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September 11 – 13, 2014 | Westin Tampa Harbour Island

CHAIR SUMMIT7TH ANNUAL

Master Class for Neuroscience Professional Development

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Charles R. Marmar, MD New York University Langone Medical Center New York, NY Jerrold F. Rosenbaum, MD Massachusetts General Hospital Boston, MA Mark H. Pollack, MD Rush University Medical School Chicago, IL

Case Challenge: Back Home and Trying to Cope with Life

Charles R Marmar, MD

● Dr. Marmar has no disclosures to report

Disclosures

Jerrold F. Rosenbaum, MD

● Other Financial or Material Support: Medavante, equity interest; PsyBrain, equity interest, board of directors

Disclosures

Mark H. Pollack, MD

● Research/Grants: NIH Equity; Doyen Medical Inc.; Medavante, Inc.; Mensante Corporation; Mindsite; Targia Pharmaceuticals

● Consultant: Concert Pharmaceuticals, Inc.; Edgemont Pharmaceuticals, LLC; Ironwood Pharmaceuticals, Inc.; Palo Alto Health Sciences, Inc.; Project Plus

● Royalty/Patent: SIGH-A, SAFER Interviews

Disclosures

John Rivera

● 23 year old male ● Married with one child ● Presents at a psychiatric clinic with his wife ●  “She insisted that I come for this appointment,

we have been arguing a lot” ●  “I just feel down and tense all the time, not

sleeping, when I do, I have nightmares” ●  “I am not working, I want to, but nothing interests

me. My wife works, that makes me feel pretty worthless”

John Rivera

● Mr. Rivera describes a long history of substance and alcohol abuse from early teens “but now I just drink” ● “I was a street kid, bad neighborhood, bad

friends, I got beat up a lot” ● “I guess the things I took or drank helped

me forget a tough life”

John Rivera

● Joined the US Marine Corps at age 17 ● Honorably discharged ● Served in active combat in Iraq (2 tours) ● Sustained shoulder and knee wounds that

ended his 6 years of service ● Prior to returning home, Mr. Rivera spent 2

months in a rehabilitation facility/hotel “with nothing to do but drink with other vets”

John Rivera

● Returning home ! “I had no idea what I was going to do, how I

would fit in” ! “I felt like a stranger to my family, my daughter

didn’t even know who I was” ! “My family doesn’t understand me and I just

get really frustrated and angry sometimes”

John Rivera

● Experiencing other symptoms of: ! Flashbacks, frequent insomnia, night sweats,

occasional agitation, and hypervigilance ! Feelings of hopelessness, avoids socialization ! Binge drinking ! Still some physical distress from his injuries

John Rivera

●  Wants to work; looking into training programs but physical injuries prevent him from looking into things he wants to do most

●  Feels unfocused with difficulty concentrating ●  When asked about his injuries, Mr. R explains that “an

IED exploded under the vehicle I was driving and I was thrown about 30 feet and injured my shoulder and knee. I was lucky compared to others”

●  I don’t remember very much about the incident

IED = improvised explosive device

TBI and PTSD Share Key Symptoms

Williamson V, et al. Iraq and Afghanistan Veterans of America. Issue Report 2009. http://iava.org/files/IAVA_invisible_wounds_0.pdf. 2009

Overlapping Invisible Injuries

No condition: 69.3%

PTSD only: 3.6%

PTSD & Depression: 3.6%

Depression only: 4%

TBI & Depression: 0.7%

TBI only: 12.2%

PTSD & TBI: 1.1%

Williamson V, et al. Iraq and Afghanistan Veterans of America. Issue Report 2009. http://iava.org/files/IAVA_invisible_wounds_0.pdf. 2009

30% of Iraq and Afghanistan Veterans Screen Positive for Probable PTSD, TBI or Major Depression

Multiple Deployments

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5%

10%

15%

20%

25%

30%

First Deployment

Second Deployment

Third/Fourth Deployment

Multiple Deployments Increase Combat

Stress

0%

5%

10%

15%

20%

25%

Deployed fewer than 6 months

Deployed more than 6 months

Longer Tours Increase Soldiers' Mental Health

Problems

Williamson V, et al. Iraq and Afghanistan Veterans of America. Issue Report 2009. http://iava.org/files/IAVA_invisible_wounds_0.pdf. 2009.

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Clinical Connections

●  No one comes home from war unchanged. But with early screening and adequate access to counseling, the psychological and neurological effects of combat are treatable

●  The most common psychological injuries experienced by new veterans are post traumatic stress disorder and major depression

●  Traumatic brain injury can be caused by bullets or shrapnel hitting the head or neck, but also by the blast from mortar attacks or roadside bombs. Closed head wounds from blasts, which can damage the brain without leaving an external mark

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