Transcript Lt. Col. Dennis McGurk, U.S. Army

Military Operational Medicine Research Program
US ARMY MEDICAL RESEARCH AND MATERIEL COMMAND
Science
to
Soldier
PTSD Treatment
Overview
CAPT Doug Forcino
Director, Military Operational Medicine Research Program
LTC Dennis McGurk
Deputy Director, Military Operational Medicine Research Program
24 June 2014
7/17/2015 2:48 AM
UNCLASSIFIED
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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
INJURY PREVENTION
AND REDUCTION
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)
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
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UNCLASSIFIED
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
7/17/2015 2:48 AM
UNCLASSIFIED
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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
Foundational
Science
• 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
Epidemiology
• 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 comorbidities
7/17/2015 2:48 AM
• 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 comorbid disorders
• Understand interplay of
biology and
environmental exposures
in resilience and the
disease process
37 (NIH)
12 (VA)
6 (DoD)
N = 55
Etiology
51 (NIH)
11 (VA)
8 (DoD)
N = 70
Prevention
and
Screening
Treatment
Treatment
•New and repurposed
psychotherapies,
• Prevention:
• New and repurposed
and
• Education, training medications,
psychotherapies,
and risk prevention/ combination
medications, and
resilience building
combination
treatments
that are
• Stigma & barriers
treatments that are
optimized
and
• Interventions
optimized
andbriefer
briefer
• Treatment approaches
•Treatment
• Screening:
address co-morbidities
• PDHRA/Quality of Lifeapproaches address
• Early screen/
• Methods for guiding
co-morbidities
assessment
personalized
• MST
treatments
•Methods
for guiding
personalized
• Long-term recovery
tracking
treatments
• Assessment:
• In-theater
• Objective/Self
report/automated •Long-term
technology
tracking
• Standardized/
Biomarkers
• Treatment
Optimization
• Diagnostic advances
21 (NIH)
50 (VA)
24 (DoD)
N= 95
UNCLASSIFIED
7 (NIH)
5 (VA)
33 (DoD)
N = 45
recovery
30 (NIH)
30 (NIH)
42 (VA)
42 (VA)
77 (DoD)
77 (DoD)
N = 149
N = 149
Services
Research
• 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
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
Optimal Treatment Solutions
2-Week Intensive Psychotherapy Program
Focused Mainly on Active Duty Service Members
Service
Member
Diagnosed
with
PTSD
• 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)
Genomic
Diagnosis
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Anticipated
80-90%
Recovery
Rate
• Diagnostic Biomarker
• Personalized Treatment
• Treatment Efficacy/Progress Evaluations
UNCLASSIFIED
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
7/17/2015 2:48 AM
UNCLASSIFIED
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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
7/17/2015 2:48 AM
UNCLASSIFIED
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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
Manipulative &
Body-based
Movement
Natural
Products
Whole Medical
Systems
Spiritual
Practices
Other
Neuro-feedback
(EEG & fMRI)
Acupuncture
Exercise and
Antioxidants
Omega-3
Supplement
Stepped Care
Acceptance &
Commitment
Therapy
Canine Assisted
Therapy
Mindfulness/MBSR
Acupressure
Yoga
Transcendental
Meditation, TMS+CPT
Trauma Releasing
Exercises
Heart Rate Variability
Training
EMDR
Cog Behavioral Social
Rhythm Therapy
Neuro-modulation
Therapy
Mind-Body Bridging
Stellate Ganglion Block
Writing
Therapy
Meditation
Sleep Focused
Mind/Body
Rehabilitation
Relaxation Response
Training
7/17/2015 2:48 AM
UNCLASSIFIED
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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
7/17/2015 2:48 AM
UNCLASSIFIED
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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
[email protected]
LTC Dennis McGurk
Deputy Director
MOMRP
301-619-2088
[email protected]
Ron Hoover, PhD
PTSD Portfolio Manager
MOMRP/GDIT
301.619.6602
[email protected]
https://momrp.amedd.army.mil
7/17/2015 2:48 AM
UNCLASSIFIED
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