Neurology in the Vietnam War.

Neurology in the Vietnam War.

Front Neurol Neurosci. 2016 Apr 1;38:201-213

Authors: Gunderson CH, Daroff RB

Abstract

Between December 1965 and December 1971, the United States maintained armed forces in Vietnam never less than 180,000 men and women in support of the war. At one time, this commitment exceeded half a million soldiers, sailors, and airmen from both the United States and its allies. Such forces required an extensive medical presence, including 19 neurologists. All but two of the neurologists had been drafted for a 2-year tour of duty after deferment for residency training. They were assigned to Vietnam for one of those 2 years in two Army Medical Units and one Air Force facility providing neurological care for American and allied forces, as well as many civilians. Their practice included exposure to unfamiliar disorders including cerebral malaria, Japanese B encephalitis, sleep deprivation seizures, and toxic encephalitis caused by injection or inhalation of C-4 explosive. They and neurologists at facilities in the United States published studies on all of these entities both during and after the war. These publications spawned the Defense and Veterans Head Injury Study, which was conceived during the Korean War and continues today as the Defense and Veterans Head Injury Center. It initially focused on post-traumatic epilepsy and later on all effects of brain injury. The Agent Orange controversy arose after the war; during the war, it was not perceived as a threat by medical personnel. Although soldiers in previous wars had developed serious psychological impairments, post-traumatic stress disorder was formally recognized in the servicemen returning from Vietnam.

PMID: 27035455 [PubMed – as supplied by publisher]

Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey.

Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey.

Clin Neuropsychol. 2016 Apr 1;:1-18

Authors: Young JC, Roper BL, Arentsen TJ

Abstract

OBJECTIVE: A survey of neuropsychologists in the Veterans Health Administration examined symptom/performance validity test (SPVT) practices and estimated base rates for patient response bias.

METHOD: Invitations were emailed to 387 psychologists employed within the Veterans Affairs (VA), identified as likely practicing neuropsychologists, resulting in 172 respondents (44.4% response rate). Practice areas varied, with 72% at least partially practicing in general neuropsychology clinics and 43% conducting VA disability exams.

RESULTS: Mean estimated failure rates were 23.0% for clinical outpatient, 12.9% for inpatient, and 39.4% for disability exams. Failure rates were the highest for mTBI and PTSD referrals. Failure rates were positively correlated with the number of cases seen and frequency and number of SPVT use. Respondents disagreed regarding whether one (45%) or two (47%) failures are required to establish patient response bias, with those administering more measures employing the more stringent criterion. Frequency of the use of specific SPVTs is reported.

CONCLUSIONS: Base rate estimates for SPVT failure in VA disability exams are comparable to those in other medicolegal settings. However, failure in routine clinical exams is much higher in the VA than in other settings, possibly reflecting the hybrid nature of the VA’s role in both healthcare and disability determination. Generally speaking, VA neuropsychologists use SPVTs frequently and eschew pejorative terms to describe their failure. Practitioners who require only one SPVT failure to establish response bias may overclassify patients. Those who use few or no SPVTs may fail to identify response bias. Additional clinical and theoretical implications are discussed.

PMID: 27032437 [PubMed – as supplied by publisher]

Transgender Veterans Face High Risk of Mental Health Problems

Among military veterans who identify as transgender, nearly 50 percent have been hospitalized due to a suicide attempt or suicidal thoughts, and 90 percent have at least one mental health diagnosis, such as depression or posttraumatic stress disorder (PTSD), according to a new study whose findings will be presented at The Endocrine Society’s 98th annual meeting in Boston.

The military population, including both active members and veterans, has a fourfold higher rate of gender dysphoria compared to the general U.S. population. Formerly known as gender identity disorder, gender dysphoria is the experience of significant distress associated with nonconformity to one’s birth gender.

“As more of our active military returns from deployment and transitions to veteran status, the health care system will be faced with treating more transgender veterans who have mental health issues,” said principal investigator Marissa Grotzke, M.D., an endocrinologist at Salt Lake City Veterans Affairs Medical Center (VAMC), Salt Lake City.

It is already known that non-veterans with gender dysphoria have distinct health care concerns and much higher rates of mental health problems, such as depression, anxiety, and suicidal thoughts. Previous studies have also shown that military veterans suffer from higher rates of mental health disorders as well, including PTSD and depression. Less is known, however, about the double mental health impact of veterans with gender dysphoria.

By examining 2014-2015 medical records at Salt Lake City VAMC, Grotzke and her team found 39 patients who had a diagnosis of gender dysphoria. Eight transgender patients were transitioning from female to male, and the other 39 were male-to-female. They included both combat and noncombat veterans and ranged in age from 21 to 68 years.

The researchers then looked for mental health conditions that coexisted with the gender dysphoria. They found that PTSD was the most commonly identified mental health diagnosis, affecting 46 percent of these veterans, followed by depression in 41 percent. Tobacco use occurred in one-third, and anxiety was present in 15 percent. Nine patients (23 percent) had other substance abuse, bipolar disorder, or schizotypal personality disorder.

Eighteen patients (46 percent) carried two or more mental health diagnoses, according to the researchers. Only four patients (10 percent) with gender dysphoria had no additional mental health problem.

“These findings highlight the need to improve the quality of care for our transgender veterans,” Grotzke said.

To address these issues, the Salt Lake City VAMC formed a multidisciplinary gender dysphoria team composed of an endocrinologist, mental health professional, pharmacist, speech therapist and vocational rehabilitation providers. Team members meet together twice a month to discuss patients and treatment plans, which Grotzke said already has been “very beneficial” for patients.

There are most likely several reasons behind the increased rates of mental health disorders found in transgender veterans. Grotzke said that traumatic brain injuries sustained in combat, military sexual abuse, and stigma related to gender struggles are common in this population.

Source: The Endocrine Society