Issues for military women in deployment: an overview.

The stresses of deployment affect both sexes, but some are either mildly or markedly different for women. These include certain female health and gynecological issues, nursing, and pregnancy. Separation from small children, isolation, the possibility of sexual assault, and risks of combat or being taken hostage are concerns for both genders. All of these issues should be addressed before and during deployment to ensure optimal individual and unit functioning and improve retention. Gynecological infections, redeployment for abnormal Papanicolaou smears, and pregnancy while on deployment can be avoided with proper hygiene and planning. There are resources available in pamphlet form, electronically, and on CD-ROM to help prepare service members, leaders, and health care personnel. Improvements in the ability to maintain personal hygiene and to communicate home should benefit both sexes.

Psychological problems associated with mission-oriented protective gear.

"Gas mask phobia," a form of claustrophobia, impacts the ability of many service members to perform their mission. Historically, some soldiers have not donned, or quickly removed, their personal protective respirators because of discomfort, ignorance, or shame. Traditionally, little attention has been paid to this as a readiness issue. Exact numbers of service members who are unable to tolerate their masks are unknown. This phobia can be avoided with adequate training and treated with principles of desensitization, but more research is needed in early identification and treatment.

Psychiatric aspects of arsonists.

Arson is a major source of property damage, injury and death in the United States. Many people who commit arson have extensive psychiatric histories and symptoms at the time of their fire-setting. However, traditionally the law enforcement community and the mental health community have not shared information about the characteristics of people who set fires. This study examined mental health records and/or prison files from 283 arsonists. 90% of arsonists had recorded mental health histories, and of those 36% had the major mental illness of schizophrenia or bipolar disorder. 64% were abusing alcohol or drugs at the time of their firesetting. Pyromania was only diagnosed in three of the 283 cases. Different motives for setting fires are discussed; many patients were both angry and delusional. A survey instrument, which captures both psychiatric and legal data, is included. Suggestions are made for gathering future "profiling" information. A matrix approach to coding diagnosis and behavior is presented.

Reactions to rape: a military forensic psychiatrist's perspective.

Accusations of rape or sexual harassment are currently very high-profile in the military. This article discusses rape allegations in the military legal system from a psychiatric perspective. The original definition of "rape trauma syndrome" and subsequent psychiatric thinking about the diagnosis are briefly outlined. Common reactions seen in military victims in this era are described. A prototypical military case is presented. An adequate evaluation of an alleged victim is outlined. Credentials and preparation of an expert witness are also briefly discussed, with cautions about the use of expert testimony in cases of alleged sexual assault and rape trauma syndrome.

Surviving the "air evac": medical and logistical issues of evacuating psychiatric patients by air from Korea to the United States.

Active duty soldiers who need a physical evaluation board for incapacitating psychiatric symptoms may be evacuated by air to the United States. The Aeromedical Evacuation (air evac) process involves many overlapping organizations, including the Army, Air Force, command, medical, and flight personnel. There are often communication problems between the different systems. Which soldiers are returned to the United States, how they get there, whether to send a medical attendant, and which medications to use for the flight are discussed. The air evac process is in transition. We hope that this paper will facilitate cooperation between the different systems and improve patient care.

Zipeprol (Zinolta) abuse among American adolescents in Korea: a discussion of the problem, clinical presentation, and treatment.

Zipeprol dihydrochloride (Zinolta) is a Korean medication that is abused by American dependent teenagers in Korea. The adolescents usually present for medical care after a seizure. Since this medication is not available in the United States, many physicians are unfamiliar with zipeprol-induced seizures. The extent of the problem, the pharmacology and mechanism of action of zipeprol, the clinical presentation, and suggestions for treatment are discussed. Military physicians should consider zipeprol overdose when a teenager presents with a seizure.

Psychiatric medications for deployment.

Standard medical sick-cell chests used in the military contain either outdated or no psychiatric medications. Yet certain psychiatric medications are either useful or essential for the field and deployment. This article discusses suitable medications for both psychiatric emergencies and for chronic treatment of depression or anxiety. Psychiatric medications to avoid in deployment are also listed. Some dosing guidelines are provided. The article ends with a proposed "psychiatric sick-call chest" to be prepared in advance of deployment.

The 528th Combat Stress Control Unit in Somalia in support of Operation Restore Hope.

The 528th Combat Stress Control (CSC) Unit activated on December 16, 1992, and deployed to Somalia in support of Operation Restore Hope on January 6, 1993. The experiences of the first 90 days are discussed, to include (1) deployment issues, (2) stresses facing the troops in Somalia, and (3) patient data. The CSC had expected to work with service members traumatized by the sight of starving children and dead bodies. Instead, the stresses were similar to those of low-intensity guerrilla warfare. Overall there were very few soldiers and marines impaired by mental health issues, and minimal psychiatric evacuations from the theater.

Depression and support systems in male army HIV+ patients.

Psychiatric interviews were conducted with 55 male Army HIV+ patients. These soldiers were diagnosed in an early stage of HIV, and were not clinically demented. Sixty-four percent were given diagnoses of a depressive disorder by a psychiatrist, while 42% self-reported depression. Fifty-five percent had a history of suicidal thoughts since their diagnosis of HIV, but only one soldier was actively suicidal. Half said that they followed a more healthy lifestyle since their diagnoses. Factors associated with a high rate of depression included being divorced, of Hispanic origin, having other medical problems, or a history of mental illness. Not telling friends and family, or feeling a lack of support from them or the military, was also significantly correlated with depression.

Treatment of gas mask phobia.

Many soldiers develop feelings of claustrophobia when wearing a protective mask. In the battlefield environment of today, it is essential that soldiers be able to tolerate gas masks. This article briefly reviews the historical use of gas masks in the U.S. Army. Two cases of treatment of gas mask phobia are described. Behavioral therapy techniques useful for treatment are summarized.

Cognitive therapy training in u.s. Psychiatry residency programs.

Cognitive therapy (CT) is a relatively new mode of psychotherapy that is effective in the treatment of depression and other psychiatric disorders. The training directors of all U.S. general psychiatry residency programs were surveyed on the amount of time offered in teaching and supervision of CT and in other treatment modalities. Of the 127 responders, 91 % offer some classroom instruction in CT, 54% offer trainees supervised clinical experience, and 23% require such experience. The ranges of instructional time offered and number of patients treated per resident are broad. Thirty-seven percent of training directors consider graduating residents as qualified to practice CT, and 11% consider graduating residents as qualified to supervise others in CT. The authors conclude that little standardization exists in CT training, and they propose a minimum requirement.

Acute generalized myoclonus following buspirone administration.

The authors present a case of a 62-year-old woman who was hospitalized with severe medical problems that included congestive heart failure secondary to mitral stenosis and atrial fibrillation, coronary artery disease, chronic renal failure, and a recent history of a right cerebral lacunar infarction. She also had a 2-year history of anxiety and depression, manifested in the hospital by frequent crying spells, sleeplessness, and ruminating about her illnesses. The patient received buspirone 5 mg three times a day for her anxiety and depression. Approximately 12 hours after her first dose, she developed dramatic myoclonus, dystonias, and akathisia. She was given 25 mg of intramuscular diphenhydramine and 1 mg of intramuscular benztropine mesylate, which resulted in little relief; however, 1 mg clonazepam caused both the myoclonic jerks and dystonias to resolve completely.