The “Postdeployment multi-symptom disorder”: An emerging syndrome in need of a new treatment paradigm.

Many veterans of Operation Enduring Freedom and Operation Iraqi Freedom have incurred blast related injuries during deployment. One of the most common blast related injuries is mild traumatic brain injury, with the long-term consequences known as postconcussive Syndrome (PCS). Because of frequent combat related injuries and lengthy deployments, many OEF/OIF returnees also report ongoing pain problems and symptoms of posttraumatic stress disorder (PTSD). A substantial percentage of these returning service members present to Department of Veterans Affairs facilities with multiple comorbid symptoms of PCS, pain, and PTSD, which we have termed “Postdeployment Multi-Symptom Disorder.” Despite the recent clinical literature suggesting that this clinical triad of symptoms appears to be a common phenomenon that may be resistant to current treatments, there has been no guidance toward how to best manage these problems. This article introduces the conceptualization of this new “disorder” comprised of the clinical triad of PCS, pain, and PTSD symptoms, and proposes an integrated treatment model based on the current empirically supported treatments for each of these conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Reports an error in Veteran interest in family involvement in PTSD treatment by Sonja V. Batten, Amy L. Drapalski, Melissa L. Decker, Jason C. DeViva, Lorie J. Morris, Mark A. Mann and Lisa B. Dixon (Psychological Services, 2009[Aug], Vol 6[3], 184-189). The copyright for the article was listed incorrectly. This article is in the Public Domain. The online version has been corrected. (The following abstract of the original article appeared in record 2009-12007-002.) The present study examined interest in family involvement in treatment and preferences concerning the focus of family oriented treatment for veterans (N = 114) participating in an outpatient Veterans Affairs outpatient posttraumatic stress disorder (PTSD) program. Most veterans viewed PTSD as a source of family stress (86%) and expressed interest in greater family involvement in their treatment (79%). These results suggest the need to consider increasing family participation in the clinical care of individuals with PTSD and to develop specialized family educational and support services for this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

The purpose of this study was to assess the comorbidity between chronic pain and posttraumatic stress disorder (PTSD) and examine the extent to which PTSD is associated with changes in the multidimensional experience of pain in a sample of Veterans with chronic pain. It was hypothesized that Veterans with comorbid chronic pain and PTSD would report significantly higher scores on measures of pain intensity, pain behaviors, pain-related disability, and affective distress than Veterans with pain alone. Data were obtained from 149 Veterans who completed self-report questionnaires as part of their participation in a Psychology Pain Management program at a northeastern Department of Veterans Affairs health care facility. Analyses indicated that 49% of the sample met criteria for PTSD. A multivariate analysis of covariance was conducted with age, sex, pain duration, and depressive symptom severity as covariates. In partial support of our hypothesis, the presence of PTSD was found to contribute significantly to measures of affective distress, even after controlling for the effects of depressive symptom severity. The implications of these data are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Reports an error in Treatment presentation and adherence of Iraq/Afghanistan era veterans in outpatient care for posttraumatic stress disorder by Christopher R. Erbes, Kyle T. Curry and Jennie Leskela (Psychological Services, 2009[Aug], Vol 6[3], 175-183). The copyright for the article was listed incorrectly. This article is in the Public Domain. The online version has been corrected. (The following abstract of the original article appeared in record 2009-12007-001.) The ongoing wars in Afghanistan (Operation Enduring Freedom or OEF) and Iraq (Operation Iraqi Freedom or OIF) make the development and application of effective postdeployment mental health treatment programs a high priority. There has been some concern that existing treatment programs for combat-related posttraumatic stress disorder (PTSD) may not fit well with OEF/OIF veterans confronted with acute mental health difficulties while reestablishing community, familial, and occupational connections after their deployment. This study utilized data gathered from a large outpatient Veterans Affairs Medical Center PTSD treatment clinic to examine differences in initial treatment presentation and treatment adherence (attendance and dropout) between a group of Vietnam era veterans (n = 54) and a group of OEF/OIF veterans (n = 106). OEF/OIF veterans reported lower levels of symptom distress on questionnaires assessing posttraumatic reexperiencing, avoidance, dissociation, and arousal symptoms but similar levels of anger and acting out behaviors and higher levels of alcohol problems. OEF/OIF veterans had significantly lower rates of session attendance and higher rates of treatment dropout than Vietnam veterans, and this difference was not accounted for by differences in treatment presentation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Psychologists bring great value to health care systems, but our ethnocentrism regarding the medical community often limits our effectiveness as agents of change. Based on experience in developing pain management services within the Department of Veterans Affairs health care system, we discuss cultural issues as central to effective systems change and provide specific recommendations for psychologists aspiring to change organized health care systems, such as the Department of Veterans Affairs. Consideration is given to the misfit of the biomedical model to chronic pain, “physics envy” affecting the authority accorded psychology, and societal stigmatization of psychopathology. A process-based definition of cultural competence is recommended as improving on psychology’s intrinsic group-based notion of culture in engaging the medical community. The systems thinking literature is sampled in summarizing practical recommendations that include identifying features of local medical culture and power dynamics between psychology and medicine that can be modified by engaging stakeholders in an interpersonally effective manner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Peritraumatic dissociation has consistently been found to be strongly correlated with PTSD. Yet it was unclear how peritraumatic dissociation affected the physiological responses of individuals with or without PTSD. Eighty-six women with a history of attempted or completed sexual assault were recruited to participate. Script-driven imagery procedures were used to assess changes in heart rate and skin conductance responses of the women during a neutral, positive, fearful, and trauma-related script. The pattern of physiological responses suggested that peritraumatic dissociation was associated with elevated physiological responses. Peritraumatic dissociation also seemed to accentuate physiological responses to general threat cues in sexual assault survivors without PTSD as well as to trauma-specific cues in survivors with PTSD. The pattern of responses during each script was also specific to the participants’ self-reported peritraumatic dissociation and level of PTSD symptoms. These findings suggested that it would behoove clinicians working with survivors of trauma to assess for peritraumatic dissociation even if PTSD is not present, as it may inform decisions about the length of exposure treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)