Transcript Lt. Col. Dennis McGurk, U.S. Army
PTSD Treatment Overview
Science to Soldier
CAPT Doug Forcino
Director, Military Operational Medicine Research Program
LTC Dennis McGurk
Deputy Director, Military Operational Medicine Research Program 24 June 2014
Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science to Soldier MISSION: Develop effective medical countermeasures against combat and operational stressors to maximize Warrior health, performance and fitness PSYCHOLOGICAL HEALTH AND RESILIENCE
THREATS
Posttraumatic Stress Disorder (PTSD) Suicide Behavior Combat and Operational Stress (Resilience as the Countermeasure) Family Transitions and Separations Alcohol/Other Drug Use Problems Violence within the Military Concussion (mTBI) INJURY PREVENTION AND REDUCTION
THREATS
Acoustic Trauma Blast Overpressure Blunt Head and Body Trauma Traumatic Brain Injury Face, Eye and Spinal Cord Injury Musculoskeletal Injury Toxic Gas Inhalation Laser Eye Injury PHYSIOLOGICAL HEALTH
THREATS
Malnutrition Dehydration Sustained Fatiguing Work (Physical/Mental) Sleep Deficit & Circadian Desynchrony Distributed/Continuous Operations Dietary Supplements ENVIRONMENTAL HEALTH AND PROTECTION
THREATS
Toxic Industrial Chemicals and Materials Dust and Air Pollution Altitude and Hypoxia Cold Stress AND Heat Stress Protective Equipment/Clothing
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Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science to Soldier
MRMC Managed Psychological Health Research
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Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science to Soldier
PTSD Joint Integrated Research Approach FY13
Treatment Foundational Science Epidemiology Etiology Prevention and Screening Treatment Services Research
•New and repurposed • Identification of normal and abnormal genomic, proteomic, and neurobiological mechanisms • Understand substrates of emotion, cognition, learning, memory, extinction, adaption/plasticity, and their role in disease onset and treatment response • Understand interplay of biology and environmental exposures in resilience and the disease process • Identify measures of underlying dysfunction, risk factors, and resilience • Development of general and PTSD- specific data bases for long term monitoring of health status, PTSD trajectories, and co morbidities • Understanding of PTSD disease processes , pathology and neurobiological mechanisms • Validated models (including pre-clinical) for PTSD, including risk and resilience factors, symptom onset, recovery and disorder trajectories • Understanding interplay between PTSD and other co morbid disorders • Prevention: • Education, training and risk prevention/ resilience building • Stigma & barriers • Interventions • New and repurposed medications, and combination treatments that are treatments that are optimized and briefer • Screening: • PDHRA/Quality of Life • Early screen/ assessment • MST •Treatment approaches address co-morbidities personalized • Assessment: • In-theater • Objective/Self report/automated personalized treatments •Long-term recovery technology • Standardized/ Biomarkers • Treatment Optimization • Diagnostic advances tracking • Access, quality and outcomes of care • Maintaining treatment fidelity in • Effective methods for disseminating best practice information and increasing adoption by providers • mental health service utilization factors • Modes of care delivery: telemedicine, internet, etc.
• Continuity of care models
37 (NIH) 12 (VA) 6 (DoD) N = 55
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51 (NIH) 11 (VA) 8 (DoD) N = 70 21 (NIH) 50 (VA) 24 (DoD) N= 95
UNCLASSIFIED
7 (NIH) 5 (VA) 33 (DoD) N = 45 30 (NIH) 42 (VA) 77 (DoD) N = 149 20 (NIH) 40 (VA) 26 (DoD) N= 86
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Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science to Soldier Service Member Diagnosed with PTSD Genomic Diagnosis
Optimal Treatment Solutions
2-Week Intensive Psychotherapy Program
Focused Mainly on Active Duty Service Members
• Prolonged Exposure Therapy /Cognitive Processing Therapy • Virtual Reality Augmentation of Psychotherapy • Pharmacologic Approaches for: Sleep/Nightmares Depression/Anxiety Cognitive Enhancers
Initial Research Validation Timeline (24-36 months)
Longer-Term Tele-Mental Health Treatments
Focused on National Guard, Reservists, Veterans and Some Active Duty Service Members with Capability for Accommodating Schedule, Geographical, Stigma, and Other Barriers to Care
• 8-12 Week Treatment Protocol • Same Drug Therapy Options As 2-Week Program • Office, Tele, or In-Home Individual Therapy • Facility-Based Group Therapy Approaches
Biomarker Research Timeline (5-7 years)
• Diagnostic Biomarker • Personalized Treatment • Treatment Efficacy/Progress Evaluations
Anticipated 80-90% Recovery Rate Neurological Indicators of Improvement
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Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science to Soldier
PTSD Treatment Research Foci
There are a limited number of evidence-based Psychotherapeutic Approaches for PTSD but numerous adaptations of these successful treatments are currently being researched, to include:
Prolonged Exposure Therapy Studies:
Compressed, web-based, in home, tele-health, combined with virtual reality, with adjunctive cognitive enhancer, compressed treatment, couples treatment, group therapy modality
Cognitive Behavioral Therapy Studies:
In home, tele-health, web-based
Cognitive Processing Therapy Studies:
Variable length protocols, group therapy modality, cognitive only, expressive writing only 5/6/2020 4:08 PM UNCLASSIFIED Slide 6 of 12
Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science to Soldier
PTSD Treatment Research Foci
Psycho-pharmacologic Research:
Psychotherapy Augmentation: Hydrocortisone, Ketamine, Propranolol, D-cyclosterine Identification/evaluation of novel compounds and repurposing of FDA approved drugs for treating PTSD: URB597, Ganaxolone, Prazosin, Trazodone, Tramadol, Nepicastet, Riluzole
Biomarker Research:
• Development of an objective, blood-based PTSD diagnostic • Identification of the biologic processes and neurological networks in the brain associated with PTSD for early diagnosis of the disorder, identification of pharmacologic treatment targets, and optimizing the selection of interventions at the individual patient level 5/6/2020 4:08 PM UNCLASSIFIED Slide 7 of 12
Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science to Soldier PTSD Treatment Research: Complementary and Alternative Medicine Approaches Mind Body
Neuro-feedback (EEG & fMRI)
Manipulative & Body-based
Acupuncture
Movement
Exercise and Antioxidants
Natural Products
Omega-3 Supplement
Whole Medical Systems
Stepped Care
Spiritual Practices
Acceptance & Commitment Therapy
Other
Canine Assisted Therapy Mindfulness/MBSR Acupressure Yoga Writing Therapy Transcendental Meditation, TMS+CPT Heart Rate Variability Training Cog Behavioral Social Rhythm Therapy Mind-Body Bridging Meditation Sleep Focused Mind/Body Rehabilitation Relaxation Response Training Trauma Releasing Exercises EMDR Neuro-modulation Therapy Stellate Ganglion Block 5/6/2020 4:08 PM UNCLASSIFIED Slide 8 of 12
Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science to Soldier
PTSD Treatment Research Foci
Consortium to Alleviate PTSD (CAP):
• DoD/VA collaboration initiated in 2013 • $45 Million Dollar research effort • Objective: To identify and evaluate novel PTSD treatments for Active Duty and Veteran populations 5/6/2020 4:08 PM UNCLASSIFIED Slide 9 of 12
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Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science to Soldier CAPT Doug Forcino Research Area Director
Military Operational Medicine Research Program Fort Detrick, MD 21702 301.619.7304
LTC Dennis McGurk
Deputy Director MOMRP 301-619-2088
Ron Hoover, PhD
PTSD Portfolio Manager MOMRP/GDIT 301.619.6602
https://momrp.amedd.army.mil
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