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• W2275648078 abstract "For nearly 30 years, the U.S. Department of Veterans Affairs (VA) has led the scientific study of the effects of war on combatants. Beginning with the development of the diagnosis of posttraumatic stress disorder (PTSD) in the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders-Third Edition) and World Health Organization (International Classification of Diseases) classification schemes, the VA has supported growth in the world's understanding of war, trauma, and PTSD. The growth in knowledge spans multiple levels of scientific analysis, from studies of behavioral genetics to pathophysiology, prevalence studies, treatment efficacy trials, and even effectiveness trials. In its most recent form, this progress is represented in the VA's national dissemination of evidence-based treatments for those war veterans who are grappling with PTSD and related psychological disorders. For those of us who have worked in the veterans' healthcare system for these past 30 years, the changes in scientific evidence, available clinical programming, and supportive public policy are great and deeply impressive. The present sequence of articles in the Journal of Rehabilitation Research and Development reflects the growth and maturation of the field. Yet more knowledge on the treatment of PTSD in combat soldiers and veterans is needed urgently as we enter the sixth year of conflict in the global war on terrorism. To date, our country has deployed more than 1.7 million Americans to Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]), with some of our military deployed multiple times. With increasing amounts of combat exposure come increasing levels of psychological distress, disorder, and impairment, findings that are consistent across wars, cohorts, countries, and cultures. Remarkably, this country is responding well to the growing needs for treatment and rehabilitation of returning war veterans. Largely as a result of the early warning signs from the Walter Reed Army Institute of Research (WRAIR), the Department of Defense and the VA began preparations for the psychological and physical war injuries that are now known as the signature wounds of OIF/OEF: PTSD and traumatic brain injury. Programs designed to treat war veterans with multiple injuries emerged concurrent with the epidemiological evidence collected at WRAIR. These polytrauma programs highlight the importance of interdisciplinary care of returning war veterans. The focus on physical, emotional, and cognitive injuries secondary to blast exposure emphasizes the inherent importance of interdisciplinary care in the rehabilitation process. While treatment models are still evolving, collaborative care that involves multiple healthcare disciplines interfacing with the individual patients, their families, and the environment in which they live and work may provide the optimal foundation for recovery. Some might argue that future progress in the treatment of PTSD will come from a more fundamental articulation of the genetic, physiological, and psychological factors that contribute to the development of PTSD. This argument may or may not be true. Will correction of a disorganized neurotransmitter system yield benefits in psychosocial functioning? Similarly, will studies identifying cognitive factors that differentiate those who develop PTSD from those who do not result in the next breakthrough treatment? Further, will uncovering the nature of the neurohormonal defects among those with PTSD lead to the development of advanced treatments? Silo-based studies of PTSD may have contributed to the current state of knowledge, but what is now needed is greater integration of studies across disciplines and specialties. Rarely do teams of individuals with requisite skills across multiple levels of analysis approach a single problem in the most sophisticated ways. Future progress in understanding PTSD, or any psychological disorder for that matter, will likely be the result of interdisciplinary studies of structure and function over time. …" @default.
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• W2275648078 title "Posttraumatic stress disorder: future directions in science and practice." @default.
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