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Yale, VA supporting troops on the home front

Medicine@Yale, 2006 - Jan Feb


Experts on PTSD help vets cope with combat trauma from Iraq, Afghan wars

More than 1.2 million Americans have gone to war in Iraq and Afghanistan since September 2001, over a quarter of whom have served more than one tour of duty. This state of affairs has created a heightened sense of urgency among Yale researchers and clinicians who study and treat post-traumatic stress disorder (PTSD) in collaboration with the Veterans Administration (VA).

Yale investigators at the Clinical Neuroscience Division of the VA National Center for PTSD (CND-NCPTSD), located at the VA Connecticut Healthcare System campus in West Haven, Conn., have established a new partnership with psychiatrists at Fort Drum in upstate New York to study how troops react to combat experiences.

Meanwhile, clinicians at the VA’s West Haven campus have expanded their staff to care for an expected influx of veterans needing treatment for anxiety and PTSD.

John H. Krystal, M.D., Robert L. McNeil Jr. Professor of Clinical Pharmacology, deputy chair of the department of psychiatry, and director of the CND-NCPTSD, notes that about 196,000 veterans have a diagnosis of PTSD, which costs the VA $274 million per year—13 percent of its total medical costs. With our troops now engaged in two wars, he says, these numbers will only increase.

“Recent survey data suggest that 10 to 20 percent of soldiers participating in combat in Iraq meet criteria for PTSD,” says Krystal.

Veterans traumatized by war—or people distressed by any other event in which they fear death or great harm to themselves or others—can be diagnosed with PTSD if they meet three criteria: unwillingly revisiting traumatic events in flashbacks or nightmares, hypervigilance and retreating from life and relationships.

Next summer, Krystal and Professor of Psychiatry and Public Health Robert A. Rosenheck, M.D., will begin a $6.9 million nationwide study funded by the VA that will test the effectiveness of the medication risperidone for veterans with chronic PTSD. The drug is a potential alternative to antidepressants, such as Prozac, that are usually prescribed.

The study is the latest in a long-term effort by Yale investigators, who have pioneered PTSD research and clinical care.

In the early 1970s, Yale psychiatrist Arthur S. Blank Jr., M.D., was one of the first clinicians in the nation to develop peer-support programs for veterans suffering from the stress-related symptoms now known as PTSD.

In 1989, when the NCPTSD was established at five campuses across the country, the Clinical Neuroscience Division was based at VA’s West Haven campus in order to forge collaborations with the strong basic and clinical neuroscience programs at Yale.

The CND-NCPTSD has gone on to become one of the most important centers advancing our understanding of the neurobiology and treatment of PTSD.

“Very early on, West Haven became a center where they really understood PTSD,” says Steven M. Southwick, M.D., professor of psychiatry, a researcher at the West Haven campus of VA Connecticut.

Southwick says that studying the neurobiology of stress responses—finding a physical manifestation of a psychological problem—has helped clinicians to understand PTSD better and to explore more effective treatments. “Before, it was all interpreted psychologically,” he says.

To prepare for the needs of returning troops, the VA Connecticut Healthcare System has recently received additional funding to expand clinical services to returning combat veterans, according to Dolores Vojvoda, M.D., assistant professor of psychiatry at the medical school and head of the PTSD and Anxiety Disorder Service in West Haven.

Vojvoda reports that, by December, therapists in her PTSD clinic had treated about 75 Iraq and Afghanistan veterans, and she expects the numbers to grow quickly.

“We are at a critical moment in the lives of the soldiers who have made sacrifices on behalf of every American citizen,” says Krystal. “We as a country have to decide whether we are going to return the favor by supporting our soldiers and respecting the sacrifices they have made by making sure they get the treatment they need and by making sure we can improve the treatments we are offering them.”