Exploring the impact of COVID-19 and restrictions to daily living as a result of social distancing within veterans with pre-existing mental health difficulties.

INTRODUCTION: Data are emerging showing the adverse consequences on mental health of the general public due to the COVID-19 pandemic. Little is known about the needs of veterans with pre-existing mental health difficulties during the COVID-19 pandemic. METHODS: Data were collected through a cross-sectional online survey from a randomly selected sample (n=1092) of military veterans who have sought help for mental health difficulties from a veteran-specific UK-based charity. The response rate was 25.2% (n=275). Participants were asked to complete a range of standardised mental health outcomes (post-traumatic stress disorder (PTSD): Post-traumatic Stress Disorder Checklist, common mental health difficulties (CMDs): 12-Item General Health Questionnaire, difficulties with anger: 5-Item Dimensions of Anger Reactions-Revised and alcohol misuse: Alcohol Use Disorders Identification Test) and endorse a list of potential stressors related to changes to daily life resulting from COVID-19. Regression analyses were fitted to explore predictors of mental health severity. RESULTS: It was observed that symptoms of common mental disorder and PTSD (69.3% and 65.0%, respectively) were the most commonly reported to have been exacerbated by the pandemic. Lack of social support and reporting increasing numbers of stressors related to COVID-19 were consistently associated with increasing severity of a range of mental health difficulties. CONCLUSIONS: Our findings suggest veterans who had pre-existing mental health difficulties prior to the outbreak of COVID-19 may be at increased risk of experiencing CMDs as a result of the pandemic. Intervening to improve levels of social support and offering practical guidance to better manage any additional stressors relating to the pandemic may provide strategies to help reduce the burden of mental health symptoms.

Comparing the profiles of UK and Australian military veterans supported by national treatment programmes for post-traumatic stress disorder (PTSD).

INTRODUCTION: The aim of this study was to compare and contrast the profiles of military veterans seeking formal support for post-traumatic stress disorder (PTSD) in national treatment programmes in Australia and the UK to better understand the needs of this vulnerable population. METHODS: Data were extracted from 1926 participants in these treatment programmes. This consisted of 1230 from the UK who had accessed support between 2014 and early 2019, and 696 from Australia who had accessed support between 2014 and 2018. Comparison was made between a number of sociodemographic characteristics (age, sex and educational achievements), military factors (branch of military, time since leaving the military and whether participants were early service leavers or not) and health outcomes (PTSD, anger, alcohol misuse, anxiety and depression). RESULTS: Small differences were observed, with those in the UK cohort appearing to be younger, having lower educational achievement, being more likely to be ex-Army, having longer periods of enlistment in the military and taking longer to seek help. Further, minor differences were reported in health outcomes, with those in the UK cohort reporting more severe symptoms of PTSD, anger, anxiety and depression. CONCLUSIONS: Overall, the observed differences between the cohorts were modest, suggesting that treatment-seeking veterans from the Australian and UK cohorts reported similar presentations. This provides evidence to support the establishment of international cohorts of treatment-seeking veterans to improve knowledge within this field.

A latent profile analysis of PTSD symptoms among UK treatment seeking veterans.

Background: Significant numbers of individuals leave the military and experience symptoms of posttraumatic stress disorder (PTSD). Veterans with PTSD symptoms rarely experience them in isolation, more commonly they are co-morbid with a range of other difficulties. Objective: Latent profile analysis (LPA) was used to explore the heterogeneity of PTSD symptom presentation. Following this, regression analysis was used to examine variables that predicted membership to the identified PTSD profiles. Methods: Data on childhood adversity, socio-demographic characteristics and mental health outcomes was collected from 386 male veterans who had engaged with mental health services in the UK. Results: LPA identified a six-profile model to best describe the sample. There was a Low symptom profile, a Severe symptom profile and four Moderate symptom profiles. The Severe symptom profile was the largest one, accounting for 37.57% of the sample. Five out of the six profiles had mean PTSD scores above the cut-off for probable PTSD. Higher rates of common mental health difficulties were associated with more symptomatic profiles. Discussion: As the vast majority of veterans met criteria for probable PTSD, the finding of six different profiles differing primarily quantitatively, but to some extent also qualitatively, suggests the importance of moving away from a 'one-size fits all' approach when it comes to treatments, towards developing interventions that are tailored to meet the specific PTSD and co-morbid symptoms profiles.

Antecedentes: Un número significativo de individuos deja el servicio militar y experimenta síntomas de trastorno de estrés postraumático (TEPT). Los veteranos con síntomas de TEPT rara vez los experimentan de forma aislada, más comúnmente son comórbidos con una variedad de otras dificultades.Objetivo: Se utilizó el análisis de perfiles latentes (LPA, en sus siglas en inglés) para explorar la heterogeneidad de la presentación de síntomas del TEPT. A continuación se usó análisis de regresión para examinar variables que predijeran la pertenencia a los perfiles de TEPT identificados.Método: Se obtuvieron datos sobre la adversidad infantil, las características sociodemográficas y los resultados de salud mental de 386 veteranos varones que habían consultado en servicios de salud mental en el Reino Unido.Resultados: LPA identificó un modelo de seis perfiles que mejor describen la muestra. Hubo un perfil de síntomas bajos, un perfil de síntomas graves y cuatro perfiles de síntomas moderados. El perfil de síntomas severos fue el más grande, representando el 37.57% de la muestra. Cinco de los seis perfiles tenían puntajes promedio de TEPT por encima del puntaje de corte para probable TEPT. Tasas más altas de dificultades de salud mental comunes se asociaron con más perfiles sintomáticos.Discusión: Como la gran mayoría de los veteranos cumplieron con los criterios de probable TEPT, el hallazgo de seis perfiles diferentes que se distinguen principalmente de forma cuantitativa, pero en cierta medida también cualitativamente, sugiere la importancia de alejarse de un enfoque 'de una sola talla' para todos cuando se trata de tratamientos, hacia el desarrollo de intervenciones que se adapten a los perfiles específicos de TEPT y síntomas comórbidos.

Post-traumatic growth among the UK veterans following treatment for post-traumatic stress disorder.

INTRODUCTION: The aim of this paper was to examine levels of post-traumatic growth (PTG) in a sample of the UK veterans who had received treatment for post-traumatic stress disorder (PTSD). METHODS: The study followed-up 149 UK veterans after they had completed standardised treatment for PTSD provided by Combat Stress. Data had previously been collected on a range of mental health outcomes before treatment, and then repeated 6 months after the end of treatment. For the current study, participants completed the post-traumatic growth inventory (PTGI) measure. Analysis was conducted to explore levels of PTG and whether there were any relationships between pretreatment and post-treatment ratings of mental health and PTG. RESULTS: The mean score on the PTGI was 32.6. Evidence of a treatment effect on levels of PTG was observed. There appeared to be a relationship between improvements in symptoms of PTSD and depression and higher levels of PTG. CONCLUSIONS: This study observed the presence of PTG following exposure to traumatic events within a sample of the UK veterans following their treatment for PTSD. PTG scores were moderately low in comparison to similar studies in the USA.

Iraq and Afghanistan veteran presentations to combat stress, since 2003.

BACKGROUND: Recently, proposals have been made to improve mental health care for U.K. military veterans. Combat stress (CS), a veteran's charity, has provided mental health services for veterans since 1919. Since 2003, service users have included veterans from the Iraq and Afghanistan conflicts; however, their pattern of help-seeking has not been evaluated. AIMS: To describe the characteristics of the veteran population of the recent Iraq or Afghanistan conflicts who sought help from CS between 2003 and May 2011. METHODS: CS Iraq and Afghanistan veteran clinical and welfare records were evaluated. RESULTS: Nine hundred and eighty-eight records were evaluated. The median time for veterans of recent conflicts to seek help from CS since discharge from military service was ~2 years, considerably shorter than the mean time of 14 years previously estimated by CS. Approximately, three-quarters of the veterans receiving a full clinical assessment (n = 114), received a diagnosis of post traumatic stress disorder (PTSD) (n = 87). Approximately half of the clinically assessed veterans self-referred to CS (51%); their most frequent diagnosis was PTSD. CONCLUSIONS: Veterans who have served in Iraq and Afghanistan are presenting to Combat stress sooner, and at a younger age, than veterans of previous conflicts and operations.

An unusual cause of chest pain in a young man: bronchogenic cysts and their cardiac manifestations.

We report a case of a 24-year-old man who presented with chest pain and electrocardiographic evidence of myocardial ischaemia. An abnormal structure located behind the heart on the urgent transthoracic echocardiogram and a computed tomography scan of the mediastinum led to prompt surgery with eventual resection of the lesion. The histology revealed fragments of connective tissue covered by squamous epithelium and ciliated epithelium, consistent with a bronchogenic cyst. The case study is accompanied by a literature review of the pathogenesis, diagnosis and management of bronchogenic cysts and their association with cardiac symptoms.

Prolonged incarceration: effects on hostages of terrorism.

BACKGROUND: In recent years there has been an explosion in the publicity surrounding hostage taking. There have been many well-publicized hostage, prisoner of war and politically motivated incarcerations. Increasingly hostages are being paraded on television and sometimes even films of executions posted on the Internet. Hostage taking has usually occurred in countries where there has been political strife and war, especially, in recent years, in Iraq and Afghanistan, most recently involving British Royal Navy Personnel in Iran and a British journalist in Palestine. AIMS: The aim of this paper is to review the adult literature regarding hostage taking with a view to highlighting the most likely psychiatric disorders that can develop during such an experience. This will aid planning and implementation of hostage rehabilitation and family reintegration post release. This paper will help build insight into the experiences and potential clinical presentations of those held hostage under conditions of torture and threat of death. It presents a framework of needs allowing the planning of rehabilitation including how to manage the family and the media. CONCLUSIONS: Further specific research is needed in order to assess the full needs of those released from prolonged incarceration held under threat of death. This will allow better planning for, and delivery of, rehabilitation of those released.

Tolerance to ACE inhibitors after cardiac surgery.

OBJECTIVES: Several studies have shown angiotensin-converting enzyme (ACE) inhibitors to confer significant mortality and morbidity benefits in heart failure. First-dose hypotension may necessitate interruption of such therapy. This is more likely to occur if the ACE inhibitor is administered early after coronary artery bypass grafting (CABG). The purpose of this study was to analyse the haemodynamic tolerance to early post-operative treatment with perindopril and enalapril in patients with impaired renal and ventricular function. METHODS: Eighty one consecutive CABG patients with a previous myocardial infarction, impaired pre-operative left ventricular ejection fraction (LVEF) on ventriculography and moderately impaired renal function (serum creatinine of 115-150 micromol/l) were randomised into three groups to receive oral placebo, perindopril (4 mg) or enalapril (5 mg) once daily. Groups were subdivided into those with mild ventricular dysfunction (LVEF = 35-65%, n = 20) and significant ventricular dysfunction (LVEF < 35%, n = 7). Exclusion criteria included oliguria (<0.5 ml/kg per h) or inotrope dependance at the point of entry on the first post-operative day. Intolerance to ACE inhibitor was defined as hypotension (<95 mmHg systolic blood pressure or a decrease exceeding 25 mmHg in systolic blood pressure) leading to oliguria (<0.5 ml/kg per h) which was unresponsive to intravenous furosemide (20 mg). In such cases ACE inhibitor treatment was discontinued and patients commenced on dopamine. RESULTS: In the groups with mild ventricular dysfunction (LVEF = 35-65%) perindopril was discontinued in 1/20 and enalapril in 4/20 patients (P = n.s). However, in the groups with significant ventricular dysfunction (LVEF < 35%) perindopril was discontinued in 2/7 and enalapril in 7/7 patients (P = 0.02). CONCLUSION: Our results suggest that after CABG, patients with moderately impaired renal function and significant ventricular dysfunction do not tolerate ACE inhibitors well when these were commenced on the first post-operative day. However, perindopril was associated with less haemodynamic deterioration than enalapril and consequently may be advantageous in this setting. rights reserved.

Repair of torn pulmonary artery in redo operation.

Intraoperative pulmonary artery tears may complicate redo cardiac operations. We report a method of repair for these tears occurring in 2 patients undergoing second redo mitral valve operation by performing transection of the aorta and primary repair of the tear. This is a safe rapid procedure which gives excellent results.

Incorporating psychological debriefing techniques within a brief group psychotherapy programme for the treatment of post-traumatic stress disorder.

BACKGROUND: The Royal Air Force Wroughton Post-Traumatic Stress Disorder (PTSD) Rehabilitation Programme is described. It comprised a 12-day structured in-patient 'course' of group psychotherapy and day-case group follow-up sessions over a one-year period. Psychological debriefing was the main therapeutic technique employed. METHOD: This is a 'before and after' open outcome study. A comprehensive assessment protocol confirmed the presence and severity of PTSD and measured co-morbid psychopathological status, occupational and social function longitudinally. RESULTS: A highly significant global response to treatment is demonstrated in the 34 subjects included in the study, with 85.3% not fulfilling the DSM-III-R criteria for PTSD at one year after treatment. CONCLUSIONS: Further controlled studies assessing the value of psychological debriefing techniques in the treatment of established PTSD are required.

The management of anticoagulation in patients with prosthetic heart valves undergoing non-cardiac operations.

Prosthetic valve thrombogenicity and bleeding complications associated with life-long anticoagulation are constant potential causes of morbidity and mortality following prosthetic valve implantation. The conflict between over- and under-anticoagulation is even more of a problem when other surgical interventions are required. Very few clinical trials have addressed this issue. We propose some guidelines based on the concept of risk-adjusted intensity of anticoagulation but stress the need for caution with interpretation of these recommendations.

Development and validation of the computerized clinician administered post-traumatic stress disorder scale-1-revised.

A computer administered version of the clinician administered post-traumatic stress disorder (PTSD) scale-1 was developed to assess PTSD in subjects presenting with psychological symptoms following exposure to a traumatic event. Both forms were administered to 40 subjects who met the Diagnostic and Statistical Manual, third edition, revised (DSM-III-R) criteria for exposure to a significantly traumatic stressor. Inter-observer reliability was demonstrated with a kappa statistic of 0.90. The computer version had a sensitivity of 0.95 and a specificity 0.95. A correlation of 0.95 was found between the two versions and the mean score difference was non-significant. The computer form demonstrated adequate internal reliability and test-retest reliability. Overall results suggest the computer version is a valid and reliable measure of PTSD.

Convergent validity of measures of post-traumatic stress disorder in a mixed military and civilian population.

The authors evaluated the validity of the Post-Traumatic Stress Disorder (PTSD) subscale of the Minnesota Multiphasic Personality Inventory (MMPI), the Impact of Event Scale (IES) and the Symptom Check List 90 (SCL-90) as continuous and dichotomous measures of PTSD in a mixed military and civilian group of 70 subjects in the United Kingdom. The MMPI-PTSD and the IES are designed specifically as measures of PTSD and the Global Symptom Index of the SCL-90 is a general measure of neurosis. All measures produced significant positive correlations with scores from the Clinician Administered Post-Traumatic Stress Disorder Scale (CAPS-1) and with each other. The IES was the most useful dichotomous measure. The optimum cut-off score for the IES producing the highest Positive Predictive Value and the lowest Apparent Total Misclassification Error Rate has been determined.