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Clinical Atlas Prestige · Evidence-first

Psych VivasPublic-community — military and veteran psychiatry

Psych Vivas · Public-community — military and veteran psychiatry

Military and veteran psychiatry — structured clinical viva

Fellowship viva covering military/veteran determinants, landmark evidence, weapons-aware risk assessment, and stepped management.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar. A 29-year-old recently discharged combat veteran presents with nightmares, hypervigilance, heavy drinking, and passive death wishes. A licensed firearm is kept at home. Discuss service-context formulation, moral injury versus PTSD, epidemiology anchors (Hoge/Fear/Seal), assessment including weapons and MST principles, PE/CPT evidence (Monson, Steenkamp), SSRI dosing, prazosin equipoise (Raskind 2013 vs 2018), dual loyalty if still serving, and disposition — without inventing compensation statutes.

Interpretation

Reveal interpretation

Priorities. Risk first: passive versus active ideation, plan, firearm access and storage, protective factors, alcohol. Then multi-domain formulation: combat exposure, PTSD clusters, moral injury themes, transition stressors, stigma barriers.[1][8]

Epidemiology. Hoge 2004 combat burden and barriers; Fear 2010 UK deployment mental health; Seal/Fulton for veteran-care prevalence with heterogeneity caveats.[1]

Differential. PTSD versus depression with memories without full clusters; moral injury guilt (formulation) versus primary depression; TBI and substance-induced states; flashbacks versus primary psychosis.[2]

Treatment. Trauma-focused PE/CPT first-line (Monson CPT; Steenkamp synthesis with residual-symptom realism). Sertraline 25–50 mg orally daily start toward 50–200 mg with monitoring if medication indicated. Prazosin: 2013 positive versus 2018 multi-site null — shared decision-making. Dual loyalty if still serving. Veteran-competent disposition without inventing statutes.[3][4][5][6][7]

Key points

Weapons and suicide first

Explicit means assessment is non-negotiable in veteran trauma presentations.[8]

Moral injury is formulation

Guilt, shame, betrayal after PMIEs — not a DSM diagnosis (Litz).[2]

Name the papers

Hoge 2004; Monson CPT; Steenkamp 2015; Raskind 2013 vs 2018; Brady sertraline.[1][3][4][5][6][7]

References

  1. [1]Hoge CW, Castro CA, Messer SC, McGurk D, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care N Engl J Med, 2004.PMID 15229303
  2. [2]Litz BT, Stein N, Delaney E, Lebowitz L, et al. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy Clin Psychol Rev, 2009.PMID 19683376
  3. [3]Monson CM, Schnurr PP, Resick PA, Friedman MJ, et al. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder J Consult Clin Psychol, 2006.PMID 17032094
  4. [4]Steenkamp MM, Litz BT, Hoge CW, Marmar CR Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials JAMA, 2015.PMID 26241600
  5. [5]Brady K, Pearlstein T, Asnis GM, Baker D, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial JAMA, 2000.PMID 10770145
  6. [6]Raskind MA, Peskind ER, Chow B, Harris C, et al. Trial of Prazosin for Post-Traumatic Stress Disorder in Military Veterans N Engl J Med, 2018.PMID 29414272
  7. [7]Raskind MA, Peterson K, Williams T, Hoff DJ, et al. A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan Am J Psychiatry, 2013.PMID 23846759
  8. [8]Pompili M, Sher L, Serafini G, Forte A, et al. Posttraumatic stress disorder and suicide risk among veterans: a literature review J Nerv Ment Dis, 2013.PMID 23995037