Description 

Since the year 2000, over 458,000 service members have sustained what is now considered the signature wound of the current conflicts, with the majority of those sustaining traumatic brain injury (TBI) that is considered mild (mTBI). While most military members have full recovery, a non-trivial minority of military members report continued psychiatric and neurological complaints. The persistence of post-concussive symptoms greater than 90 days in those with a history of TBI are non-specific and may include headaches, nausea, dizziness and vertigo, fatigue, irritability, and concentration problems. These sequelae may or may not be directly attributable to the concussive event or may be associated with co-occurring (or pre-existing) conditions such as PTSD, depression, anxiety, insomnia, pain, or alcohol and substance use disorders. Combat-related TBI may be more frequently associated with PTSD and more prominent symptoms even in the face of less severe head injury compared with civilian TBI. Following the opening of the National Intrepid Center of Excellence (NICoE) in Bethesda in 2010, Intrepid Spirit Centers have opened across the United States to serve as satellites to extend care to service members with TBI. Using an interdisciplinary model of care, these centers allow concurrent care from disciplines including Primary Care, Neurology, Psychiatry, Psychology, Physical Therapy, Vestibular Training, Cognitive Rehabilitation, Speech and Language Therapy, and others. The majority of those engaging in this treatment report a significant response. NICoE supports research on TBI evaluation and treatment, as well as long-term outcome studies of military members with TBI. The Home Base Program, a national nonprofit based in Massachusetts, is dedicated to healing the invisible wounds of war in Veterans, Service Members, and their Families. Since its inception in 2009, the program has delivered direct clinical care, wellness, and education at no cost to more than 25,000 Veterans and their Family Members. The program has created comprehensive evaluation and treatment care models for PTSD, TBI, and their co-morbidities that are delivered by a multidisciplinary team comprising psychiatry, psychology, physiatry, social work, speech language therapy, physical therapy, and nutritionists. The Home Base Program is advancing the field by discovering novel treatments for PTSD and TBI, improving the effectiveness of current treatments, and assessing factors influencing treatment access and outcome. This panel will look at lessons learned from Operation Enduring Freedom/Operation Iraqi Freedom combat military service members and Veterans. It will focus on aspects of TBI relevant to the practicing psychiatrist, viz., mechanisms of injury, diagnostic approach, co-morbidities, and evidence-based treatments. We will provide an overview of current areas of TBI research including biomarkers, neuroimaging, and the correlation between TBI and dementia.

Format 

Recorded webinar.

This content was recorded during the APA 2023 Annual Meeting.

Learning Objectives 

1. Learn about military combat Traumatic Brain Injury (TBI) and recognize post-concussive sequelae in both active duty and Veteran populations.
2. Recognize overlapping constellations of symptoms including depression, anxiety, insomnia, posttraumatic stress disorder (PTSD), and chronic pain.
3. Recognize lessons learned from current models of rehabilitation among neurology, psychiatry, and physiatry to comprehensively address the needs of military service members and Veterans with TBI.
4. Learn about the long-term impact of military TBI, advances in military and Veteran TBI research including MRI techniques, VR-based interventions, posttraumatic headaches, and co-morbid PTSD.
5. Understand the clinical and research gaps, priorities, challenges, and opportunities.

Target Audience 

Medical Students, Residents/Fellows, Psychiatrists, non-psychiatrist Physicians

Estimate Time to Complete 

Estimated Duration: 1.5 hours
Program Start Date: May 1, 2025
Program End Date: May 1, 2028

How to Earn Credit 

Participants who wish to earn AMA PRA Category 1 Credit™ may do so after completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit  

In support of improving patient care, the American Psychiatric Association is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

The APA designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Faculty and Planner Disclosures 

The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity. 

Instructors 

• Sofia Matta, MD
• Christina La Croix, MD, DO
• Kaloyan Tanev, MD, MPH

Planners  

• Vishal Madaan, MD, Chief of Education and Deputy Medical Director at the American Psychiatric Association.

Accessibility for Participants with Disabilities 

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. Please contact the American Psychiatric Association at 202-559-3900, if you require assistance seven (7) business days prior to the start of a live webinar. 

Technical Requirements 

This internet-based CME activity is best experienced using any of the following: 

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari 
• Internet Explorer 11+ 

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player. 

Optimal System Configuration: 

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version) 
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version) 
• Internet Connection: 1 Mbps or higher 

Minimum Requirements: 

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content 
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content 

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance