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Concussion or mild traumatic brain injury (mTBI) is associated with long-term impairments in military personnel. Diagnosis of the condition remains clinically challenging. Neurological examination and cognitive symptoms may not accurately map the nature and severity of underlying brain injury. Neuroimaging techniques, such as diffusion tensor imaging (DTI), show promise as an effective tool in delineating the microstructural neural changes and corresponding clinical consequences following mTBI. This paper discusses the diagnosis and management of concussion, in the military context, using two cases of veterans who suffered blast-related mTBI. Insights on an integrated approach to concussion in the military, incorporating thorough neurological and neuropsychological examination and application of advanced neuroimaging are presented. [ABSTRACT FROM AUTHOR]

Background: Figures from the Department of Veterans' Affairs indicate there may be over 30,000 Australian veterans that have or may yet develop some form of service-related mental illness. There is a growing body of evidence that there is a spiritual dimension to soldiers' wounds. Purpose: The purpose of this paper is to understand the causes, symptoms and healing pathways for spiritual wounds, Method and materials: Firstly, exploration of the nature of veteran spirituality, Secondly, how a veteran's spirit can be wounded and what form these wounds take will need to be understood, Finally, approaches to healing these spiritual wounds. Results: There is a strong and growing body of empirical evidence highlighting linkages between diminished spiritual functioning and mental health issues such as post-traumatic stress disorder (PTSD). Properly trained and accredited medical and psychological practitioners are required to deliver treatment in their space. Conclusion: There is limited evidence of any spiritual institution or facility of any nature making a significant contribution in the support of veterans whose Defence service has led to mental health issues with a spiritual or faith basis. Determining what role spiritual institutions or facilities should take will need to be a major area for further study. [ABSTRACT FROM AUTHOR]

Accurate recall of exposure to traumatic events is essential for diagnosis, treatment and compensation However, in the context of military combat, reports of trauma exposure may not be stable over time Increased reporting over repeated assessments has been associated with PTSD and its re-experiencing (B) symptoms Other competing explanations emphasise poorer health This study reports on 388 Australian Vietnam veterans who were interviewed 21 and 36 years after repatriation Combat exposure was assessed using a 21- item American scale PTSD and the symptom clusters were assessed with standardised psychiatric diagnostic interviews, and self-administered measures of health were included Although total combat scores were highly correlated across the two assessments (r = 865), stability of individual items differed widely Sixty-eight per cent of responses were stable, 17 5% were unstable increased reports, and 14 5% were unstable decreased reports In hierarchical regression analyses, combat was the strongest predictor of stable reports but a weaker predictor of increased and decreased reports Having a history of PTSD, particularly intrusion symptoms, significantly predicted stable reports A history of PTSD was a significant but weaker predictor of increased reports of combat exposure Suggestions of intrusive symptoms and poorer health as explanations of increased reports of exposure were not supported. [ABSTRACT FROM AUTHOR]

Background: Pharmacological management of complex psychological conditions and physical comorbidities in Vietnam veterans can be challenging, particularly when there are multiple prescribing clinicians. Purpose: To investigate the incidence of psychotropic polypharmacy in a cohort of Australian Vietnam veterans with post-traumatic stress disorder (PTSD). Methods: Subanalysis of data from a cross-sectional study of Vietnam veterans conducted at Gallipoli Medical Research Foundation from 2014-2015. Relationships between psychotropic polypharmacy and health outcomes were assessed, and anticholinergic burden scores calculated. Results: Of 160 participants with PTSD, 107 (66.9%) were treated with psychotropic medications, with 53 (33.1%) prescribed two or more. The most common combination was antidepressants with anxiolytics (21.5% of those treated). Polypharmacy was significantly associated with PTSD symptom severity (p<0.01), comorbid depression (p<0.05) and current suicidality (p<0.01). Anticholinergic burden scores ranged from 0--7, with 37.5% of participants classed as medium risk (score = 1--2) and 16-9% as high risk (≥3). Conclusion: Psychotropic polypharmacy prevalence in Australian Vietnam veterans with PTSD is high. This condition is commonly refractory to pharmacotherapeutic intervention, often leading to trials of combination therapy without supportive scientific evidence. Further research would be beneficial in evaluating potential efficacy versus harm of combination therapies to assist in rationalising prescription of multiple medications. Conflict of Interest: No conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Background: International studies suggest that high-dose opioid use is more common in veterans with posttraumatic stress disorder (PTSD) than those without in the treatment of musculoskeletal pain. Purpose: This article aims to examine the use of analgesics by Australian veterans with musculoskeletal pain by conducting a drug utilisation evaluation and to examine use by PTSD status. Methods: A cross-sectional study of Vietnam veterans with musculoskeletal pain was conducted using Australian Government Department of Veterans' Affairs (DVA) data. The study reviewed the proportion of dispensed prescription analgesics between 1 July 2015 and 30 June 2016. The volume of opioids dispensed per veteran was calculated as oral morphine equivalents (OME). Results were stratified by PTSD status. Results: 10 318 Vietnam veterans with musculoskeletal pain were included and 59% were dispensed analgesics. The most frequently dispensed analgesics were paracetamol (dispensed to 31% of veterans with PTSD and 28% without PTSD; p<0.01) and paracetamol with 30 mg codeine (19% of veterans with PTSD and 16% without; p<0.0001). Opioid analgesics were more likely to be dispensed to veterans with PTSD than without (35% v 32%, p=0.002); however, there was no significant difference in the volume dispensed (median of 1.2 [interquartile range (IQR) 0.4-5.8] OMEs per veteran per day for those with PTSD, compared to median 1.3 OMEs [IQR 0.4-6.3] per veteran per day for those without, p=0.3). Conclusion: Many veterans with service-related musculoskeletal pain did not receive prescription analgesics. Veterans with PTSD were more likely to be dispensed analgesics than those without, but PTSD did not appear to influence the volume of opioid dispensed. [ABSTRACT FROM AUTHOR]

An abstract of the article "The ADF Theatre Project: A performing arts rehabilitation project" by Alison Creagh is presented.

Background: Recent conflicts in the Middle East have seen rapid developments in the use of unmanned aerial vehicles (UAV). The Australian Government plans to acquire a number of UAVs to perform a range of operations. Purpose: To determine whether UAV operators are exposed to greater or special risks to their mental health than other combatants. Method: A non-systematic, narrative literature search was undertaken into the mental health of UAV operators. Results: The adverse effect of occupational stressors, such as long working hours, on well-being and mental health outcomes emerged strongly. Prevalence rates of clinically significant symptoms of PTSD (Post Traumatic Stress Disorder) for UAV operators were found to be low, ranging between 2 - 5%. Conclusion: These outcomes were consistent with occupational stressors found in the military context and previous findings on other military personnel with low combat exposure. This review is a first step towards establishing an evidence base to inform the management of mental health problems in UAV operators. [ABSTRACT FROM AUTHOR]

The author reflects on the Four Corners program on post-traumatic stress disorder in the Australian Defence Force (ADF). He mentions the development of a one-day workshop by the Australian Military Medicine Association (AMMA) featuring topics related to the military health services and personnel. The author provides information on the joint conference of AMMA and Controversies in Civilian and Military Trauma.

The article discusses the diagnosis of post-traumatic stress disorder (PTSD) among the officers of the Australian Defense Force (ADF). It states that PTSD may appear in different ways such as depressed mood and poor performance in the workplace. Its pre-morbid aspects include mood disorders, alcoholism, and disciplinary problems and can also be triggered by the memories. It also mentions that the prevalence of PTSD on the ADF is overestimated.

The article focuses on the opinion piece published in the "Journal of Military and Veterans' Health" (JMVH's) April 2010 edition. It states that the opinion aims to stimulate the debate on post traumatic stress disorder (PTSD), addressing the trouble in both the general and health community on the accurate diagnosis of PTSD of the returning veterans. It contends that the piece may cause further distress to genuine PTSD sufferers who have placed their lives in danger in service to Australia.