The article “6 screening questions for military veterans” (Pearls, Current Psychiatry, September 2008) is a well written and thorough review for clinicians treating active duty personnel and military veterans. A very important and clinically relevant seventh question is to ask about traumatic brain injury (TBI) that may have occurred during training or deployment to Iraq or Afghanistan. One tool clinicians can use to screen these patients is the Brief Traumatic Brain Injury Screen developed by the Defense and Veterans Brain Injury Center.1 Coupled with a clinical interview, this 3-question survey will assist clinicians in identifying possible TBI patients. Referring TBI patients to a polytrauma rehabilitative center through the Department of Veterans Affairs is part of a comprehensive treatment plan.2
Timothy Berigan, MD
Psychiatrist
Raymond W. Bliss Army Health Center
Fort Huachuca, AZ
1. Schwab KA, Baker G, Ivins B, et al. The Brief Traumatic Brain Injury Screen (BTBIS): investigating the validity of a self-report instrument for detecting traumatic brain injury (TBI) in troops returning from deployment in Afghanistan and Iraq. Neurology 2006;66(5)(suppl 2):A235.
2. Friedmann-Sánchez G, Sayer NA, Pickett T. Provider perspectives on rehabilitation of patients with polytrauma. Arch Phys Med Rehabil 2008;89(1):171-8.
Dr. Barry responds
Mild traumatic brain injury (mTBI) is one of the signature diagnoses of the conflicts in Iraq and Afghanistan, and we’re learning more about the pathogenesis, manifestations, sequelae, and treatment of this syndrome. Most veterans have basic knowledge about this condition because the military educates and screens all personnel for mTBI and employs aggressive, multi-disciplinary treatment plans for those in need. Thus, clinical interview, physical examination, and screening for mTBI—as suggested by Dr. Berigan—might yield useful information for clinicians treating veterans.
Matthew James Barry, DO
Chief of psychiatric services
U.S. Army’s Medical Department Activity
Fort Huachuca, AZ