Pathophysiology

The Academy of Medical-Surgical Nurses (AMSN) has taken the American Nurses Association pledge to support the White House’s Joining Forces initiative.

Medical-surgical nurses should know how to provide health care for the military service member. These resources will be a primer for the medical-surgical nurse on Pathophysiology of Traumatic Brain Injury (TBI), Post Traumatic Stress Disorder (PTSD) and Depression.

AMSN Recommended Resources

Scholarly Papers

American Medical Association. (2012, November). Amygdala Volume Changes in Posttraumatic Stress Disorder in a Large Case-Controlled Veterans Group. Archives of General Psychiatry, 69(11), 47-48.
Abstract on study of affects of PTSD on volumetric changes in the amygdala.

Boschert, Sherry, S. (2013). Trauma's physical effects persist for years. Clinical Psychiatry News, Retrieved from http://www.clinicalpsychiatrynews.com/single-view/trauma-s-physical-effects-persist-for-years/58729de290d56a06e079564c2c30ef7c.html?tx_ttnews[sViewPointer]=1
This article discusses three studies that suggest that the neurobiological effects of trauma persist for years and might help survivors better handle future trauma or increase their risk of cardiovascular disease and other problems.

Barnes, S. M., Walter, K. H., & Chard, K. M. (2012). Does a history of mild traumatic brain injury increase suicide risk in veterans with PTSD? Rehabilitation Psychology, 57(1), 18-26.
This finding highlights the importance of screening and treating military personnel and veterans for PTSD

Capehart, B., & Bass, D. (2012). Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury. Journal of Rehabilitation Research and Development, 49(5), 789-812. http://www.rehab.research.va.gov/jour/2012/495/capehart495.html
VA/DOD Clinical Practice Guidelines are used to manage PTSD with comorbid TBI in combat veterans. This article addresses cognitive problems, and blast injury as a novel injury in combat veterans. 

Goodrich, G. L., Flyg, H. M., Kirby, J. E., Chang, C., & Martinsen, G. L. (2013). Mechanisms of TBI and visual consequences in military and veteran populations. Optometry and Vision Science, 90(2), 105-112.
This study seeks to determine if the type and amounts of vision problems are present in blast and non-blast TBI. The study found that the mechanism of injury didn’t result in differences. More research is needed.

Haley, R., Charuvastra, E., Shell, W., Buhner, D., Marshall, W., Biggs, M., …Vernino, S. (2012, November). Cholinergic Autonomic Dysfunction in Veterans With Gulf War Illness. Archive of Neurology, 1-10. doi:10.1001/jamaneurol.2013.596
Research findings to associate symptoms in Gulf War veterans with cholinergic autonomic dysfunction.

Joscelyne A., McLean S., Drobny J., Bryant R.A. (2012, November). Fear of memories: the nature of panic in posttraumatic stress disorder. European Journal of Psycho-Traumatology, 3, 19084.
Comparing cognitive response to panic attacks from PTSD and from panic disorder (PD).

LeardMann CA, Powell TM, Smith TC, et al. Risk Factors Associated With Suicide in Current and Former US Military Personnel. JAMA. 2013;310(5):496-506. doi:10.1001/jama.2013.65164.
The objective of this study was to "prospectively identify and quantify risk factors associated with suicide in current and former US military personnel including demographic, military, mental health, behavioral, and deployment characteristics."

McAllister, T. W., & Stein, M. B. (2010). Effects of psychological and biomechanical trauma on brain and behavior. Annals of the New York Academy of Science, 1208, 46-57.
This paper reviews the literature on the neural substrate of biomechanical and psychological injury.

Pallavi Nishith, P., Duntley, S. P., Domitrovich, P. P., Uhles, M. L., Cook, B. J., & Stein, P. K. (2003). Effect of cognitive behavior therapy on heart rate variability during REM sleep in female rape victims with PTSD. Journal of Traumatic Stress, 16(3), 247-250. http://link.springer.com/article/10.1023%2FA%3A1023791906879?LI=true
Article explores the effectiveness of cognitive behavior therapy (CBT) in female rape victims not in a war situation.

Peskind, E. R., Petrie, E. C., Cross, D. J., Pagulayan, K., McCraw, K., Hoff, D.,...Minoshima, S. (2011). Cerebrocerebellar hypometabolism associated with repetitive blast exposure mild traumatic brain injury in 12 Iraq war Veterans with persistent post-concussive symptoms. NeuroImage, 54(Suppl.1), S76-S82.  http://www.sciencedirect.com/science/article/pii/S1053811910004027
Connection between post-concussive symptoms and structural or functional brain damage

Pizzi, C., Manzoli, L., Mancini, S., & Costa, G. M. (2008). Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function. European Heart Journal, 29, 1110-1117. http://eurheartj.oxfordjournals.org/content/29/9/1110.long
Article on pathophysiological relationships between depression and cardiac risk factors including heart rate variability, used as a supporting reference to other military-specific articles on heart rate variability as a risk factor for cardiac disease.

Risdall, J. E., & Menon, D. K. (2011). Traumatic brain injury. Philosophical Transactions of the Royal Society, 366, 241-250. http://rstb.royalsocietypublishing.org/content/366/1562/241.full
Protocols of blast-induced mild TBI need to be modified from civilian TBI. 

Spelman, J. F., Hunt, S. C., Seal, K. H., & Burgo-Black, A. L. (2012). Post deployment for returning combat veterans. Journal of General Internal Medicine, 27(9), 1200-1209.
Provides a comprehensive review of these health concerns and offers practical management guidelines for primary care providers in light of relationships between physical, psychological and psychosocial concerns in this population.

Spira, J. L., Pyne, J. M., Wiederhold, B., Wiederhold, M., Graap, K., & Rizzo, A. (2006). Virtual reality and other experiential therapies for combat-related posttraumatic stress disorder. Primary Psychiatry, 13(3), 43-49. http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=429
The use of virtual reality as a psychiatric intervention to address PTSD.

Tan G, Dao TK, Farmer L, Sutherland RJ, & Gevirtz R. (2011). Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): A pilot study. Applied Psychophysiology and Biofeedback, 36(1), 27-35. http://link.springer.com/article/10.1007/s10484-010-9141-y
Describes the positive correlation between low heart rate variability as a physiological presentation, and the occurrence of PTSD.

Vaccarino, V., Goldberg, J., Rooks,C., Shah, A., Veledar, E., Faber, T., Votaw, J. , Forsberg, C., Bremner, J. (2013 June). Posttraumatic Stress Disorder and Incidence of Coronary Heart Disease: A Twin Study. Journal of the American College of Cardiology. Retrieved from http://www.sciencedirect.com/science/article/pii/S0735109713025060
This twin study on middle-aged Vietnam-era veterans found that post-traumatic stress disorder (PTSD) is associated with an increased risk of coronary heart disease beyond standard risk factors, adverse health behaviors, and family genetics. A history of PTSD, therefore, should alert clinicians to an increased risk of cardiovascular events and to identify possible therapeutic therapies to minimize stress.

Verdeli, H., Baily, C., Vousoura, E., Belser, A., Singla, D., & Manos, G. (2011). The case for treating depression in military spouses. Journal of Family Psychology, 25(4), 488-496.
This review presents a rationale for targeting depression among military spouses.

Yoder, M., Tuerk, P. W., Price, M., Grubaugh, A. L., Strachan, M., Myrick, H., & Acierno, R. (2012). Prolonged exposure therapy for combat-related posttraumatic stress disorder: Comparing outcomes for Veterans of different wars. Psychological Services, 9(1), 16-25. http://psycnet.apa.org/journals/ser/9/1/16/
The study compared exposure therapy treatment outcomes across veterans of three wars.

Journal of Traumatic Stress (http://www.istss.org/JournalofTraumaticStress/3841.htm)
Peer-reviewed journal that publishes trauma studies from the Iraq and Afghanistan wars. Issue articles include:

Combat-Related PTSD Nightmares and Imagery Rehearsal: Nightmare Characteristics and Relation to Treatment Outcome (pages 511–518)

Description of PTSD nightmares using Imaging Rehearsal as an intervention with results suggesting that an olfactory component of the original trauma may be more treatment resistant. PTSD outcomes of veterans who receive residential treatment. Exploration of symptoms/syndromes related to aggression and suicide in returning veterans Study explores young males who have already experienced PTSD and those who demonstrate resilience. PTSD disabilities compared over 5 years between Army and Marine veterans.

Government Guidelines:

United States Department of Veteran Affairs. (2009). Management of Concussion/mild Traumatic Brain Injury. Retrieved from http://www.healthquality.va.gov/mtbi/concussion_mtbi_full_1_0.pdf
Practice guidelines for the clinician treating TBI with graded treatment recommendations.

United States Department of Veteran Affairs. (2009). Management of Major Depressive Disorder. Retrieved from http://www.healthquality.va.gov/mdd/mdd_sum09_c.pdf
A detailed description of Major Depressive Disorder (MDD) and Suicidal Assessment in the Veteran

United States Department of Veteran Affairs. (2010). Management of Post-Traumatic Stress. Retrieved from http://www.healthquality.va.gov/ptsd/ptsd-sum_2010a.pdf
Practice guidelines for the clinician treating PTSD with graded treatment recommendations.

Websites

 

Presentations

Lee, E., Theus, S. (2012, November 13). What is the Difference Between Time-Domain Heart Rate Variability Measures in Younger “Heart-Healthy” Female Veterans with and without Military Sexual Trauma? [PowerPoint slides] 2012 Joining Forces to Restore Lives: Nursing Education and Research in Veterans Health, November 13, 2012

Webb, Mary, A. Rossiter, F. Sahebzamani, M. Groer, The Effect of Sexual Trauma and Assault on the Health of Women Veterans, PowerPoint presentation at the 2012 Joining Forces to Restore Lives: Nursing Education and Research in Veterans Health, November 13, 2012