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.
Lamberg L. Military Psychiatrists Strive to Quell Soldiers’ Nightmares of War. JAMA. 2004;292(13):1539–1540. doi:10.1001/jama.292.13.1539
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