Differential impact of type of killing on posttraumatic stress disorder symptoms in U.S. Army soldiers deployed to Afghanistan.

Over the past 20 years, U.S. military conflicts in Iraq and Afghanistan have been marked by high rates of combat and wartime killings. Research on Vietnam-era service members suggests that the type of killing (i.e., killing a combatant vs. noncombatant) is an important predictor of later mental health problems, including posttraumatic stress disorder (PTSD). The present study aimed to update these findings by exploring the impact of type of killing on PTSD symptoms using a sample of postdeployment active duty U.S. Army personnel (N = 875). Using multiple regression analysis, we found that the act of killing a noncombatant was significantly associated with PTSD symptoms, B = 7.50, p < .001, whereas killing a combatant was not, B = -0.85, p = .360. This remained significant after controlling for demographic variables, depressive symptoms, and general combat experiences. These findings support the need for thoughtful postdeployment screenings and targeted clinical interventions.

Impact of comorbid post traumatic stress disorder on multiple sclerosis in military veterans: A population-based cohort study.

BACKGROUND: Very little is known regarding the impact of post traumatic stress disorder (PTSD) on the course of multiple sclerosis (MS). OBJECTIVES: To explore the impact of pre-existing PTSD on MS relapses, magnetic resonance imaging (MRI) activity, and disability in a large population-based cohort. METHODS: Military Veterans with MS and PTSD prior to symptom onset (MSPTSD, n = 96) were identified using the Department of Veterans Affairs MS databases. MSPTSD cases were matched to MS controls without PTSD (n = 95). Number of relapses, number of new T2 lesions and new gadolinium lesions on brain MRI, and neurological disability were abstracted between 2015 and 2019. RESULTS: The mean annualized relapse rate was greater in the MSPTSD group versus controls (0.23 vs 0.06, respectively; p < 0.05), as was the annualized mean number of new T2 and gadolinium-enhancing lesions on brain MRI (0.52 vs 0.16 and 0.29 vs 0.08, respectively; p < 0.05). Disability accrual (time to Disability Status Scale 6.0) was more rapid (23.7 vs 29.5 years, p < 0.05) in relapsing MS patients with PTSD. CONCLUSION: Patients with MSPTSD have higher disease activity and reach disability endpoints more rapidly than controls. This is the first study to show PTSD as a potentially modifiable risk factor for MS relapses, MRI activity, and disability.

Integration of Neuropsychological Services in a VA HIV Primary Care Clinic.

The Department of Veteran Affairs (VA) is the largest health care provider for individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), with >28,000 Veterans with HIV/AIDS enrolled in care. Advances in medical treatment have improved the life-limiting effects of the disease, though many chronic symptoms persist. Comprehensive care is critical to manage the diverse constellation of symptoms. However, many patients face challenges to receiving optimal care due to limited resources, mistrust of health care providers, and/or co-occurring medical, psychiatric, and substance use disorders. The VA is a leader in developing integrated models of care to address these barriers. The inclusion of subspecialty mental health and substance abuse treatment in HIV care has been implemented across many VAs, with evidence of improved patient outcomes. However, neuropsychology has not traditionally been included, despite the fact that cognitive dysfunction represents one of the most ubiquitous complications of HIV/AIDS. Cognitive impairment is associated with myriad negative outcomes including medication non-adherence, reduced quality of life, and increased mortality. We contend that neuropsychologists are uniquely equipped to contribute to the comprehensive care of patients with HIV/AIDS. Neuropsychologists understand the range of factors that can impact cognition and have the requisite knowledge and skills to assess and treat cognitive dysfunction. Although we focus on HIV/AIDS, neuropsychologists often play critical roles in the provision of care for other infectious diseases (e.g., hepatitis C).

Interdisciplinary rehabilitation of mild TBI and PTSD: a case report.

BACKGROUND: Prevalence of mild traumatic brain injury (mTBI) or concussion on the battlefield in Iraq/Afghanistan has resulted in its designation as a 'signature injury'. Civilian studies have shown that negative expectations for recovery may lead to worse outcomes. While there is concern that concussion screening procedures in the Veteran's Affairs Healthcare System and the Department of Defence could fuel negative expectations, leading to negative iatrogenic effects, it has been difficult to document this in clinical settings. The aim of this report is to describe the case of a veteran with comorbid mTBI/PTSD with persistent symptoms of unknown aetiology and the effects of provider communications on the patient's recovery. METHODS: Case report of a veteran with reported mTBI, including provider communications, neuropsychological test results and report of functioning after changes in provider messages. RESULTS: Two-years post-mTBI, the patient attributed cognitive difficulties to his brain injury, but neuropsychological assessment found that his cognitive profile was consistent with psychological rather than neurological dysfunction. After providers systematically emphasized expectations of recovery, the patient's daily functioning improved. CONCLUSIONS: This case illustrates difficulties in mass screening for and treating mTBI. Recommendations for improvement include clinician training in effectively communicating positive expectations of recovery after concussion.

Use of an insulin pen by homeless patients with diabetes mellitus.

PURPOSE: To assess the impact of an insulin delivery system, the NovoPen, on diabetes treatment for the homeless. DATA SOURCES: Homeless patients (n = 23) with diabetes and using insulin were identified from a registry of patients with diabetes maintained at the Homeless Outreach Medical Services clinical sites. Baseline evaluations included glycosylated hemoglobin (HbA1c) measurements and a questionnaire about the patient's current treatment practices. Patients were instructed in the use of the NovoPen; HbA1c measurements and questionnaires were repeated after 3 and 6 months of participation. CONCLUSIONS: Reductions of HbA1c were observed at 3 and 6 months. The authors concluded that use of the pen improved patient compliance and thus glycemic control. IMPLICATIONS FOR PRACTICE: Patients had improved quality of life after using the pen to administer insulin. Nurse practitioners should recognize quality of life issues when treating patients with chronic diseases. Nurse practitioners who care for homeless diabetes patients can promote better care for this population by educating homeless shelter staff about diabetes and its management.