Most soldiers will only experience the mild to moderate forms of deployment-related stress. Most of these stress reactions, although unpleasant in the short term, do not result in long-term problems. In some cases, however, the stress from combat events can cause more serious problems that require additional help.

Generally, there are four kinds of deployment-related stress problems: Combat/Operational Stress Reactions (COSRs); Adjustment Disorders; Acute Stress Disorder (ASD); and Posttraumatic Stress Disorder (PTSD).

During the Civil War, PTSD was called “soldier’s heart.” In World War II, it was “battle fatigue.” Studies estimate that nearly 30 percent of Vietnam veterans (some 830,000) have experienced some level of PTSD. MORE ON PTSD.

10JUL2010: Today, more than 150,000 veterans of the Iraq and Afghanistan wars have been officially diagnosed with PTSD. The number likely is higher because of the stigma attached to the disorder and also because some service members have sought out private treatment rather than through the Defense Department or Department of Veterans Affairs (VA). As many as 300,000 war vets from Iraq and Afghanistan have experienced post-traumatic stress disorder. Now, the process for getting treatment and compensation for PTSD is being streamlined.

The government is taking what President Barack Obama calls "a long overdue step" to aid veterans with post-traumatic stress disorder, making it easier for them receive federal benefits. The changes that Veteran Affairs Secretary Eric Shinseki will announce Monday fulfill "a solemn responsibility to provide our veterans and wounded warriors with the care and benefits they've earned when they come home," Obama said in his weekly radio and online address Saturday.

As PTSD is better understood, what Secretary Shinseki calls “the hidden wounds of war” are being addressed in many ways by a growing number of communities, agencies, and organizations around the country. This streamlined system will apply to vets of earlier wars, including Vietnam.

“They’ve been required to produce evidence proving that a specific event caused their PTSD. And that practice has kept the vast majority of those with PTSD who served in non-combat roles, but who still waged war, from getting the care they need,” said Obama. No longer will veterans have to prove what caused their illness. Instead, they would have to show that the conditions surrounding the time and place of their service could have contributed to their illness. "I don't think our troops on the battlefield should have to take notes to keep for a claims application," the president said. "And I've met enough veterans to know that you don't have to engage in a firefight to endure the trauma of war."

Veterans advocates and some lawmakers have argued that it sometimes could be impossible for veterans to find records of a firefight or bomb blast. They also have contended that the old rules ignored other causes of PTSD, such as fearing a traumatic event even if it doesn't occur. That could discriminate against female troops prohibited from serving on front lines and against other service members who don't experience combat directly.

"This is a long overdue step," Obama said. "It's a step that proves America will always be here for our veterans, just as they've been there for us. We won't let them down. We take care of our own." A study last year by the RAND Corp. think tank estimated that nearly 20 percent of returning veterans, or 300,000, have symptoms of PTSD or major depression. A senior official at the Department of Veterans Affairs said the agency doesn't expect the number of veterans receiving benefits for PTSD to rise dramatically, as most veterans with legitimate applications for benefits do eventually get claims. The goal is simply to make the claims process less cumbersome and time-consuming, said the official, who would speak only on condition of anonymity ahead of the VA's announcement.

Department of Veterans Affairs: http://www.ptsd.va.gov/

GROUP COUNSELING

"Deprogram" military conditioning and training for civilian life

Learn to ID triggers; self-monitoring; coping mechanisms; communication skills

Group Activities: Vets helping vets; group recreation; group service projects

ESI MENTORING

Navigating assistance w/ gvt institutions

Help accessing local assistance programs

Academic tutoring

Career counseling

Life skills coaching

Family counseling

Financial consultation

There is no one magic medication or intervention available that will ‘cure’ an anxiety disorder. Typical treatments for Anxiety include: Benzodiazepines—a group of drugs that help to reduce anxiety, panic attacks and have sedating properties; Tricyclic antidepressants—a group of drugs that relieve depression (which can accompany anxiety); these medications tend to have numerous side effects; and Beta Blockers, Selective Serotonin Reuptake Inhibitors.

Commonly prescribed antidepressants: Valium, Paxil, Prozac, Celexa, Effexor, Remeron Many of the prescribed drugs can produce the same mental disturb-ances that define PTSD, such as hyper-arousal, insomnia and paranoia; and be addictive; side-effects 20 times more than psychiatrists report.

But there are serious issues surrounding drug therapy for PTSD - one of the most serious is "Off-Labelin" where drugs for other maladies are prescribed for other disorders, without FDA approval. Some of the most common are:

Klonopin: epilepsy seizure; Zoloft: SSRI – suicide, birth defects controversy; Neurontin: an anti-convulsive drug; Risperdal: prescribed for schizophrenia and bipolar disorder; and Seroquel, which is probably the most controversial and dangerous of them all.

Seroquel has been associated with increased psychosis, heart attacks and sudden death. There are now 26,000 civil lawsuits against AstraZeneca, the maker of Seroquel. Risperdal, a potent brain chemistry changing drug given for schizophrenia, bipolar disorder and certain autisms, is also being dispensed to make soldiers “fit” for combat. Neither Seroquel or Risperdal have been approved for treating PTSD, and both are under Congressional investigation for being over-prescribed for unapproved mental conditions.

15 drug cases settled under the False Claims Act from 1996 through 2010, totaling $8.7b, involved off-label or fraudulent marketing and misbranding. Eli Lilly paid out $1.42b in 2009 — $615 million of that criminal fines for selling Zyprexa to doctors for use in children, despite the fact that it was not approved for this age group. The largest Big Pharma companies say that off-label use is a necessary and common.

A potentially deadly "off-label" drug manufactured by pharmaceutical giant AstraZeneca has been linked to the deaths of soldiers returning from war. Yet the FDA continues to approve it.

In the last two years, Sgt Eric Layne,Pfc. Derek Johnson, 22, of Hurricane, W. Va.; Cpl. Andrew White, 23, of Cross Lanes, W.Va.; Cpl. Chad Oligschlaeger, 21, of Roundrock, Texas; Cpl. Nicholas Endicott, 24, of Pecks Mill, W.Va.; and Spc. Ken Jacobs, 21, of Walworth, N.Y. have all died suddenly while taking Seroquel cocktails.

Death certificates and other records collected by veteran family members suggest more than 100 similar deaths among Iraq and Afghanistan combat vets and other military personnel, many on PTSD cocktails with Seroquel and other antipsychotics, antidepressants, mood stabilizers, sleep inducers, and pain and seizure medications.

Since the 2008 publication of “The Battle Within,” the Denver Post’s exposé of a “pharmaco-battlefield” in Iraq, in which troops were found to be routinely propped up on antidepressants, the Department of Defense (DOD) has sought to curb the deployment of troops with mental health problems to combat zones. The DOD has also stepped up monitoring of soldiers who have been medicated, according to the Hartford Courant. Thirty-four percent of the 935 active-duty soldiers who made suicide attempts in 2007 were on psychoactive drugs.

Although it has not been approved for PTSD, Pentagon purchases of Seroquel nearly doubled between 2003 and 2007. Elspeth Ritchie, medical director of the Army’s Strategic Communications Office told the Denver Post the drug is “increasingly utilized as an adjunct for PTSD.”

A search of the U.S. National Library of Medicine database yields 20 articles linking “Seroquel” and “sudden death,” 24 linking “Seroquel” and “QT prolongation” (a heart disturbance that can lead to death), 55 linking “Seroquel” and “toxicity,” and others linking Seroquel with the terms “cardiac arrest” and “death.”

View Full Article: Prescription For Disaster

An Anger Management Intervention Model For Veterans With PTSD

By April Gerlock, R.N., C.N.S. - NCP Clinical Quarterly 6(3): Summer 1996

Anger and rage are prevalent emotions in individuals experiencing posttraumatic stress disorder (PTSD; 1), as well as in male veterans with PTSD. Vietnam combat veterans experience more anger and hostility than their civilian counterparts (5-6), and Vietnam combat veterans with PTSD experience more anger than Vietnam combat veterans without PTSD. A greater capacity for violence also figures predominantly in veterans with PTSD. Vietnam theater veterans with PTSD report statistically higher rates of hostility and physical aggression towards their partners than their non-PTSD counterparts. This predilection for hostility and assaultive behaviors contribute greatly to readjustment difficulties in veterans with PTSD.

Attention to and treatment of the anger component of PTSD is considered an essential element in trauma recovery work. Despite highly variable approaches to anger management intervention, goals include a reduction in the level of anger experienced by the veteran as well as learning constructive ways to manage and express anger. The model presented here combines a cognitive and behavioral approach (developed in consultation with Anne Ganley, April, 1984). It is currently used in outpatient treatment with veterans (with and without PTSD), and has been adapted for inpatient PTSD treatment as well. However, the treatment model was designed for veterans with generic anger management problems, and not as treatment for those who are domestically violent. Anger management fails to account for the premeditated controlling behaviors associated with domestic violence.

View Full Article: Anger Management