Cognitive activation studies indicate increased amygdalar and decreased medial prefrontal cortical responding to threat, and impaired responding in rostral anterior cingulate cortex to emotional tasks. 28 – 31 In brief, symptom provocation studies have implicated anterior limbic-related areas in PTSD including regions in the medial prefrontal, anterior cingulate, orbitofrontal, insular, and medial temporal cortices as well as the amygdala. Recent reviews provide an excellent summary of what is presently known about the functional neuroanatomy of PTSD. Two recent survey studies of military personnel following deployment indicate that combat-related traumatic brain injury (TBI) is associated with increased incidence of PTSD. These have concluded that development of psychiatric symptoms following TBI is relatively common, with 13%–27% exhibiting PTSD. 25 Increased incidence of PTSD in military personnel experiencing TBI is consistent with research studies in other populations. 24 There is also evidence that veterans with combat-related PTSD have more severe symptoms than veterans with PTSD due to noncombat-related events. A retrospective study in combat veterans found that head injury was associated with increased frequency of PTSD, and combat-related head injury was associated with increased severity of PTSD. 23 The rate of PTSD was 22% in the group without and 45% in the group with mild TBI. 2 Similarly, an inpatient study of service members who had experienced both a burn and blast injury (n=76) found that 32% were positive for PTSD. In another survey study the rate of PTSD was ∼7% in those without evidence of brain injury (n=1,960), ∼34% with level 1 mild TBI (altered mental status, n=163), and ∼47% with level 2 mild TBI (loss of consciousness, amnesia, or head injury, n=112). 1 The rate was ∼44% in those who reported a loss of consciousness (n=124). 7 In a group who reported experiencing a concussion while deployed (as indicated by altered mental status, n=260), ∼27% screened positive for PTSD. 19 – 22 Studies in military personnel indicate that higher rates of PTSD are associated with having experienced potentially brain-injuring conditions ( Figure 1 ). 17, 18Īlthough at one time it was believed that the loss of consciousness and memory deficits that frequently result from TBI made it unlikely that PTSD would develop, recent studies have found that PTSD can develop even when the patient has no conscious memory of the traumatic event. 2 These results are consistent with the incidence of PTSD symptoms following significant orthopedic trauma in civilians. 16 Another post-deployment survey study reported an increased incidence of PTSD with number of injury mechanisms: ∼14% for one, ∼29% for two, and ∼51% for three or more. This rate is very similar to an earlier study assessing the increased risk for PTSD due to combat-related injury. 1 The rate was almost doubled (∼16%) in those reporting bodily injury during deployment. 7 A recent survey study of soldiers following return from deployment reported that ∼9% of military personnel who had not been injured while deployed screened positive for PTSD. 12 – 15Ī history of experiencing physical injury during deployment is associated with a higher prevalence of post traumatic stress disorder (PTSD) post-deployment. 9 Several studies from the Defense and Veterans Brain Injury Center (DVBIC) of soldiers returning from Afghanistan or Iraq document the occurrence of traumatic brain injury (TBI) in many soldiers. 10, 11 The great majority of injuries were due to explosions, and many involve more than one area of the body (polytrauma). Recent studies detailing the most common injuries have found that approximately one-half involved the head or neck. 8, 9 These protect soldiers from mortal internal injuries but not from extremity trauma or concussive brain injuries. This is partially due to more rapid and sophisticated medical response on the battlefield and to improved protective equipment such as Kevlar vests. 7 Military personnel are returning from combat with different levels and types of injury than in previous wars. T here is growing evidence that physical injury during deployment is associated with a higher prevalence of mental health issues post-deployment.
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