Pioneering research to imprPioneering research to improve outcomes for post-traumatic stress disorder presented at Military Health Research Forum
New research on post-traumatic stress disorder (PTSD) is being presented this week at the Military Health Research Forum (MHRF), a scientific conference hosted by the Department of Defense (DOD) Congressionally Directed Medical Research Programs (CDMRP). Depending on the conflict in which they served, 10 to 30 percent of soldiers who have spent time in war zones experience the debilitating and life-altering symptoms of post-traumatic stress disorder (PTSD). With the active duty service member and veteran populations growing, PTSD is on the rise and researchers are working to improve care provided to military personnel.
A number of PTSD-focused studies presented at the MHRF evaluate the effectiveness of both pharmacologic and alternative treatment options. Topics examined include employing virtual environments and novel medicines to help military personnel diagnosed with PTSD and/or other co-morbidities, and the use of psychiatric service dogs to help troops manage the symptoms of PTSD.
"PTSD is a condition that has affected decades of war veterans, and treatments continue to evolve," stated Captain E. Melissa Kaime, M.D., Director of the CDMRP. "The novel PTSD research being presented at the MHRF represents advancements in therapy for this condition that we believe will improve patient care and outcomes for our service men and women."
Virtual Environments for Cognitive and Affective Dysfunction in Mild Traumatic Brain Injury and Post-Traumatic Stress Disorder: Development of a 21st Century Treatment Platform
Principal Investigator: Charles Levy, M.D., North Florida Foundation for Research and Education, Inc.
About 20 percent of combat veterans returning from Iraq suffer from mild traumatic brain injury (mTBI) or PTSD. Treatment for these conditions consists of medication and traditional psychotherapy, demanding frequent travel to a clinic, a potential hardship for many veterans.
Researchers led by Charles Levy, M.D., chief of Physical Medicine and Rehabilitation Services for the North Florida/South Georgia Veterans Health System, seek to leverage combat veterans' comfort and familiarity with communications technology and immersive environments (through cell phones, the internet, and video games) and build a prototype of a virtual world environment (VWE) in which to conduct therapy. The VWE will simulate everyday life encounters that are challenging to those with mTBI/PTSD, and allow the veteran and therapist to confront and overcome barriers that block successful social reintegration.
The clinical team chose a supermarket as the virtual scenario where veterans could receive cognitive and emotional challenges, including following a shopping list, purchasing items, making change, colliding with other shopping carts, and engaging with clerks and other patrons at check-out. Currently, a virtual supermarket is under construction that allows a therapist and patient, each at their own computer, to enter the virtual supermarket and experience these challenges together.
This research explores an innovative new concept. Previous use of virtual reality exposure among combat veterans has been limited to portraying battle as a part of exposure therapy.
"Oftentimes, the nuances of everyday life can unexpectedly trigger angry responses from warfighters hindered by mTBI and PTSD," Levy said. "This project shows great potential to expedite and expand care to veterans and wounded warriors in a short timeframe, in a way that minimizes travel for treatment, and in a cost-effective manner."
Pharmacologic Management of Post-Traumatic Stress Disorder and Co-Morbid Alcohol Dependence in Veterans
Principal Investigator: Ismene Petrakis, M.D., Yale University
The combination of PTSD and alcohol dependence is a serious clinical condition for military veterans. When a veteran suffers from PTSD and alcohol dependence simultaneously, he or she generally experiences more psychosocial and medical problems, more frequent relapses, and more serious symptoms than those who suffer from only one or the other. Research into the treatment of these disorders has included the use of medications, which has been proven effective in alcoholism, clinical depression, and, in some cases, for symptoms of PTSD in those without simultaneous alcoholism. Preliminary data from two clinical trials presented at the MHRF show that therapeutic options may be effective in treating both symptoms of PTSD and alcohol dependence.
In the first clinical trial, 93 veterans with PTSD and alcohol dependence, who were psychiatrically stable, were randomized to receive naltrexone (opioid antagonist) and disulfiram (Antabuse) alone or in combination for 12 weeks. Results showed that patients with PTSD experienced less alcohol craving, used less alcohol, and had fewer psychiatric symptoms when taking medication (either or both of the drugs), compared to those on placebo.
The second study compared paroxetine, the serotonin re-uptake inhibitor, with desipramine, the noradrenergic re-uptake inhibitor, in reducing the symptoms of PTSD and alcohol consumption in veterans with acute cases of PTSD (when symptoms have lasted less than three months) and alcohol dependence. The study also examined whether naltrexone further reduced alcohol consumption. Preliminary findings show that desipramine and paroxetine are equally effective in reducing symptoms of PTSD. However, there was no advantage to including naltrexone as a combination therapy to reduce alcohol consumption.
"Post-traumatic stress disorder coupled with alcohol dependence continues to handicap our veterans," says Principal Investigator Ismene Petrakis, Associate Professor of Psychiatry at the Yale University School of Medicine. "These studies suggest that there are treatments available for patients who are suffering acute symptoms as well as for those who are relatively stable."
Prazosin Reduces Trauma Nightmares and Severe Sleep Disturbance in Soldiers Deployed in Iraq
Principal Investigators: Murray Raskind, M.D., Seattle Institute for Biomedical and Clinical Research, and Major Jess Calohan, A.R.N.P., Madigan Army Medical Center, Fort Lewis, WA
Soldiers who experience traumatic nightmares and sleep disturbances have less than optimal functioning in the demanding combat environment, and these symptoms are difficult to treat. Prior research has revealed that prazosin improves sleep and daytime function in Vietnam combat veterans with chronic PTSD and is a highly effective and well-tolerated option for the reduction and possible elimination of trauma nightmares.