War and combat exposure pose great risks to the vision system.More recently,vision related deficiencies and impairments have become common with the increased use of powerful explosive devices and the subsequent rise i...War and combat exposure pose great risks to the vision system.More recently,vision related deficiencies and impairments have become common with the increased use of powerful explosive devices and the subsequent rise in incidence of traumatic brain injury(TBI).Studies have looked at the effects of injury severity,aetiology of injury and the stage at which visual problems become apparent.There was little discrepancy found between the frequencies or types of visual dysfunctions across blast and non-blast related groups,however complete sight loss appeared to occur only in those who had a blast-related injury.Generally,the more severe the injury,the greater the likelihood of specific visual disturbances occurring,and a study found total sight loss to only occur in cases with greater severity.Diagnosis of mild TBI(mTBI)is challenging.Being able to identify a potential TBI via visual symptoms may offer a new avenue for diagnosis.展开更多
Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the on...Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury(m TBI) is problematic since SSRIs could exacerbate post-concussion syndrome(PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy.Methods: We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of m TBI.Discussion: We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full-scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.Trial registration: NCT04280965.展开更多
基金supported by in-kind donation in the form of authors’time from Blind Veterans UK,Blinded Veterans Association(U.S.),Madigan Army Medical Center,Veteran Affairs Health Care System,Iowa City Veteran Affairs Center for the Prevention and Treatment of Visual Loss and the University of Iowa。
文摘War and combat exposure pose great risks to the vision system.More recently,vision related deficiencies and impairments have become common with the increased use of powerful explosive devices and the subsequent rise in incidence of traumatic brain injury(TBI).Studies have looked at the effects of injury severity,aetiology of injury and the stage at which visual problems become apparent.There was little discrepancy found between the frequencies or types of visual dysfunctions across blast and non-blast related groups,however complete sight loss appeared to occur only in those who had a blast-related injury.Generally,the more severe the injury,the greater the likelihood of specific visual disturbances occurring,and a study found total sight loss to only occur in cases with greater severity.Diagnosis of mild TBI(mTBI)is challenging.Being able to identify a potential TBI via visual symptoms may offer a new avenue for diagnosis.
基金supported by the South Central Mental Illness Research,Education,and Clinical Center (SC MIRECC),which is a MIRECC for Veterans Integrated Service Network (VISN) 16&17。
文摘Background: Selective serotonergic reuptake inhibitors(SSRIs) are first-line pharmacologic treatments for patients with posttraumatic stress disorder(PTSD), but must be given over extended period of time before the onset of action. The use of SSRIs in PTSD patients with mild traumatic brain injury(m TBI) is problematic since SSRIs could exacerbate post-concussion syndrome(PCS) symptoms. VA/DOD guidelines identify trauma-focused psychotherapy as the best evidence-based treatment for PTSD, but overall effectiveness is limited by reduced levels of patient engagement and retention. A previous study from this research group suggested that quetiapine monotherapy, but not risperidone or valproate, could increase engagement in trauma-focused psychotherapy.Methods: We report the study protocol of a pilot study funded under the South-Central Mental Illness Research, Education, and Clinical Center pilot study program from the U.S. Department of Veterans Affairs. This randomized, open-label study was designed to evaluate the feasibility of completing a randomized trial of quetiapine vs. treatment as usual to promote patient engagement in PTSD patients with a history of m TBI.Discussion: We expect that the success of this ongoing study should provide us with the preliminary data necessary to design a full-scale randomized trial. Positive efficacy results in a full-scale trial should inform new VA guidelines for clinical practice by showing that quetiapine-related improvements in patient engagement and retention may be the most effective approach to assure that VA resources achieve the best possible outcome for veterans.Trial registration: NCT04280965.
