1. MENTAL HEALTH
IN WAR & PEACE
DIPLOMA MILITARY MEDICAL CARE
UCC
Dr. Ann Payne
Consultant Psychiatrist
8/10/15
2. Aim of workshop (1.5 hr)
• Common mental health problems
• What about each other?
• Self?
3. Resilience (US Army)
http://www.realwarriors.net/active
• Five Dimensions of Strength
• physical,
• emotional,
• social,
• spiritual,
• and family (& financial)
Question; Which do you think are affected by Mental Health
difficulties?
6. 26 yo Corporal Sean Wilson reports
recurrent chest pains no pain now. ED (3
times in 1 month)
‘I have a pain over my heart, can’t breathe,
think I’m going to die’
History – Vital to r/o current cardiac risk
Examine- findings?
What are your differential diagnoses?
7. Cardiac risks
• Smoker, BP, DM, family history, lipids,
prior history, medication
• Fully explore type of pain & assoc symptoms
• Drugs /alcohol
• Injury/ trauma
• Any doubt – urgent medical review
• Examine
10. DEAD HEAD* SWAMP – depression history
taking made easy!
• D – Depressed mood H*
• E – Energy levels
• A – ‘Ahh nooh’..Anhedonia (no enjoyment)
• D – Death – thoughts about death and self harm – i.e. Risk!
• S – Sleep pattern
• W – Worthlessness, guilt
• A – Appetite
• M –Mental focus/ concentration
• P – Physical (psychomotor) agitation and retardation
• - See more at: http://almostadoctor.co.uk/content/systems/neurology-
psychiatry/psychiatry/depression#sthash.u7ccLPxW.dpuf
20. Interview (2) Capt Chato 38y o
• Believes his wife can hear his thoughts.
• Objects are being moved in house
• Building up over 2 weeks
• Barricading up windows
• Stopped going to work
• Now History & MSE
• Volonteers, positive feedback and diagnosis
21. Interview (3) Sgt. Dave Dunne 28y o, just back
from deployment mission in Mid East (months)
• Insomnia, irritability, startled by noise.
• Now History & MSE
• What are the possible diagnosis here?
22. Interview (3) Acute Stress, Adjustment disorder
or PTSD? (ICD 10)
• Catastrophic event / pervasive threat+
• Vivid dreams, memories, ‘flashbacks’
• Active avoidance similar threat
AND
• insomnia,
• irritability, anger
• startle response
• hypervigilence
• Concentration decreased
• (symptoms occur within 6 months)
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