* used most frequently in conjunction with standard psychotherapies

There are also newer effective approaches to healing PTSD that integrate cognitive, emotional and sensory motor experience.
What therapies treat PTSD symptoms by integrating cognitive, emotional and sensory/motor experience?

Noted trauma authority and author Bessel van der Kolk has written, "... re-living trauma often occurs in the form of physical sensations that precipitate emotions of terror and helplessness. Learning how to manage and release these physical sensations from trauma-based emotions is an essential aspect of the effective treatment of PTSD.”

There are now a number of schools of what has come to be known a somatic psychotherapy which utilize cognitive, emotional and sensory/motor experience to treat PTSD. These include:

* EMDR therapy combines a somatic therapeutic approach with eye movements or other forms of rhythmical stimulation, such as hand taps or sounds that stimulate and integrate the left and right hemispheres of the brain. See Helpguide's EMDR Therapy: A Guide to Making An Informed Choice for more information and practitioner listings.

* Somatic experiencing is a therapy developed by Peter Levine that incorporates observations of how animals treat themselves following traumatic events and focuses on restoring normality to the stress response. According to Levine, the symptoms of trauma result from highly activated incomplete biological response to threat. Wild animals have the ability to “shake off” this excess energy. By enabling humans to do the same, trauma can be healed. See Helpguide's Panic, Biology, and Reason: Giving the Body Its Due in the references & resources below for more information and practitioner listings.

http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm

Posted: 05/ 29/ 07 4:15 pm Post subject:

PTSD May Up Heart Disease Risk
By: Psych Central News Editor
on Wednesday, Jan, 3, 2007

Reviewed by: John M. Grohol, Psy.D.
on Wednesday, Jan, 3, 2007

Digg this!

The link between stress and heart disease has been hypothesized for years. However, the relationship between posttraumatic stress disorder and increased risk of coronary heart disease has not been vigorously studied. New research discovers advanced symptoms of posttraumatic stress disorder may increase the risk of coronary heart disease in older men.

The report is found in the January issue of the Archives of General Psychiatry, a JAMA journal.

Numerous studies have found that cardiovascular disease and its risk factors are more common among individuals with posttraumatic stress disorder (PTSD), according to background information in the article. But to the authors’ knowledge, no prospective studies to date have examined PTSD in relation to CHD risk.

Laura D. Kubzansky, Ph.D., of the Harvard School of Public Health, Boston, and colleagues conducted a prospective study to test the hypothesis that high levels of PTSD symptoms may increase CHD risk, using two different measures of PTSD (the Mississippi Scale for Combat-Related PTSD and the Keane PTSD scale).

The authors analyzed data on 1,946 men enrolled in the Veterans Affairs Normative Aging Study. All the study subjects were community-dwelling men from the Greater Boston area who served in the military. The authors looked for incident (new cases) of coronary heart disease occurring during follow-up through May 2001.

Using the Mississippi Scale for Combat-Related PTSD, the authors found that for each increase in symptom level, the men had a 26 percent increased risk for non-fatal heart attack and fatal CHD combined. They had a 21 percent increased risk for all CHD outcomes combined (non-fatal heart attack, fatal CHD, and angina). The findings were replicated using the Keane PTSD scale.

“This pattern of effects suggests that individuals with higher levels of PTSD symptoms are not simply prone to reporting higher levels of chest pain or other physical symptoms but may well be at higher risk for developing CHD,” the authors write.

“These data suggest that prolonged stress and significant levels of PTSD symptoms may increase the risk for CHD in older male veterans,” they conclude. “These results are provocative and suggest that exposure to trauma and prolonged stress not only may increase the risk for serious mental health problems but are also cardiotoxic.”

Posted: 05/ 29/ 07 4:16 pm Post subject:

Yale Faculty to Direct $6.9 Million VA Study of PTSD
Main Category: Psychology / Psychiatry News
Article Date: 12 Sep 2005 - 9:00 PDT
| email to a friend | printer friendly | view or write opinions |

sign up to our weekly newsletter
Sign up for news alerts

rate this article

Yale School of Medicine will direct a $6.9 million nationwide study into the effectiveness of an anti-psychotic medication for veterans with chronic, military service-related post-traumatic stress disorder (PTSD).

The Yale-led study is funded by the U.S. Department of Veterans Affairs. It is the first multi-center trial to evaluate a non-SRI treatment for PTSD symptoms and the first multi-center study of the medication treatment of PTSD to focus on veterans.

PTSD is the most prevalent and costly psychiatric diagnosis treated within the U.S. Department of Veterans Affairs, said John Krystal, M.D., professor in the Department of Psychiatry at Yale School of Medicine. He said there are an estimated 196,000 veterans with PTSD. Five percent of all Veterans Administration (VA) patients and 25 percent of all patients with mental health diagnoses have a diagnosis of PTSD. Thirteen percent of all VA mental health costs, or $274 million, is spent to care for veterans with PTSD.

"Recent survey data suggest that 10 to 20 percent of soldiers participating in combat in Iraq meet criteria for PTSD," Krystal said. "Thus, there is good reason to anticipate a substantial influx of veterans with PTSD into VA treatment programs."

Currently, there are only two medication treatments approved by the U.S. Food and Drug Administration for the treatment of PTSD and both are in the same class of antidepressant, the serotonin reuptake inhibitors (SRI's).

"Although antidepressants are the most commonly prescribed medications to treat PTSD symptoms, these medications often have limited effectiveness for veterans with long-standing PTSD symptoms related to their military service," said Krystal. "The study will determine whether an 'atypical' antipsychotic drug, risperidone, is effective for treating PTSD symptoms in veterans who have not responded to antidepressant treatment. It builds on emerging evidence that atypical antipsychotic drugs may be important new medications for treating PTSD symptoms that are unresponsive to antidepressants."

Krystal and Robert Rosenheck, M.D., also a professor of psychiatry at Yale, will direct the study from the VA Connecticut Healthcare System in West Haven. Krystal also leads the Clinical Neuroscience Division and Rosenheck heads the Evaluation Division of the VA's National Center for PTSD.

Four hundred veterans with chronic, military service-related PTSD will be enrolled at 20 VA hospitals from across the United States over a two-year period. Half of the patients will receive risperidone and half will receive placebo for six months. The primary objective is to determine whether PTSD symptoms are reduced by risperidone. This study also will evaluate whether other consequences of PTSD will respond to risperidone, including sleep disturbance, violent behavior, cognitive impairment, alcohol and substance abuse, and reduced quality of life. It will also explore whether it is safe and cost-effective to prescribe risperidone to veterans with PTSD.

"PTSD is an important and timely focus for VA research," Krystal said. "The Vietnam Veterans Readjustment Study, published in the early 1990s, showed that more than 15 percent of a nationwide sample of veterans still had sufficient symptom levels to meet diagnostic criteria for PTSD 15 yeas after the end of the Vietnam War. New cases of PTSD have been associated with each successive U.S. military engagement and peacekeeping mission since the Vietnam War. This new study may help to address an important unmet need for these veterans, their families, and the VA."

Yale News Releases are available via the World Wide Web at http://www.yale.edu/opa

Posted: 05/ 29/ 07 4:28 pm Post subject:

Clarification to This Article

The Institute of Medicine says that Nancy Andreasen, the head of an expert panel about post-traumatic stress disorder among veterans who was quoted in a May 9 A-section article, misspoke during a briefing with reporters. Andreasen said that veterans who are employed cannot receive disability compensation for PTSD. The institute says Andreasen meant to say that veterans can receive some PTSD disability compensation if they have jobs, but not at the 100 percent disability level.

VA Benefits System for PTSD Victims Is Criticized

By Shankar Vedantam
Washington Post Staff Writer
Wednesday, May 9, 2007; Page A03

The government's methods for deciding compensation for emotionally disturbed veterans have little basis in science, are applied unevenly and may even create disincentives for veterans to get better, an influential scientific advisory group said yesterday.

The critique by the Institute of Medicine, which provides advice to the federal government on medical science issues, comes at a time of sharp increases in cases of post-traumatic stress disorder (PTSD) among veterans and skyrocketing costs for disability compensation. The study was undertaken at the request of the Department of Veterans Affairs amid fears that troops returning from the wars in Iraq and Afghanistan will produce a tidal wave of new PTSD cases.

Tell Us Your Story

Got a story to share about your experience with the military or VA health care systems? Contact The Washington Post at (202) 334-4880 or by e-mail at militarycare@washpost.com.

Between 1999 and 2004, benefit payments for PTSD increased nearly 150 percent, from $1.72 billion to $4.28 billion, the report noted. Compensation payments for disorders related to psychological trauma account for an outsize portion of VA's budget -- 8.7 percent of all claims, but 20.5 percent of compensation payments.

VA officials said they welcomed the report. "VA is studying the findings, conclusions and recommendations of the report to determine actions that can be taken to further enhance the services we provide," spokesman Matt Burns said in a statement.

The report suggested changes to VA policies, but the panel could not say whether those changes would result in more or fewer PTSD diagnoses, or in greater or lesser expense for taxpayers. "PTSD has become a very serious public health problem for the veterans of current conflicts and past conflicts," said psychiatrist Nancy Andreasen of the University of Iowa, who chaired the panel. Noting the shortcomings of the VA system, Andreasen added that "a comprehensive revision of the disability determination criteria are needed."

She said the current VA system, in which PTSD compensation is limited to those who are unable to hold a job, places many veterans in a Catch-22.

"You can't get a disability payment if you get a job -- that's not a logical way to proceed in terms of providing an incentive to become healthier and a more productive member of society," she said.

The practice is especially wrong, she added, because it is at odds with VA policies for other kinds of injuries. To determine the compensation a wounded veteran should get, the government assigns one a disability score. Veterans who are quadriplegic, for example, can be assigned a disability level of 100 percent even if they hold a job, whereas veterans with PTSD must show they are unable to work to get compensation.

Andreasen said the policies are "problematic, in the sense that they require the person given compensation to be unemployed. This is a disincentive for full or even partial recovery."

One solution suggested by the panel was to set a minimum compensation level for veterans disabled by PTSD, which would allow those who can seek work to do so.

"This is the report the VA didn't want," said Larry Scott, founder of the group VAWatchdog.org, who applauded the conclusions. If the IOM's recommendations are implemented, he said, they will cost VA "billions of dollars -- more staff, more staff training, more data collection, more clinical evaluations and higher awards."

The report identified problems with both arms of VA's evaluation and compensation procedures: A veteran currently undergoes an evaluation to determine if he or she has PTSD, and the results are used by other raters to determine the level of disability and the amount of compensation.

The Institute of Medicine panel said the scale used to evaluate veterans is outdated and largely designed for people who suffer from other mental disorders. Andreasen and other members also said they had heard from veterans who had received wildly different kinds of evaluations -- some lasting 20 minutes while others took hours. The scientists said VA should standardize the evaluations using state-of-the-art diagnostic techniques.

While VA requires its experts to determine what proportion of a veteran's disabilities were caused by particular traumatic experiences, and to what extent overlapping symptoms are related to particular disorders, the IOM said there is no scientific way to classify symptoms in this manner.

"The VA's disability policies for veterans with PTSD were developed over 60 years ago and now require major, fundamental reform," said Chris Frueh, a former VA clinician who is now a psychologist at the University of Hawaii at Hilo and was not involved with producing the new report. But even though better care is needed for veterans, Frueh said, it is important not to assume that trauma always results in a mental disorder.

"Scientific evidence indicates that resilience is the most common human response to trauma," he said. "Even for the most severe forms of trauma, such as rape or combat, most people do not develop PTSD."

http://www.washingtonpost.com/wp-dyn/content/article/2007/05/08/AR2007050801746.html

Posted: 05/ 29/ 07 4:30 pm Post subject:

THE HUMANE GUIDE TO VA BENEFITS

FOR VETERANS WITH PTSD

OR:

SO . . . YOU'VE DECIDED TO TAKE ON THE GOVERNMENT

BY: SARGE & LESLIE LINTECUM

Copyright © 1998 All Rights Reserved

MR. & MRS. SARGE ENTERPRISES

(BUT FEEL FREE TO PRINT OUT THIS GUIDE TO HELP YOU OR OTHERS)

The following information has been compiled over the past seventeen years by Leslie Lintecum as she took Sarge through his nine year battle with the VA to achieve his "100% Total and Permanent" status, and from Sarge's first hand experiences with the VA during this time. Please feel free to print out this guide for future reference.

STEP #1: You must notify the VA, in writing, that you are applying for disability benefits (or appealing a previous decision). This starts the clock running on the process and this date will be how far back they will pay you to when you win your claim. Do this first, and the sooner the better. You will receive a conformation letter to let you know that they have started your claim. Save this and all letters that you receive from the VA as well as copies of all letters that you send to them.

WHAT YOU NEED FOR STEP #1: After you have notified the VA to start your claim you need to gather evidence of your disability. Anyone that knew you before and after your service duty can write a letter explaining how you differ now from how you were before your service. Ask family members and anyone else that knew you both before and after your service. These letters are important, get as many as you can but one or two will do. Write one yourself with details of specific battles or events that were traumatic during your service. It will be painful but go into detail. You may need to work on this letter a little at a time. Don't let it upset you too much, put it aside for awhile but keep coming back until it is finished.

Document your claim with government records to show traumatic battles etc.. To get any pertinent documents from the government about your military service use this hyperlink:

CLICK HERE TO FIND WHERE TO SEND FOR YOUR
MILITARY PERSONNEL RECORDS

The length of time that it takes for each step, once the ball is in the VA's court, may tend to be discouraging. However, that time is really working for you. Your back pay check will be bigger the longer it takes and we all know that receiving a lump sum gives you an opportunity to make the money work for you, whereas the same amount trickled in over a long period of time gets spent as it comes in.

STEP #2: Your rating exam will be scheduled within 30-60 days after your claim is initiated, so here are some things that you need to know. Be truthful, but don't forget that you are there to tell about your problems so do just that. Don't dress up, the doctor needs to see you as you are on your average day. If you normally veg out for days at a time at home without grooming but you show up at the rating exam well groomed and in a suit and tie you are deceiving the doctor, he or she needs to see you as you are on an average day.

WHAT YOU NEED FOR STEP #2: You need to convey to the doctor your problems, both verbally and visually.

--------------------------------------------------------------------------------

A description of PTSD symptoms that your rating doctor will be looking for follows:

Diagnostic Criteria for Post-traumatic Stress Disorder

A. Existence of a recognizable stressor that would evoke significant symptoms of distress in almost everyone.

B. Re-experiencing of the trauma as evidenced by at least one of the following:

(1) recurrent and intrusive recollections of the event

(2) recurrent dreams of the event

(3) sudden acting or feeling as if the traumatic event were reoccurring, because of an association with an environmental or additional stimulus

C. Numbing of responsiveness to or reduced involvement with the external world, beginning some time after the trauma, as shown by at least one of the following:

(1) markedly diminished interest in one or more significant activities

(2) feeling of detachment or estrangement from others

(3) constricted affect

D. At least two of the following symptoms that were not present before the trauma:

(1) hyperalertness or exaggerated startle response

(2) sleep disturbance

(3) guilt about surviving when others have not, or about behavior required for survival

(4) memory impairment or trouble concentrating

(5) avoidance of activities that arouse recollection of the traumatic event

(6) intensification of symptoms by exposure to events that symbolize or resemble the traumatic event.

Subtypes: Post-traumatic Stress Disorder, Acute

A. onset of symptoms within six months of trauma

B. duration of symptoms less than six months Post-traumatic Stress Disorder, Chronic or Delayed Either of the following, or both:

(1) duration of symptoms six months or more (chronic)

(2) onset of symptoms at least six months after the trauma (delayed)

--------------------------------------------------------------------------------

Although they announced that the GAF Scores were discontenued in 2003 they are still using them so here they are.

GAF Scores What Do They Mean?

GAF Scores and Percentage of disability

0-40 = 100% Disability

41-50 = 70% Disability

51-60 = 50% Disability

61-70 = 30% Disability

71-80 = 10% Disability

81-100 = 0% Disability

--------------------------------------------------------------------------------

What are the four levels of 100% disibility?

The 4 levels of 100% PTSD are:

The First Level
100% with part of the percentage being "unemployability" - for instance, 70% PTSD with 30% "unemployability" equaling 100%. The pay is the same, but the benefits aren't, and it's likely that the Vet with this rating will be scheduled for future ratings/evaluations, especially if the Vet is appealing to get the 100% rating without the "unemployability" clause.

The Second Level
100% with the entire percentage being PTSD. The pay is the same, but the extra benefits for the spouse and children don't kick in until the third level. Future ratings/evaluations usually occur because the Vet appeals to get the "permanent and total" rating.

The Third Level
100% "permanent and total." The key phrase here is "permanent and total." The pay is the same, but the benefits increase to include educational benefits for the spouse and children until the age of 23, CHAMPVA medical coverage for the spouse and children until the age of 18 or until the age of 23 if they attend school
full time, PX/Base privileges for the Vet, spouse, and children until the age of 18 or until the age of 23 if they attend school full time. The "permanent and total" status also includes free vehicle registration and hunting/fishing licenses.

The 4th level
This level of 100% kicks in when the Vet has been rated at "100% permanent and total" for 20 years. It's then in a "protected" status where the percentage can not be reduced unless the claim was found to be based on fraud. It use to be 10 years, but it was changed to 20 years just as the Vietnam Vets started getting
compensation for PTSD.

**Note**
If a Vet is rated at "100% permanent and total" for at least 10 years and he passes away, even if it's not from his service-connected disability, the spouse receives monthly compensation.

--------------------------------------------------------------------------------

Also from the horse's mouth:

Criteria For Disability Evaluation - Nervous Conditions

In evaluation of nervous conditions it is important to describe all symptoms attributable to the underlying condition. The frequency and severity of such symptoms are essentials of evaluation. How these symptoms affect the day-to-day adjustment to society is of concern. Describe any changes in behavioral patterns including irritability, anger, confusion, loss of confidence, inability to concentrate, memory loss, fear or panic, explosion into aggressive action, uncontrolled tremors, ability to withstand pressure or stress, withdrawal, loss of interest. Impairment of ability to relate to people, socially and industrially, is important factor in the determination of degree of disability. Reduction of reliability, flexibility and efficiency levels are anticipated with resultant industrial and social inadaptability as condition progresses, so detailed report of such circumstances should be reported. Furnish data on medication and other therapeutic measures prescribed.

--------------------------------------------------------------------------------

An opinion as to prognosis is sought.

The preceding two sections, (Diagnostic criteria for Post-traumatic Stress Disorder and Criteria For Disability Evaluation - Nervous Conditions), are what your doctor has been taught to look for in his or her evaluation of you. "Chronic" PTSD is the requirement to be rated 100% disabled from PTSD. Study these two sections noting all of the symptoms that pertain to you. This will help you understand your own PTSD better. This is important because we usually precede getting to this point (applying for disability) with a long number of years of denial. Many vets are shocked at how many of the above symptoms they have. This is the beginning of the end of the denial stage for many vets. You will also be evaluated through your body language and eye contact. Don't force yourself to look in the doctors eyes if it is not normal or comfortable. You will be giving the doctor misleading information. If you don't usually look people in the eye but you make yourself look into the doctors eyes the doctor will miss seeing one of your symptoms. Act in your normal manor so that the doctor can see and understand your problems.

It will take a long time for the rating board to make a decision about your rating exam, within 6-8 months. (Remember your back pay is building this whole time.) After you receive the results of this rating you will have 1 year to appeal the decision. If you wait more than 1 year you lose your back pay date and would only be paid back to the date that you reapplied after the year elapsed. So don't wait, appeal immediately no matter what percent you get. Yes, even if the board rates you at 100% you still need to appeal the decision because there are 4 levels of 100% and the first level doesn't even cover your wife and children.

IMPORTANT: Two or three days after your rating exam go to the VA hospital where your records are and request a copy of the rating exam. This is not secret information, it is your right to know what is in your records. Read what the rating exam doctor had to say about you after the exam.

--------------------------------------------------------------------------------

The AXIS I through AXIS V are your evaluation. The most important is AXIS I being the diagnosis, or what was found wrong, and AXIS V is the prognosis, or how it looks for future progress. Also you will find it says, "Competent for VA purposes," don't worry about that it's a good thing. It just means that you don't need to be locked up against your will, or "committed" as the doctors prefer saying.

AXIS I: MAJOR PSYCHIATRIC ILLNESSES, INCLUDING SUBSTANCE ABUSE.

AXISII: PERSONALITY DISORDERS/FEATURES

AXIS III: PHYSICAL PROBLEMS (MEDICAL DIAGNOSIS-AS OPPOSED TO A PSYCH DIAGNOSIS)

AXIS IV: PSYCHOSOCIAL STRESSORS (homeless, unemployment, marital conflict, etc.)

AXIS V: GLOBAL ASSESSMENT of FUNCTIONING SCALE, expressed as: none, mild, moderate, severe and then it'll have numbers listed to represent, eye movement, or non-eye contact, tearful, fearful, and these kinds of assessments. (0 is a drooling brain dead person, 100 is a perfectly functioning individual.)

--------------------------------------------------------------------------------

DON'T MISS THIS! Some very helpful advice on submitting your claim donated to this site by Patience Mason, Editor, The Post-Traumatic Gazette and author of Recovering From the War! ADVICE FROM PATIENCE MASON!

--------------------------------------------------------------------------------

We hope this guide and information are useful to you. Feel free to copy or print out this guide, but please respect the copyright by not removing our names or copyright information.

This guide is meant to be used in a loop. In other words, when you get through the process and are awarded a percentage of disability, you should go to the beginning of this guide and re-appeal for a higher percentage by simply following the steps again. Hope it helps.

~ Sarge and Leslie ~

http://ptsdhelp2000.com/ptsd1.html

Posted: 05/ 29/ 07 4:31 pm Post subject:

Psychiatr News July 21, 2006
Volume 41, Number 14, page 1
© 2006 American Psychiatric Association
Services
* Email this article to a Colleague
* Similar articles in this journal
* Alert me to new issues of the journal
* Download to citation manager
Google Scholar
* Articles by Levin, A.
* Articles citing this Article
* Search for Related Content
Government News
VA to Keep Using DSM To Diagnose PTSD in Vets
Aaron Levin

A government-requested report says there is no need to change DSM-IV criteria for diagnosing posttraumatic stress disorder when evaluating veterans for the disorder.

DSM-IV criteria for posttraumatic stress disorder (PTSD) are well-founded and should remain the standard for diagnosis, the Institute of Medicine (IOM) reported in June. The report had been requested by the Department of Veterans affairs in response to concern about increasing numbers of veterans applying for PTSD disability compensation.

Diagnosis should be carried out by experienced clinicians familiar with DSM-IV standards, added the IOM group, chaired by Richard Mayeux, M.D., M.S., a professor of neurology, psychiatry, and epidemiology at the College of Physicians and Surgeons at Columbia University.

"The committee strongly concludes that the best way to determine whether a person is suffering from PTSD is with a thorough, face-to-face interview by a health professional trained in diagnosing psychiatric disorders," Mayeux said.

"In asking the IOM to evaluate and confirm the DSM-IV criteria, the VA was not seeking to challenge the criteria but to provide validation of those criteria to those who did challenge them," said Ira Katz, M.D., Ph.D., deputy chief patient care services officer for mental health at the VA. "The goals were very well met."

Acceptance of the DSM-IV criteria meant that new, idiosyncratic standards need not be created and verified, a major concern for Darrel Regier, M.D., M.P.H., executive director of the American Psychiatric Institute for Research and Education and director of APA's Division of Research.

"Frankly, I'm surprised that things went so smoothly," Regier told Psychiatric News. "A panel of experts agreed that the present criteria were evidence based and that there were plenty of assessment instruments to use."

Separating diagnosis from treatment and disability was a good choice because the latter two issues probably lay more at the heart of the VA's concerns, said Regier.

The IOM committee will also review evidence for PTSD treatment and prognosis and for determining standards of disability related to the disorder. Those two reports are expected by the end of the year.

Although the primary diagnostic tool for PTSD is the knowledge and experience of the clinician, the report also suggested that use of structured or semistructured interviews such as the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for DSM-IV (SCID), the PTSD Symptom Scale—Interview Version (PSS-I), can complement clinical interviews.

While some of these interviews might take time to administer, they can provide indications of presence and severity of symptoms.

Time Shouldn't Be Concern

"If you're making judgments with major treatment and compensation implications, time shouldn't be an issue," said Regier.

Self-report instruments of war-related stress may help the clinician elicit greater detail about trauma exposure than an initial interview would, said the report, but "they should not substitute for a comprehensive diagnostic interview."

The VA uses the same four-question screening test for PTSD as the Department of Defense. It also uses a number of other instruments to evaluate symptoms and treatment response but has no system-wide convention for choosing them.

No biomarkers currently have sufficient sensitivity and specificity to be useful for diagnosing PTSD, noted the IOM committee, in response to a question from the VA. Neuropsychiatric tests might help validate subjective reports, but they were less useful diagnostically because results might characterize other psychiatric disorders as well.

The IOM also noted that PTSD was a true disorder because it met standards for validity, having distinct clinical features that had been consistently documented in a variety of settings and cultures, longitudinal stability, and some evidence that genetic factors accounted for about one-third of PTSD symptoms.

Disability Claims Questioned

At committee hearings in February, several speakers suggested that many veterans applying for disability compensation for PTSD through the VA were not suffering from the disorder, but looking for a government pension. clinicians should be aware of the potential for malingering and should consider discrepancies in the patient's reports, lack of cooperation in evaluation or treatment, and evidence of antisocial personality disorder in their evaluation, said the committee, echoing APA recommendations.

"Part of the reason for asking that clinically well-trained people evaluate patients is to avoid overdiagnosing people faking PTSD," said Regier. Several psychometric tests, like the MMPI-2 or the Impact of Event Scale–Revised, do a good job of detecting fakery, he added. Other speakers at the February hearings presented evidence that there were few instances of malingering among Vietnam War veterans studied. although the impetus for the IOM report arose from concern about veterans of earlier wars, Katz said that about 30 percent of returning veterans of Iraq and Afghanistan come to the VA for medical care. Of those, 33 percent have mental health concerns, and 15 percent of that group have at least some symptoms of PTSD.

Nothing specific in the report should cause the VA to change its approach to diagnosing PTSD, but the department is continually seeking to improve its services, said Katz. "The issue isn't business as usual, but enhancement as usual," he said. "The VA views the best diagnosis as an evolving process, guided by empirical-research evidence and accumulating evidence."

The IOM report also did not presage any developments for PTSD criteria that might appear in DSM-V, said Regier. Research over the next several years may generate new information that could confirm present standards or guide new ones, he said.

"Posttraumatic Stress Disorder: Diagnosis and Assessment" is posted at <www.nap.edu/catalog/11674.html#toc>.

http://pn.psychiatryonline.org/cgi/content/full/41/14/1

Posted: 05/ 29/ 07 4:35 pm Post subject:

Related Links: What is PTSD? / Tips on Working with Your Service Representative / Get Help / Apply / Develop Evidence / Establish Diagnosis / Establish Stressor / How the VA Evaluates Levels of Disability / How to Respond to the VA's Decision / Incarcerated Veterans / VA Medical Services / Help for Children / Social Security Benefits / Vietnam Veterans of America / Lawyers

VVA’s Guide on PTSD

PURPOSE

The purpose of this guide is to assist you, the veteran, or your survivor(s), in presenting your claim for benefits based on exposure to psychologically traumatic events during military service that has resulted in post-traumatic stress disorder (PTSD). It is always best to seek the assistance of an experienced veterans service representative when presenting a claim to the U.S. Department of Veterans Affairs (VA).

This guide describes the VA's current programs for providing disability compensation to veterans who suffer from PTSD, as well as for the survivors of such veterans. Under current VA regulations, you can be paid compensation for PTSD if you currently have a clear medical diagnosis of the disorder, evidence that a sufficiently traumatic event (called a “stressor”) occurred during active military service and medical evidence that the in-service stressor is causally related to your PTSD. Once the VA determines that your PTSD is service-connected, it will then decide how seriously your symptoms impair your social and industrial abilities (i.e., your capacity to start and maintain personal relationships and your ability to work).

This guide does not address treatment techniques, but does provide suggestions for obtaining the appropriate care. Additional resources are available to help you to better understand what other VA programs may be available to you.

PTSD is not a new problem. It is simply a more recent label for an age-old disorder that has been in existence since stone-age warriors were beating each other with clubs. Around 1980, the American Psychiatric Association designated PTSD to describe a delayed-stress syndrome commonly experienced by combat-veterans. This condition had previously been referred to as “shell-shock” and “war/combat neurosis”. Although PTSD is often associated with Vietnam veterans, it appears in veterans of all wars and eras.

There have been many changes in the VA's rules involving PTSD since 1980 and some additional changes are expected soon as a result of new understanding about PTSD. Recent decisions by the U.S. Court of Appeals for Veterans Claims have also forced changes in how the VA processes PTSD claims. It is important to keep up with these changes by accessing the VVA website (www.vva.org), as well as the VA’s website (www.va.gov) for the latest information. You can also contact a VVA service representative in your area to answer any questions that you might have about PTSD or the claims adjudication process in general (www.vva.org, click on “Veterans Benefits”, then on “Service Representatives” and select your state of residence).

We have included in this guide a short description of what to do if the VA denies your claim or establishes an unjust rating percentage for your disability.

http://www.vva.org/benefits/ptsd.htm

~~~~~~~~

How The VA Evaluates Levels Of Disability

Once the VA has awarded service connection for PTSD, it will then review the most current clinical evidence of record to determine how the severity of your symptoms impairs your social and industrial (ability to work) capacity. The VA has a schedule of rating disabilities, located in title 38 C.F.R., Part 4. The VA has established “Diagnostic Codes” (DC) for various medical and psychiatric disorders, which include a description of the severity of related symptoms and a corresponding disability percentage (called a “rating” or “evaluation”). Although there are different DCs for covered psychiatric disorders, the VA evaluates the level of disability due to psychiatric disorders under the same criteria, regardless of the actual diagnosis. 38 C.F.R. §4.130, DC 9411, governs PTSD ratings. This regulation provides graduated ratings of 0%, 10%, 30%, 50%, 70% or 100%. A 0% rating is noncompensable, This means that you have service-connected PTSD, however, there is little or no impairment as a result. VA compensation payments begin at 10% and increase at each rating level.

The VA has adopted the criteria established in the DSM-IV as the basis for its psychiatric ratings, including PTSD. There is also a diagnostic matrix called the Global Assessment of Functioning Scale (GAF) that is used to determine your level of disability. The lower the GAF score, the higher the level of social and industrial impairment. Section 4.130 is reproduced below. You can share this with your psychiatric provider of care, who can prepare a report or opinion letter for submission to the VA that describes your level of impairment.

Bear in mind that even if the severity of your symptoms do not satisfy the diagnostic criteria for a 100% (or total) evaluation under the rating schedule, if your rating is high enough, another VA regulation (38 C.F.R. § 4.16) allows the VA to pay you at the 100% level if medical evidence demonstrates that your are unable to obtain or maintain substantially gainful employment as the result of your service-connected PTSD. The technical term for this is a total rating on the basis of individual unemployability due to service-connected disability (TDIU or IU).

38 C.F.R. § 4.130, DC 9411
General Rating Formula for Mental Disorders:

Total occupational and social impairment, due to such symptoms as: gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation occupation, or own name …………………..100%

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships ...................................... 70%

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining Effective work and social relationships ………………..50%

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) ............................ 30%

Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication .................. 10%

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication .............................. 0%

To find the current VA disability compensation monthly payment rates, please go to the VA website at www.va.gov. From the homepage, click on “Compensation”, then on “Rate Tables”. Additional monthly payments may be available based on the beneficiary’s number of dependents.

Posted: 05/ 29/ 07 4:40 pm Post subject:

Key Iraq wound: Brain trauma
By Gregg Zoroya, USA TODAY

A growing number of U.S. troops whose body armor helped them survive bomb and rocket attacks are suffering brain damage as a result of the blasts. It's a type of injury some military doctors say has become the signature wound of the Iraq war.

By H. Darr Beiser, USA TODAY

Known as traumatic brain injury, or TBI, the wound is of the sort that many soldiers in previous wars never lived long enough to suffer. The explosions often cause brain damage similar to "shaken-baby syndrome," says Warren Lux, a neurologist at Walter Reed Army Medical Center in Washington.

"You've got great body armor on, and you don't die," says Louis French, a neuropsychologist at Walter Reed. "But there's a whole other set of possible consequences. It's sort of like when they started putting airbags in cars and started seeing all these orthopedic injuries." (Related item: TBI gallery)

The injury is often hard to recognize — for doctors, for families and for the troops themselves. Months after being hurt, many soldiers may look fully recovered, but their brain functions remain labored. "They struggle much more than you think just from talking to them, so there is that sort of hidden quality to it," Lux says.

To identify cases of TBI, doctors at Walter Reed screened every arriving servicemember wounded in an explosion, along with those hurt in Iraq or Afghanistan in a vehicle accident or fall, or by a gunshot wound to the face, neck or head. They found TBI in about 60% of the cases. The largest group was 21-year-olds. (Related story: Survivors struggle to regain control)

From January 2003 to this January, 437 cases of TBI were diagnosed among wounded soldiers at the Army hospital, Lux says. Slightly more than half had permanent brain damage. Similar TBI screening began in August at National Naval Medical Center in Bethesda, Md., near Washington. It showed 83% — or 97 wounded Marines and sailors — with temporary or permanent brain damage. Forty-seven cases of moderate to severe TBI were identified earlier in the year.

The wound may come to characterize this war, much the way illnesses from Agent Orange typified the Vietnam War, doctors say. "The numbers make it a serious problem," Lux says.

An explosion can cause the brain to move violently inside the skull. The shock wave from the blast can also damage brain tissue, Lux says. "The good news is that those people would have been dead" in earlier wars, says Deborah Warden, national director of the Defense and Veterans Brain Injury Center. "But now they're alive. And we need to help them."

Symptoms of TBI vary. They include headaches, sensitivity to light or noise, behavioral changes, impaired memory and a loss in problem-solving abilities.

In severe cases, victims must relearn how to walk and talk. "It's like being born again, literally," says Sgt. Edward "Ted" Wade, 27, a soldier with the 82nd Airborne Division who lost his right arm and suffered TBI in an explosion last year near Fallujah. Today, he sometimes struggles to formulate a thought, and his eyes blink repeatedly as he concentrates.

http://www.usatoday.com/news/nation/2005-03-03-brain-trauma-lede_x.htm

Posted: 06/ 15/ 07 7:18 pm Post subject:

Studies link Gulf War illnesses to sarin gas

By Kelly Kennedy - kellykennedy@militarytimes.com
Posted : June 11, 2007

As benefits administrators, officials and politicians argue the worthiness of studies on Gulf War syndrome, researchers say they have no doubts that they’ve found the cause: sarin gas.

And they have advice for the as many as 300,000 troops exposed to small doses of sarin in 1991: Don’t use bug spray, don’t smoke and don’t drink alcohol.

“Don’t do anything that would aggravate a normal, healthy body,” said Mohamed Abou-Donia, a neurobiology scientist at Duke University who conducted two studies for the Army.

Research released in early May showed that 13 soldiers exposed to small amounts of sarin gas in the 1991 Persian Gulf War had 5 percent less white brain matter — connective tissue — than soldiers who had not been exposed. A complementary report showed that 140 soldiers who were exposed had the fine motor skills of someone 20 years older — what researchers called a “direct correlation” to exposure.

The study was noteworthy because it was funded by the Veterans Affairs and Defense departments, and used Pentagon data to triangulate the locations of troops who were in the path of a huge sarin plume unleashed when U.S. forces destroyed an Iraqi chemical weapons dump in Khamisiyah in March 1991. The study also used new technology to look at troops’ brains.

Of the 700,000 service members who served in Desert Storm, 100,000 have reported mysterious symptoms. Until recently, each study commissioned by the VA and Pentagon concluded the problems were caused by stress and had no physical cause.

The new data released in early May was the work of researcher Roberta White, chairwoman of the Department of Environmental Health at Boston University School of Public Health.

The debate over this issue goes back 16 years to when U.S. forces blew up the chemical munitions dump in Khamisiyah and released a plume of sarin gas to which thousands of U.S. troops were exposed — something the Pentagon denied until 1997.

As more research was done, and as veterans systematically sought details through Freedom of Information Act requests, scientists showed Desert Storm vets exposed to sarin were at higher risk for brain cancer. And the veterans eventually showed the Pentagon knew that as many as 300,000 service members had breathed in small doses of the toxic fumes.

In 1999, working on behalf of the Rand Corp., Beatrice Golomb, professor of internal medicine at the University of California, San Diego School of Medicine, reviewed every study she could find on the issue. She said it was the first time anyone had pulled all that research together.

Golomb said she found a link between symptoms of Gulf War veterans and their exposure to sarin, pyridostigmine bromide and bug repellent, all of which overstimulate muscles by inhibiting acetylcholinesterase, a chemical that signals muscles to stop moving. The tongue, being a big muscle, eventually cuts off a person’s ability to breathe if it is overstimulated.

PB in large enough amounts is harmful, but in small doses it prevents nerve agents from overstimulating muscles, and the effects of PB itself are temporary and reversible.

But for Gulf War vets, exposure to a combination of two or more of those substances may have been the kicker. Abou-Donia’s research showed the combination of nerve agents, PB, bug spray and stress could cause any of those chemicals — as well as any lurking viruses — to cross the blood-brain barrier, causing other problems. He said he has no doubt there are other long-term effects of low doses of sarin on other body systems. He cited muscle weakness, fibromyalgia and chronic fatigue as symptoms.

White’s work at Boston University followed animal research that showed persistent central nervous system effects and acetylcholinesterase inhibition following exposure to sarin at levels too low to produce clinically observable symptoms.

Another human study in 1997 showed subtle deficits in short-term memory and attention, a slight elevation of hospitalization for circulatory diseases, and a two-fold increase in brain-cancer deaths more than four years after exposure.

To Abou-Donia, the connection became clear after terrorists hit a Tokyo subway with sarin in 1995. Hospital workers who were never in the subway but who worked with sickened passengers came down with the same symptoms reported by Gulf War veterans.

“At last they can have peace of mind because they know what it was, most likely,” he said.

But, he said, there isn’t much that can be done now — although he cautioned Gulf War vets not to use insecticide.

“It’s kind of too late to do much of anything,” he said. “But the body has many redundant systems. Usually, if the damage is small, other neurons will take over. As time goes by, people will adapt.”

A list of units exposed to sarin in the 1991 Persian Gulf War is online at http://www.gulflink.osd.mil/forces_in_hazard_00.htm.

Posted: 06/ 17/ 07 8:30 am Post subject:

http://www.washingtonpost.com/wp-dyn/content/article/2007/06/14/AR2007061401643.html

Pentagon Report Criticizes Troops' Mental-Health Care

By Ann Scott Tyson
Washington Post Staff Writer
Saturday, June 16, 2007; Page A02

U.S. troops returning from combat in Iraq and Afghanistan suffer "daunting and growing" psychological problems -- with nearly 40 percent of soldiers, a third of Marines and half of the National Guard members reporting symptoms -- but the military's cadre of mental-health workers is "woefully inadequate" to meet their needs, a Pentagon task force reported yesterday.

The congressionally mandated task force called for urgent and sweeping changes to a peacetime military mental health system strained by today's wars, finding that hundreds of thousands of the more than 1 million U.S. troops who have served at least one war-zone tour in Iraq or Afghanistan are showing signs of post-traumatic stress disorder (PTSD), depression, anxiety or other potentially disabling mental disorders.

"Not since Vietnam have we seen this level of combat," said Vice Adm. Donald Arthur, co-chairman of the Department of Defense Mental Health Task Force. "With this increase in . . . psychological need, we now find that we have not enough providers in our system," he said at a Pentagon news conference yesterday unveiling the report. "Clearly, we have a deficit in our availability of mental-health providers."

The ongoing "surge" of more than 30,000 additional U.S. troops in Iraq and Afghanistan will exacerbate this gap, as will the rapid growth in the number of soldiers, Marines and other troops -- now about half a million -- who have served more than one combat tour, heightening the risk of mental illnesses, the report said.

As in the aftermath of Vietnam, the costs of untreated mental illness will rise dramatically over time, the report warned. "Our nation learned this lesson, at a tragic cost," it said. "The time for action is now."

Defense Secretary Robert M. Gates is required by law to develop a plan of action within six months on the 95 recommendations included in the 64-page report.

The task force, composed of seven military and seven civilian professionals with expertise in military mental health, was formed in May 2006. It based its report on visits to 38 U.S. military care facilities in the United States, Europe and Asia; interviews with care providers, military personnel and their families and commanders; as well as expert testimony and research.

The task force found that 38 percent of soldiers, 31 percent of Marines, 49 percent of Army National Guard members and 43 percent of Marine reservists reported symptoms of PTSD, anxiety, depression or other problems, according to military surveys completed this year by service members 90 and 120 days after returning from deployments.

Two "signature injuries" from Iraq and Afghanistan are PTSD and traumatic brain injury, it said. Symptoms include nightmares and other sleep problems, trouble concentrating, anger, recklessness, and self-medication with drugs and alcohol.

The task force identified several barriers to care, including the stigma associated with seeking help, poor access to providers and facilities, and disruptions in care as service members move locations.

"Stigma in the military remains pervasive and often prevents service members from seeking needed care," the report said, citing anonymous surveys that show most members with symptoms of mental health problems do not seek help.

Some soldiers underreport problems because they want to stay with their units, and military officials note that many soldiers undergoing treatment for stress or other mental problems are allowed to deploy again after a screening to determine the intensity of their symptoms or depending on what medications they are taking. Those on lithium, for example, should not deploy while those on another class of medications similar to Prozac may be able to, said Army Col. Elspeth Cameron Ritchie, who assisted the task force.

"If you have a post-traumatic stress reaction, it's not your fault," Arthur said. "It's up to leadership to say to folks that post-traumatic stress reactions are an absolutely normal part of combat operations."

Proposals by the task force to reduce stigma include embedding health-care providers with units and offering treatment at primary medical care facilities, where service members can seek psychological help without singling themselves out. An additional recommendation is for the military to begin training troops to become more psychologically resilient, in part by conditioning them mentally, much as they conduct their physical training.

"We can use virtual-reality therapy, typing smells in to create a virtual environment," that resembles a battlefield, said Col. Jonathan H. Jaffin, commander of Army medical research.

National Guard and reserve members -- who often live far from military bases and return from deployments to rural communities -- face "particularly constrained" access to clinical care as well as to the military chaplains and family support networks that active-duty personnel can tap, the report said.

"The current complement of mental health professionals is woefully inadequate" to prevent and treat members of the military and their families, the report said. But it called the process for recruiting additional trained personnel -- both civilian and military -- "time consuming and cumbersome," stating for example that the number who could be recruited over the next six months would be "well below" the number required to meet the needs.

The shortage is deepening as active-duty mental-health professionals, also stressed by repeated deployments and other frustrations, are leaving the military in growing numbers, the report said. The Air Force has lost 20 percent of mental health workers from 2003 to 2007, while the Navy lost 15 percent between 2003 and 2006, and the Army lost 8 percent from 2003 to 2005.

Financial resources for mental health treatment in the military are also lacking, the report found. Congress provided a boost of $600 million for PTSD and traumatic brain injury in the 2007 supplemental war funding, but more will be needed, S. Ward Casscells, assistant secretary of defense for health affairs, said at the news conference.

Posted: 06/ 17/ 07 8:57 am Post subject:

Posted: 06/ 26/ 07 7:58 am Post subject:

Fredericton chosen as site of new stress clinic for veterans

FREDERICTON (CP) - Fredericton has been chosen as the site of the first of five new operational stress injury clinics in Canada.

The clinics are for veterans, members of the Canadian Forces and the RCMP suffering from service-related psychological injuries, such as post-traumatic stress disorder.

There new additions will double the five clinics that are already set up across the country.

Ottawa is committing $1.5 million to establish the clinic in Fredericton, which will have an annual operating budget of $1 million.

Veterans Affairs Minister Greg Thompson says his department will operate the clinics to help people who are living with a mental health condition as a result of their service to Canada.

The Fredericton clinic is expected to open by late fall of this year.

Posted: 06/ 26/ 07 10:10 am Post subject:

Thanks JB a separate thread for PTSD is an excellent idea.

The unfortunate part is that there is so many great article written on it but so little being actually done.

We have to get the message out that this is real and the help they need is a necessity.

Thanks again
_________________
FREE DOMINION FORUM RULES
All the great things are simple, and many can be expressed in a single word: freedom; justice; honor; duty; mercy; hope ~ Sir Winston Churchill
"The problem with socialism is that eventually you run out of other people''''s money." Margaret Thatcher

	The time now is 09/ 02/ 10 10:18 pm
	Home ∴ Forum ∴ Recent ∴ Register ∴ Profile ∴ Log in to check your private messages ∴ Log in FAQ ∴ Search ∴ Donate ∴ Activist's Toolbox ∴ FD Links ∴ FD Swag [ Login to join chat ] FD Arcade - Click Here-->