Evidence-Based Reviews

TRAUMATIZED TROOPS How to treat combat-related PTSD

Current Psychiatry. 2006 May;5(5):39-52

Timothy W. Lineberry, MD Sriram Ramaswamy, MD

References

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Thousands of U.S. troops are seeking mental health care after being deployed in Iraq. Among 222,000 Army and Marine Iraq veterans, 35% sought treatment in the year after returning home—many for posttraumatic stress disorder (PTSD).^{In a related article, we discuss the diagnosis and treatment of military sexual trauma, a form of PTSD.}

Persistent pathology

The greater the intensity of an Iraq/Afghanistan veteran’s combat experiences (“firefights”), the more likely the soldier is to develop PTSD.^{Traumatic brain injury: Choosing medications for neurobehavioral symptoms”). Sexual trauma also may cause or exacerbate PTSD.^{Military sexual trauma: How to identify and treat a unique form of PTSD”).}}

Table 1

3 domains of posttraumatic stress disorder symptoms

Domain	Symptoms
Re-experiencing	Recurrent, intrusive, distressing recollections or dreams of traumatic event Acting or feeling as if the event were recurring Intense psychological distress or physiologic reactions when exposed to internal or external cues
Avoidance and numbing	Efforts to avoid thoughts, feelings, or conversations about the trauma or activities, places, or people that arouse recollections Inability to recall an important aspect of the trauma Markedly less interest or participation in significant activities Feeling detached or estranged from others Restricted range of affect Sense of a foreshortened future
Increased arousal	Difficulty falling or staying asleep Irritability or angry outbursts Difficulty concentrating Hypervigilance Exaggerated startle response
Source: DSM-IV-TR

FigurePTSD screen for war veterans

Source: U.S. Department of Veterans Affairs. Afghan & Iraq Post-Deployment Screen, Attachment B. Screening for risk factors associated with development of post-traumatic stress disorder (PTSD)

Cognitive therapy

Psychotherapy is the cornerstone of PTSD treatment; skilled therapists may achieve greater efficacy and more-durable results than medications do. Evidence strongly supports cognitive behavioral therapy—including exposure therapy, anxiety management, and cognitive therapy.^{U.S. troops returning home: Are you prepared? Current Psychiatry 2006;5(1):12-22.}

U.S. Department of Veterans Affairs. Seamless Transition Home. http://www.seamlesstransition.va.gov. Accessed March 13, 2006.

American Psychiatric Association. Practice guideline for the treatment of acute stress disorder and posttraumatic stress disorder. http://www.psych.org/psych_pract/treatg/pg/PTSD-PG-PartsA-B-C-New.pdf.

Drug brand names

Carbamazepine • Carbatrol
Fluoxetine • Prozac
Lamotrigine • Lamictal
Lithium • Lithobid, others
Mirtazapine • Remeron
Paroxetine • Paxil
Prazosin • Minipress
Sertraline • Zoloft
Trazodone • Desyrel
Temazepam • Restoril
Valproic acid • Divalproex, others
Venlafaxine • Effexor
Zolpidem • Ambien

Disclosures

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products. Drs. Lineberry, Bostwick, and Rundell served on active duty in the U.S. Air Force. Dr. Ramaswamy is staff psychiatrist, Omaha Veterans Administration. and Director of Psychopharmacology Research, Creighton University, Omaha, NE.