A historical overview of combat stress control units of the U.S. Army

Combat stress control units have been deployed to the Gulf War, Somalia, Haiti, Guantanamo Bay, Bosnia, and Kosovo. They have been very flexible and useful mental health tools for commanders in both combat and peacekeeping operations for the past decade. In their operational role they have been effective, but their garrison mission remains unclear. This article summarizes the uses, missions, and lessons learned from the various combat stress control missions around the world.     

Aggressive behavior in combat veterans with post-traumatic stress disorder

The incidence of aggression and violent behavior in combat veterans varies and can be observed with regard to the presence or absence of post-traumatic stress disorder (PTSD). Significantly greater occurrence of aggression was observed in combat veterans with PTSD compared with those without PTSD. There are various types of aggressive behavior that frequently are combined. Autoaggressive (suicidal) and heteroaggressive (interpersonal violence) behaviors predominate, with dominating verbal aggression and impulsive somatic reactions. Impulsive reactions are more frequently directed toward unknown persons, whereas verbal aggression is mostly aimed at known people. In the occurrence of aggressive behavior in combat veterans with PTSD, important roles are played by education level, low socioeconomic status, maltreatment in childhood, and previous types of violent behavior (before participation in war events).     

The clinical picture of acute combat stress reaction among Israeli soldiers in the 1982 Lebanon War

This study examined 100 randomly selected medical charts of Israeli psychiatric casualties of the 1982 Lebanon War in order to determine the clinical picture of combat stress reaction as recorded by clinicians on the battlefield. We found nine categories of symptoms. The most prevalent clinical picture (48% of cases) was polymorphic, followed by anxiety (13%) and labile states (11%). Only 41% of cases were mono-symptomatic and stable. Examination of the polymorphic and labile clinical pictures revealed that the most prominent symptomatology was anxiety and depression. In the labile states, the most widespread beginning symptom was anxiety and the most prevalent end state was found to be depression. These findings are discussed in light of reports from other wars.     

Reactivation of combat stress after a family member's enlistment

Reactivation of traumatic stress syndromes classically occurs in individuals who have recovered from acute stress reactions or from post-traumatic stress disorder. Triggers of traumatic reactivation may resemble the circumstances of the original trauma or may be less specific, connected to life events such as illness or retirement. In Israel, because of the continuous reminders of combat, reactivation of combat stress has been studied closely. A family member's enlistment is a potential trigger for reactivation. This article explores the general meaning of enlistment for family members, and the reactivation that may accompany that enlistment, through the examination of two cases.     

Psychologic stress of participants in combat actions and their subjective feelings

Using the method of nameless interrogation, there were investigated 119 service-men, served by contract on Northern Caucasus. 76,5% of investigated persons recognized different types of distress. The most often, features of psychic ill-being were signed by persons, obtained different wounds. Among typical symptoms of acute stress reactions the most often were the evidences of "invasion" (21%), tension (13,5%), lowed attune (14,3%). It's necessary attend, that involuntary revising and high irritation with an aptitude of evidence of anger often worried participants of warfare. Tension, backward, worried, in general, the persons, not yet participated in warfare. Persons, participated in warfare for the first time,signed the psychic tension rather rare. Lowed attune were signed very rare for the persons, served in the area of contraterrorist actions for the second time and having a big battle experience. During the evaluation of comorbidity of different symptoms of stress disease were signed, that the most often with another types of symptoms are conjoined: high irritation, sense of weariness, sense of fault and lowed attune. These symptoms can serve as markers of tendency to syndrome-making and, that's why, require special attention of psychologist and psychiatrist of military unit of medical service.     

The role of blood glucose availability and fatigue in the development of cognitive impairment during combat training

INTRODUCTION: The aim of this study was to determine whether inadequate nutrition would produce a reduction in the blood glucose concentration and impair cognitive function. METHODS: Energy intake, blood glucose, and cognitive function were measured in 18 male subjects during a 4-d military field exercise. Baseline measures of fasting blood glucose, body mass, cognitive function, and mood were taken before the start of combat training. Measurements of blood glucose, cognition, and well-being were then repeated during every subsequent 24 h period. Activity levels were monitored continuously using wrist-worn activity monitors. RESULTS: Subjects experienced an increase in symptoms relating to hypoglycemia after 24 h in the field (p < 0.01), vigor decreased (p < 0.001), and fatigue increased (p < 0.001). After 48 h, subjects reported feelings of depression (p < 0.05), anger (p < 0.01), and confusion (p < 0.001). Delayed memory recall was significantly impaired after 48 h (p < 0.05), and there was a decrease in vigilance (p < 0.01). Between 48 and 72 h, there was a decrease in immediate memory recall (p < 0.05). Delayed memory recall and vigilance remained impaired, but did not deteriorate further. When subjects were extracted from the field after 96 h, nude BM had decreased by 2% (p < 0.05). CONCLUSION: Although it was possible to reproduce the symptoms and cognitive impairment associated with hypoglycemia, there was no change in blood glucose concentration throughout the 4-d period. The impairment in cognitive function is likely to have been the result of significant sleep deprivation.     

氧化应激在低压缺氧性肺动脉高压形成中的作用

目的观察低氧对血清中活性氧(ROS)水平的影响,探讨氧化应激在低压缺氧性肺动脉高压形成中的作用。方法将24只Wistar大鼠随机分为平原对照组(C组),缺氧组(H组),N-乙酰半胱氨酸组(N组),缺氧+N-乙酰半胱氨酸组(H+N组)。建立低压缺氧模型21 d后,测定其右心室收缩压(RVSP)和平均肺动脉压(mPAP);HE染色观察各组大鼠的肺动脉壁厚度;比色法测定血清中ROS的含量。结果与C组相比,H组RVSP、mPAP明显升高(均P<0.05),HE染色示H组肺动脉壁增厚,且血清中ROS水平明显升高(P<0.05);给予ROS清除剂NAC后,RVSP及mPAP降低,肺血管重塑减弱。结论低氧时氧化应激参与了低压缺氧性肺动脉高压的形成。     

A knowledge assessment of combat stress reaction in Army Family Practice residents

Combat stress reaction occurs when a soldier's ability to function effectively is impaired by overwhelming stressors in a combat environment. During recent wars, Combat stress reaction has accounted for 30% to 40% of all casualties. Army Family Physicians can expect to be assigned to frontline medical units in time of war and, therefore, should be able to accurately diagnose and treat combat stress reaction. This paper reports an investigation of the knowledge Army Family Practice residents have of combat stress reaction. The results show that Army Family Practice residents are deficient in their knowledge of combat stress reaction.     

The role of radiotherapy in the control of midbrain tumours

This study examined 37 patients who were referred to the Queensland Radium Institute between 1980 and 1989 with tumours of the midbrain to determine if there were any factors which were associated with an improved prognosis. In those patients in whom histology was available, the grade of the tumour was of importance. High grade tumours had a shorter survival than low grade tumours. There was a dose response effect with increasing survival as the dose increased from less than 45Gy up to 50Gy. There were no deaths beyond two years, implying that two year survival is an indicator of long term survival.     

The role of stress cardiac magnetic resonance in women

Coronary artery disease (CAD) is the leading cause of death in women. Nevertheless, extensive evidence demonstrates under-diagnosis and under-treatment of women for suspected or known ischemic heart disease (IHD). Stress cardiac magnetic resonance (CMR) is becoming readily available and offers significant advantages over other stress imaging modalities. The high spatial and temporal resolution of CMR provides the unique ability to identify subendocardial ischemia, viability, and the presence of microvascular disease. Furthermore, CMR is free from ionizing radiation, and image quality is not compromised by attenuation artifacts or patient size. Over the past two decades, evidence-based data have demonstrated the high diagnostic and prognostic performance of stress CMR in the context of IHD, often superior to other stress imaging techniques. Importantly, ad hoc studies confirmed these results in women with known or suspected IHD. Stress CMR warrants consideration as the modality of choice for women requiring an imaging test for ischemia given its strong evidence base, superior test characteristics, comprehensive nature, and unique ability to characterize both epicardial and microvascular disease.     

救援官兵战斗应激反应心理干预工作模式的建构

 灾难救援已成为武警部队一项重要的非战争军事任务。突发的高风险、高强度的救援任务会使官兵产生应激反应,甚至发生应激障碍。心理干预是救援官兵应激障碍发生的保护性因素,在预防、缓解、治疗应激反应及障碍中起着至关重要的专业性作用。本研究在对相关文献进行回顾性研究的基础上,结合自身对救援官兵心理服务的实践工作经验,在“大干预”概念下,提出“两结合、三阶段的综合心理干预工作模式”,即预防性心理干预与反应性心理干预相结合、心理治疗性干预与教育发展性干预相结合的任务前、任务中、任务后三阶段干预模式,并对每个阶段的干预目标、内容及策略方法进行了探讨。     

Epidemiology of colds in military units during a German out-of-area mission in Kosovo (former Yugoslavia)

In the opinion of soldiers and unit surgeons, specific environmental and climatic conditions in the mission in the former Yugoslavia increase the incidence of severe infections of the respiratory tract (so-called "Kosovo Cough"). Proof is pending. Thus, colds were analyzed during Bundeswehr operations in the province of Kosovo. Over a period of 4 weeks in January 2003, all German soldiers who reported for medical treatment or requested medicine were registered. Patients provided information about their disease as well as information about smoking habits, etc. Two hundred three soldiers (9.2% of all) were treated for a cold. Although 72 soldiers (35.5%) complained about a subjectively perceived unusually long and severe clinical course, all infections proved uncomplicated from an objective viewpoint. The findings are inconsistent with an increased incidence of colds. There was no indication of the existence of the so-called "Kosovo Cough."     

Infection control of field dental units

The need for infection control procedures exists for dental care provided outside of dental treatment facilities. In a wartime scenario or during military training exercises, traditional dental clinic settings may not be available and the dental officer will be required to treat patients using equipment provided by the Army's Table of Organization and Equipment. This article reviews the dental literature and makes recommendations to aid the dental officer in developing an infection-control protocol for field dental equipment.     

Cyproheptadine for combat nightmares in post-traumatic stress disorder and dream anxiety disorder

Pharmacologic treatment of patients with post-traumatic stress disorder often involves antidepressant drugs. Combat nightmares often persist. The addition of cyproheptadine, in a median dose of 16-24 mg orally at night, controls the nightmares.     

Post-traumatic stress disorder in an elderly combat veteran: a case report

In this case report, an elderly combat veteran with a chronic course of post-traumatic stress disorder (PTSD) that was untreated for nearly 60 years was evaluated and treated with a combination of medication and graded exposure psychotherapy. To the best of our knowledge, there have been no reports on graded exposure in the elderly. The course of treatment lessened the key symptom domains of PTSD. Comorbid depression was also lessened. Although a single case report, it would appear that elderly patients do respond to psychotherapeutic techniques such as graded exposure therapy. Given the large percentage of the elderly population that has witnessed combat and due to the continuing military conflicts that the United States has been involved in over recent decades, treatments for PTSD in an aging population will be necessary.