I am finding low growth hormone levels in OEF/OIF veterans with tbi./ptsd that have been homeless. This population is very vulnerable because they feel lost around groups of people. Those with mild to moderate TBI are our most difficult challenge because there are no residential programs for this group that would combine both TBI and PTSD treatment programs to support integration. Out- patient treatment is not intense enough and difficult to keep the veteran engaged they become frustrated with the system so they end up leaving housing and become homeless again. Any thoughts on low hormone level and emotional instability support poor decision making? Does motivational interaction even having any therapeutic affect on this population?
Pituitary dysfunction after brain injury is a well-recognised phenomenon, although the true prevalence and impact is still under research.
A recent UK study looking at blast TBI in particular appears to support the idea that blast TBI related pituitary dysfunction is linked to poor cognitive function.
Ann Neurol. 2013 Oct;74(4):527-36. doi: 10.1002/ana.23958. Epub 2013 Sep 24.
Pituitary dysfunction after blast traumatic brain injury: The UK BIOSAP study.
Baxter D, Sharp DJ, Feeney C, Papadopoulou D, Ham TE, Jilka S, Hellyer PJ, Patel MC, Bennett AN, Mistlin A, McGilloway E, Midwinter M, Goldstone AP.
Yes, it impairs higher levels of decision making. thank you for your input
Pituitary gland injury is possibly a chronic disorder caused concomitantly with other endocrine dysfunctions arising from exposure to extreme stress, especially over a long period. A fascinating study of a soldier from WW1 (Private Eagerfield) showed the victim presenting with War Hyperthyroidism, Hyperadrenalism, (General Adaptational Syndrome). Private Eagerfield exhibited a bizarre facial expression (immobility of the upper eyelid and downward rotation of the eye) indicating von Graefe's syndrome
Thank you so much for your response. Facial expression is a very interesting finding in this population. It would be interesting to study facial expressions of returning OIF/OEF veterans during interviews. I sometimes have to stop during the interview and ask the veteran if something is bothering them. They often have disturbed or pre anger type look. This population is very complex and takes a lot of energy to treat and care for their immediate and long term needs and planning.
Thank you for your insightful information.
They also may suffer from PTSD/TBI the s/s can overlap. They will present with numbness. The OEF/OIF/OND Veteran can still be in combat mod and with PTSD/TBI they do not trust anyone. The fact taht they are with you shows me that they trust you but just think if you were in combat if you show emotion it could mean your life or someone you cared about. When they are in combat they cannot stop and feel.
That is very good information that was recently confirmed with two young OEF/OIF vet I have been following, who will not see mental health anymore. they are very overwhelmed by going to the hospital and need quiet space. They have broken spirits and their once tender hearts have been injured by the violence of war. I do have to tell them upfront that I may have to make decisions that they are not happy with but are the safest way to care for them. thank you for sharing your knowledge and experience
Do these individuals also have a history of substance use/abuse? Opioids are known to affect endocrine function.
This is very interesting.
http://www.psychiatrictimes.com/suicide/delayed-suicides-forgotten-battalion/page/0/1?GUID=E7ED468C-BA8B-4A19-8A47-AC23F4C5219F&rememberme=1&ts=14112015
In my personal experiences with blast-related and other TBI injuries, PTSD/MDD, and acquired neuroendocrine dysfunction, many of the comments above do not address diagnostic evaluations necessary to treat underlying somatic and psychological health issues. In many instances, homeless veterans are not screened for TBI or neuroendocrine dysfunction prior to treatment regimens based on touted "best practices" or "gold standards." In other words, treatment is rarely patient-centered, rather institutionally- or academically-centered.
In my own case, I advocated for increasingly advanced diagnostic imagery and laboratory testing. Guess what? I was right, blast exposures had in fact caused neuronal damage to frontal, occipital, and temporal lobes, and hypoxic and or mechanical injury to my pituitary gland. Some of the underlying hormonal dysfunctions: low testosterone, low growth hormone, elevated TSH, increased ACTH, etc. Point being, without treating the underlying neuroendocrine dysfunction treatment for PTSD/MDD was difficult at best, ineffective at worst. The relationship between neuroendocrine dysfunction and mental health is resiliency. It's extremely difficult to muster the energy necessary to participate in cognitive processing therapy, prolonged exposure therapy, etc. Hell, it's sometimes all you can do to get up and get dressed.
I'm assuming many homeless veterans, at least from contemporary wars, are suffering from undiagnosed underlying injuries. Throwing pills at the problem, or quasi-diagnostic guesswork, will not benefit these populations. My position simply stated is we need standard diagnostic evaluations not only before and during military service, but also when exiting service, post-service, and during intervention services. Look how many undiagnosed TBI's and mental health issues remain untreated until they reach the point of crisis.
The social and health delivery services systems are reactive, but that doesn't mean we should accept these cost-constrained models as the only viable options. Just as you mentioned above in your observations during interviews with veterans: "I sometimes have to stop during the interview and ask the veteran if something is bothering them. They often have disturbed or pre-anger type look." Your instincts are telling you something is amiss; they are good, so follow them!