Medical News and Perspectives
October 6, 2004

Military Psychiatrists Strive to Quell Soldiers’ Nightmares of War

JAMA. 2004;292(13):1539-1540. doi:10.1001/jama.292.13.1539

In Iraq, “I couldn’t tell the difference between my nightmares and what I experienced every day,” a US soldier told his psychiatrist at the Walter Reed Army Medical Center (WRAMC), Washington, DC. “Now that I am home,” the soldier said, “the difference is clear.”

US soldiers serving in Iraq and Afghanistan who seek help for combat stress can receive brief treatment in the field, according to Theodore Nam, MD, chief of inpatient psychiatry at WRAMC. Treatment, provided with the expectation that soldiers soon will return to their units, includes a few days of regular meals and sleep, counseling, and possibly medication for mild to moderate mood and anxiety disorders. The “PIES” principle—proximity, immediacy, expectancy, simplicity—“aims to conserve the fighting force,” Nam said, “without overdiagnosing those who are physically and psychologically drained.” Soldiers whose symptoms persist or worsen, he noted, are evacuated for more definitive diagnosis and treatment.

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