Suchergebnisse

Vincent F Capaldi II1 Gary H Wynn21Department of Psychiatry, Walter Reed Army Medical Center, Washington, DC, USA; 2Department of Military Psychiatry, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA Abstract: Poststroke depression (PSD) is a common sequela of stroke associated with increased morbidity and mortality among stroke survivors. PSD has been associated with poorer rehabilitative outcomes, longer inpatient stays, inefficient use of medical resources, worsened cognitive decline, and increased suicidality. This article reviews the definition and proposed etiology of PSD as well as current and emerging evidence-based prevention, screening, and treatment modalities. The timely use of prevention and treatment techniques including pharmacologic and nonpharmacologic methods may improve treatment outcomes and enhance the quality of life in stroke patients.Keywords: poststroke depression, SSRI, TCA, stroke, CBT

Mental health is increasingly being recognized as both a leading cause of disability worldwide and an important area of opportunity for biological breakthroughs. A major limitation in the current diagnosis and management of severe psychiatric conditions is the exclusive reliance on subjective clinical information in the absence of available laboratory tests. A lack of objective biomarkers that reliably identify mental health disorders, and which could serve as targets for diagnosis, treatment response monitoring, and the development of novel therapeutics, remains a fundamental challenge of psychiatry today. Although clinical tests are well established in other areas of medicine, their development in psychiatry has been relatively slow. So far, no biomarkers or other risk markers are available to create profiles to enhance prediction and therapeutic selection in psychiatry. As novel 'omics-based technologies – such as genomics, proteomics, and metabolomics – and advanced imaging modalities enable researchers to probe the molecular to systemic underpinnings of various disorders, opportunities arise to explore the biological basis for mental health and disease. It is anticipated that specific alterations in blood-based molecular biomarkers, such as DNA, RNA, protein, and metabolite levels, will lead to standardized tests to facilitate diagnosis as they reflect the underlying etiology and mechanisms of disease. They may also pave the way for earlier and more effective treatment and monitoring of patients. Ultimately, the coordinated effort of relevant civilian and military stakeholders – including researchers, physicians and funders – together with standardization initiatives, will be vital to overcoming existing challenges to advance personalized mental health care using sensitive and specific biomarkers.

While the basics of pharmacokinetics and pharmacodynamics have not changed much in the past two decades, the world of pharmacogenomics has seen much advancement and refinement. These advances have improved the clinical utility and applicability for those caring for individuals with a range of conditions. Indeed, there are now simple clinical tests that can tell a provider potentially useful information about clinical decisions regarding prescribing practices. This article reviews the basics of pharmacokinetics and drug interactions before covering the concepts of pharmacogenomics and pharmacogenomics testing. Further, it discusses the topic of pharmacogenomics testing as it relates to the practice of military mental health providers. It explores several case scenarios to aid in clinical relevance and understanding. This article also addresses the issue of baseline pharmacogenomic testing; A recent Canadian military example and an in-depth table of commercially available pharmacogenomic tests are provided.

Introduction: Smartphones have made promising contributions to the field of military mental health by providing novel app-based approaches to enhance training and deployment, data collection, and creating social domains for participants to share information and perform research. Methods: This article reviews four applications designed specifically for military members and Veterans that increase mental health literacy, overcome barriers to care, and enhance well-being and performance. Results: The Road to Mental Readiness (R2MR) app is an on-the-go training tool based on cognitive behavioural theory (CBT). Unit Victor connects Veterans in a secure chat environment and provides information on available supports. UrMMIND is a pre-deployment tool designed to reinforce healthy behaviours and teach coping techniques. iFeel passively collects and analyses individual smartphone data to detect early signs of depression. Discussion: Mobile apps are playing an ever-increasing role within health care and, when designed and integrated correctly, can yield many benefits. While security and privacy need to be carefully weighed and addressed, they hold the potential to empower the end user in a range of novel ways that were not possible before.

Abstract. Background: Lowered eye blink rate may be a clinically useful indicator of acute, imminent, and severe suicide risk. Diminished eye blink rates are often seen among individuals engaged in heightened concentration on a specific task that requires careful planning and attention. Indeed, overcoming one's biological instinct for survival through suicide necessitates premeditation and concentration; thus, a diminished eye blink rate may signal imminent suicidality. Aims: This article aims to spur research and clinical inquiry into the role of eye blinks as an indicator of acute suicide risk. Method: Literature relevant to the potential connection between eye blink rate and suicidality was reviewed and synthesized. Results: Anecdotal, cognitive, neurological, and conceptual support for the relationship between decreased blink rate and suicide risk is outlined. Conclusion: Given that eye blinks are a highly observable behavior, the potential clinical utility of using eye blink rate as a marker of suicide risk is immense. Research is warranted to explore the association between eye blink rate and acute suicide risk.

Cytokines, including chemokines, are small secreted proteins, which specifically effect on the interactions and communications between cells. Pro-inflammatory cytokines are produced predominantly by activated macrophages and are involved in the upregulation of inflammatory reactions. Dysregulation of cytokines is associated with post-traumatic stress disorder (PTSD). Here, we use both before-and-after and case–control studies to search for potential chemokine biomarkers associated with PTSD onset, risk, and resilience as well as stress responses in US military service members deployed to Iraq and Afghanistan. Blood samples and scores of the PTSD Checklist (PCL) were obtained from soldiers pre- and post deployment (pre, post). Forty chemokines were measured using the Bio-Plex Pro Human Chemokine Panel Assays. The before-and-after analysis showed potential markers (CCL2, CCL15, CCL22, CCL25, CXCL2, and CXCL12) are associated with PTSD onset, and CCL3, CXCL11, and CXCL16 are related to stress response. The case–control study demonstrated that CCL13, CCL20, and CXCL6 were possible PTSD risk markers, and CX3CL1 might be a resilience marker. In addition, CCL11, CCL13, CCL20, and CCL25 were correlated with the PCL scores, indicating their association with PTSD symptom severity. Our data, for the first time, suggest that these dysregulated chemokines may serve as biomarkers for PTSD onset, risk, and resilience as well as stress responses, and may benefit developing approaches not only for PTSD diagnosis but also for PTSD treatment.

Introduction: Virtual reality (VR)-based interventions, wearable technology and text mining hold promising potential for advancing the way in which military and Veteran mental health conditions are diagnosed and treated. They have the ability to improve treatment protocol adherence, assist in the detection of mental health conditions, enhance resilience and increase a patient's motivation to continue therapy. Methods: This article explores five cutting-edge research projects designed to leverage VR-based interventions, wearable technology, and text mining to improve military and Veteran mental health. A computer-animated virtual agent provides online coaching for posttraumatic stress disorder (PTSD) patients in their own homes to enhance treatment compliance. A head-mounted display safely immerses PTSD patients in a virtual world to relive past experiences and associate them with new meanings. Gaming and simulation technology are tested as a way to improve resilience and performance in military members in deployment-related scenarios. Guidelines are developed for the creation of wearable assistive technology for military members and Veterans. Text mining is explored as a way to assist in the detection of PTSD. Results: VR-based therapy, gaming and simulation, wearable assistive and sensory technology, and text mining hold promise for diagnosing, monitoring, and treating military mental health conditions. Discussion: The five research projects presented have made promising contributions to the field of military and Veteran mental health, either by advancing diagnostic trajectories, contributing to therapy or enhancing the process by developing new approaches to delivering preventive or curative care.

Insomnia is a worldwide problem with substantial deleterious health effects. Twin studies have shown a heritable basis for various sleep-related traits, including insomnia, but robust genetic risk variants have just recently begun to be identified. We conducted genome-wide association studies (GWAS) of soldiers in the Army Study To Assess Risk and Resilience in Servicemembers (STARRS). GWAS were carried out separately for each ancestral group (EUR, AFR, LAT) using logistic regression for each of the STARRS component studies (including 3,237 cases and 14,414 controls), and then meta-analysis was conducted across studies and ancestral groups. Heritability (SNP-based) for lifetime insomnia disorder was significant (h2g = 0.115, p = 1.78 × 10-4 in EUR). A meta-analysis including three ancestral groups and three study cohorts revealed a genome-wide significant locus on Chr 7 (q11.22) (top SNP rs186736700, OR = 0.607, p = 4.88 × 10-9) and a genome-wide significant gene-based association (p = 7.61 × 10-7) in EUR for RFX3 on Chr 9. Polygenic risk for sleeplessness/insomnia severity in UK Biobank was significantly positively associated with likelihood of insomnia disorder in STARRS. Genetic contributions to insomnia disorder in STARRS were significantly positively correlated with major depressive disorder (rg = 0.44, se = 0.22, p = 0.047) and type 2 diabetes (rg = 0.43, se = 0.20, p = 0.037), and negatively with morningness chronotype (rg = -0.34, se = 0.17, p = 0.039) and subjective well being (rg = -0.59, se = 0.23, p = 0.009) in external datasets. Insomnia associated loci may contribute to the genetic risk underlying a range of health conditions including psychiatric disorders and metabolic disease.

OBJECTIVE: We examined early first deployment and subsequent suicide attempt among U.S. Army soldiers. METHOD: Using 2004-2009 administrative data and person-month records of first-term, Regular Army, enlisted soldiers with one deployment (89.2% male), we identified 1,704 soldiers with a documented suicide attempt during or after first deployment and an equal-probability control sample (n=25,861 person-months). RESULTS: Logistic regression analyses indicated soldiers deployed within the first 12 months of service were more likely than later deployers to attempt suicide (OR=1.7 [95% CI=1.5-1.8]). Adjusting for socio-demographic characteristics, service-related characteristics, and previous mental health diagnosis slightly attenuated this association (OR=1.6 [95% CI=1.5-1.8]). Results were not modified by gender, deployment status, military occupation, or mental health diagnosis. The population-attributable risk proportion for deploying within the first 12 months of service was 17.8%. Linear spline models indicated similar risk patterns over time for early and later deployers, peaking at month 9 during deployment and month 5 post-deployment; however, monthly suicide attempt rates were consistently higher for early deployers. CONCLUSIONS: Enlisted soldiers deployed within the first 12 months of service have elevated risk of suicide attempt during and after first deployment. Improved understanding of why early deployment increases risk can inform development of policies and intervention programs.