Innovations in C-L Psychiatry Care for Veterans with PTSD and TBI

Providing mental health care to veterans requires empathy and specialized knowledge. Our workshop focuses on treatment issues facing consultation-liaison psychiatrists working with veterans. Combat deployments affect the physical and mental health of veterans. Common mental health conditions encountered in veterans include PTSD, depression, suicide, substance abuse, traumatic brain injury (TBI), chronic musculoskeletal pain, medically unexplained symptoms (e.g., fatigue, somatic, and cognitive complaints such as memory, attention, and concentration difficulties), and sleep disturbances. Moral injury, defined as damage done to an individual's core morality or moral worldview as a result of a stressful or traumatic life event, has been shown to significantly impact mental and physical health outcomes.

Individuals with PTSD have a higher risk of developing medical illnesses, such as cardiovascular disease. The conceptual model of allostasis and allostatic load may serve as a mechanism through which stress, and more specifically PTSD, might precipitate medical illness. Allostasis is the adaptive process of maintaining homeostasis by expending and directing energy towards challenges, while allostatic load represents the cumulative cost to an organism of enduring repetitive cycles of adaptation.

20 min: Dr. James Rustad will review innovative models of care for treating veterans with PTSD and comorbid medical illness, including the use of screening tools important for the workup of veterans with mental health symptoms, such as the PCL-5 PTSD screen and the Neurobehavioral Symptom Inventory. He will also share his experience providing integrated care for veterans in collaboration with VA primary care.

20 min: Dr. Patrick Ho will describe integrative medicine (complementary and alternative medicine) approaches to treatment of TBI and PTSD. They will provide an overview of and evidence for the mind-body medicine interventions which have been most extensively studied in veteran populations, including mindfulness-based stress reduction, yoga, mantram repetition, and biofeedback. We will also briefly introduce diet and nutrition interventions and herbs and supplements, which have not been as extensively studied in veteran populations.

20 min: Dr. Doug Noordsy will share his expertise as director of lifestyle psychiatry at Stanford to discuss use of physical exercise for managing allostatic load and brain recovery in PTSD.

20 min: Dr. Davin Quinn will explore the use of brain stimulation in the recovery of veterans with TBI by presenting data from his multi-center clinical trial (NAVIGATE-TBI) of fMRI guided brain stimulation combined with virtual reality therapy to treat veterans with mild TBI and chronic neurosensory symptoms.

10 min: Conclusions
Our session will be instrumental for consultation-liaison psychiatrists who treat veterans. After this session, attendees will have a better understanding of tools available to evaluate veterans with mental health symptoms and integrative medicine, physical exercise, and brain stimulation treatment options.