**7. Conclusion**

Throughout the years we have gained a far better understanding of posttraumatic stress disorder. We have refined our diagnostic criteria for the disorder and developed more complex theories for understanding its' etiology. With the high prevalence of soldiers who are affected by posttraumatic stress disorder, it is important that we continue to refine our

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**Psychiatric Management of** 

**Focus on Psychopharmacology**

*6Professor of Psychiatry and Family & Preventive Medicine,* 

Don J. Richardson1,2,3, Jitender Sareen4,5 and Murray B. Stein6

*2Department of Psychiatry, University of Western Ontario, London, Ontario, 3Centre for National Operational Stress Injury, Veterans Affairs Canada, 4Operational Stress Injury Clinic, Deer Lodge, Winnipeg, Manitoba, 5Professor of Psychiatry, Psychology and Community Health Sciences,* 

*1Parkwood Operational Stress Injury Clinic, St. Joseph's Health Care- London, Ontario,* 

Military-related posttraumatic stress disorder (PTSD) occurs in a significant minority of veterans and often presents with complex psychiatric co-morbidity (Kessler et al., 1995, Keane and Kaloupek, 1997, Keane and Wolfe, 1990, Forbes et al., 2003, Kulka et al., 1990, Sareen et al., 2004). Twelve month and lifetime prevalence rates of PTSD in the Canadian Regular Forces has been reported as 2.8% and 7.2% respectively (Statistics Canada, 2002). In Canadian veterans pensioned with a medical condition, the 1 month prevalence was 10.3% (Richardson et al., 2006). Other military samples have shown 6 month and lifetime prevalence rates of 11.6 and 20.0% respectively (O'Toole et al., 1996). The large variation in PTSD rates might be a function of the time elapsed between the end of a mission and the start of the mental health evaluation, the nature and frequency of potentially traumatic events within each mission and differences in measurement used i.e. self-report screening

Patients with PTSD often present first to their primary care clinician with mental health issues, (Del Piccolo et al., 1998) and as such demonstrate increased healthcare service use and costs (Kulka et al., 1990, Ronis et al., 1996, Marshall et al., 1998, Hankin et al., 1999, Kessler et al., 1999, Switzer et al., 1999, Elhai and Ford, 2005, Elhai et al., 2005, Gavrilovic et al., 2005, Richardson et al., 2006). Studies indicate that military-related PTSD is more prone to somatisation (McFarlane et al., 1994) and is associated with more physical health problems (Boscarino, 1997, Boscarino and Chang, 1999, Schnurr and Jankowski, 1999, Schnurr et al., 2000, Sledjeski et al., 2008, Jakupcak et al., 2008, Sareen et al., 2007, Elhai et al., 2007). Evidence also shows that PTSD is often associated with significant comorbidity including major depression, substance abuse, suicidality, (Kessler et al., 1995, Keane and

**1. Introduction** 

tools vs. diagnostic interview.

**Military-Related PTSD:** 

*University of Manitoba, Winnipeg, Manitoba,* 

*University of California San Diego,* 

*1,2,3,4,5Canada* 

*6USA* 

Williams, I. & Bernstein, K. (2011). Military Sexual Trauma Among U.S. Female Veterans. *Archives of Psychiatric Nursing,* Vol. 25, No. 2 (April 2011), pp. (138–147) **3** 
