Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Initial Assessment (2012) / Chapter Skim
Currently Skimming:
10 Findings and Recommendations
10 Findings and Recommendations
Pages 363-378
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 363... ...
to prevent posttraumatic stress disorder (PTSD) and to screen, diagnose, treat, and rehabilitate service members and veterans who have PTSD.
|
From page 364... ...
The DoD and the VA, with their comprehensive electronic medical records, have the ability to track, collate, and analyze data on PTSD programs and services for those receiving care in their facilities. For the DoD, this information should be collected both in garrison as well as in deployed locations.
|
From page 365... ...
The committee commends the DoD and the VA for the development of the joint VA/DoD Clinical Practice Guideline for Management of PostTraumatic Stress (VA and DoD, 2010) that presents the evidence base for numerous PTSD treatments, but notes that there is little information on adherence to its use by DoD or VA mental health providers (Kirchner, 2011)
|
From page 366... ...
The committee applauds the collaborative efforts of the DoD and the VA in the development of the VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress (2010) , discussed in Chapter 7, and the joint guidelines for other medical conditions that are frequently comorbid with PTSD such as those for postdeployment health, concussion and mild TBI, substance use disorder, major depressive disorder, and several types of pain (for example, VA and DoD, 2009)
|
From page 367... ...
Many of the PTSD prevention and treatment programs in the DoD and the VA are or will be undergoing evaluation. Knowledge of the results will be critical for informing programs in other facilities so that ineffective programs may be discontinued and effective programs implemented.
|
From page 368... ...
to be a critical part of the PTSD care continuum. Many National Guard and reservists also may not see military mental health providers but rather see their own civilian primary care physicians or use TRICARE primary care physicians.
|
From page 369... ...
Lack of a system to identify which treatments, other than pharmaceuticals, were provided to which patients makes it difficult to determine the extent to which CPT or PE therapy is being used at the local level and the outcomes of the treatments. New guidance from the DoD assistant secretary of defense for health affairs requires that training of DoD mental health providers be tracked (DoD, 2010)
|
From page 370... ...
It has developed programs to include mental health providers in the theater of war and as close to the front lines as possible to counsel service members and prevent the exacerbation of stress reactions. A number of CAM treatments are being proposed and are being used for managing PTSD, but as with early treatment interventions, there is a lack of empirical evidence for their effectiveness.
|
From page 371... ...
C1. Specialized intensive PTSD programs and other approaches for the delivery of PTSD care, including combining different treatment approaches and such emerging treatments as complementary and alternative medicine and couple and family therapy, need to be rig orously evaluated throughout DoD facilities (including TRICARE
|
From page 372... ...
Such knowledge could ultimately help to prevent PTSD, target effective PTSD treatments, improve quality of life, and reduce treatment costs.
|
From page 373... ...
For example, the use of some medications commonly prescribed for PTSD in civilian populations or nondeployed service members may be prohibited for some service members in a combat zone or performing some duties. In spite of considerable efforts to reduce stigma for active-duty service members by finding less obvious methods to deliver mental health care, the perception persists that those who seek such care are flawed or that receiving care can be a detriment to a military career.
|
From page 374... ...
Although some service members and veterans have a diagnosis of PTSD alone, PTSD often occurs with other mental health conditions or physical disorders that complicate diagnosis and treatment. There is considerable evidence that PTSD is more common among veterans and active-duty service members who are diagnosed with other psychiatric problems such as depression and substance abuse or misuse, medical conditions such as TBI and pain, or who display other problematic psychosocial behaviors such as aggressive driving or intimate partner violence.
|
From page 375... ...
The VA and the DoD have developed clinical practice guidelines for several of the common PTSD comorbidities -- including substance use disorders, major depressive disorder, concussion and mild TBI -- and postdeployment health, all of which are referred to in the VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress. The guideline also recommends a collaborative care strategy be developed in the primary care setting for patients who have comorbidities, with an emphasis on first treating the most severe symptoms and disorders and only calling in specialists as needed.
|
From page 376... ...
Although most service members who served in Iraq and are serving in Afghanistan are Army soldiers, the Marine Corps also has a substantial presence and has sustained numerous casualties. The Navy and Air Force also have been engaged in these conflicts, but their personnel are far fewer (see Chapter 1)
|
From page 377... ...
2010. Guidance for mental health provider training for the treatment of post-traumatic stress disorder and acute stress disorder.
|
From page 378... ...
2009. VA/DOD clinical practice guideline for management of concussion and mild traumatic brain injury.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.