Newswise — The University of California, San Diego (UC San Diego) School of Medicine will lead a $60 million, five-year, 10-site Clinical Consortium funded by the Department of Defense Psychological Health/Traumatic Brain Injury Research Program (DoD PH/TBI) to conduct studies leading to the prevention and treatment of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), two prevalent but poorly understood battlefield-related disorders that affect millions of individuals, both military and civilian.
Murray B. Stein, M.D., M.P.H., Professor of Psychiatry and Family and Preventive Medicine at UC San Diego and Staff Psychiatrist at the Veterans Affairs San Diego Health System (VASDHS), will direct the multi-center Clinical Consortium. Ronald G. Thomas, Ph.D., Professor of Family and Preventive Medicine and Neurosciences and Director of the Division of Biostatistics at UC San Diego, is co-principal investigator of the Consortium.
This nationwide network of study sites will test new therapies to prevent illness and enhance recovery in individuals at risk for adverse psychological, emotional and cognitive outcomes resulting from a traumatic injury, and for individuals who have already developed chronic neuropsychiatric problems because of an injury. The program will also focus on the short- and long-term symptoms caused by mild head injuries, which Stein says are not well understood in the treatment of military or civilian populations. The multi-center project is part of a $300 million commitment by the DOD to "prevent, mitigate, and treat the effects of traumatic stress and traumatic brain injury on function, wellness, and overall quality of life for service members as well as their caregivers and families."
"PTSD/TBI research has its roots in medical disciplines that study brain function, brain injury, and changes in cognition and behavior, each using very different methods," said Director of Congressionally Directed Medical Research Programs, Captain E. Melissa Kaime, M.D. "The DOD PTSD/TBI Clinical Consortium will bring neurologists, neurosurgeons, psychiatrists and psychologists together pooling their best tools and information to considering the full spectrum of clinical care needed for recovery of our service men and women."
"A recent report from the Institute of Medicine (IOM) lamented the lack of efficacious treatments for PTSD, and the same could be said for TBI. The Clinical Consortium aims to contribute substantially to help fill these gaps," said Stein. "We will bring together specialists at academic research centers, VA hospitals, and active military sites nationwide to help us understand what happens to people who suffer traumatic injuries, including mild head injuries such as concussions. This will help us design treatments that can most appropriately address the needs of people who develop PTSD and TBI"¦ and, hopefully, even find ways to prevent them."
In addition to overseeing the Clinical Consortium, UC San Diego Medical Center is also one of the participating study sites, with Raul Coimbra, M.D., Ph.D., professor of surgery and director of the UC San Diego Division of Trauma, Burns and Critical Care leading the San Diego TBI/PTSD Clinical Research Center. The nine other participating centers are based at academic, Veterans Affairs, and military centers at Dartmouth College, Duke University, Madigan Army Medical Center, Uniformed Services University of the Health Sciences, Medical University of South Carolina/University of South Carolina, Spaulding Rehabilitation/Brigham Women's/Massachusetts General Hospital in Boston, University of Cincinnati, University of Maryland, and University of Washington.
"This is an exciting opportunity to do not only cutting edge clinical research but to make a difference in the lives of the many individuals and families in our own community who have been devastated by the consequences of injury in general and TBI and PTSD in particular," said Coimbra
"The men and women who have bravely served our country deserve the highest quality of care, including those veterans who suffer from posttraumatic stress disorder and traumatic brain injuries," said U.S. Senator Diane Feinstein (D-CA). "This $60 million in federal grant funding will help launch a clinical research center formed by the University of California, San Diego School of Medicine -- designed to improve our understanding and treatment of PTSD and TBI. This new clinical research center will serve as an important resource for the thousands of active-duty service men and women and the more than 250,000 veterans located in the San Diego area."
"I am pleased to learn that UCSD received this award from the Department of Defense and that these dollars will be used to help our service men and women," said U.S. Congresswoman Susan Davis (D-San Diego), a member of the House Armed Services Committee.
"This consortium exemplifies the university's culture of innovation and multi-disciplinary collaboration," said UC San Diego Chancellor Marye Anne Fox. "We are proud to lead this consortium, and have our researchers and clinicians work together to solve medical mysteries, and find new treatments and therapies that will improve lives. This consortium is yet another example of the local impact, national influence and global reach of UC San Diego."
"This important new project underscores UC San Diego's commitment to addressing critical health issues of local, national and global concern," said David Brenner, M.D., Vice Chancellor for Health Sciences at UC San Diego. "We applaud the Department of Defense for their unprecedented support of this critical and timely effort to understand more about the significant impact of traumatic brain injury on both military and civilian patients."
Background: PTSD and TBI
Nearly 7.7 million Americans suffer from PTSD in any given year, according to the National Institute of Mental Health. PTSD is a neuropsychiatric illness that was first formally diagnosed in soldiers and war veterans, though it is now recognized to afflict many civilians as well. PTSD is caused by horrific, life-threatening traumatic experiences that can occur during combat deployments. In civilian settings, it can result from serious motor vehicle collisions, domestic violence, rape and other acts of criminal violence, and natural disasters such as hurricanes. PTSD symptoms include re-experiencing the trauma through flashbacks, intrusive thoughts and nightmares, avoidance of reminders of the trauma, excessive anxiety and trouble concentrating. Many people with PTSD also develop depression (sometimes with suicidal feelings) and substance abuse problems. Recent data from Afghanistan and Iraq suggest that more than 1 in 10 military personnel involved in these conflicts develop PTSD.
An estimated 1.4 million Americans suffer TBI each year, leaving 235,000 hospitalized and 50,000 dead, according to the Centers for Disease Control and Prevention. While most cases are mild, and often lead to recovery, many patients suffer lasting damage to their short-term memory and problem-solving abilities. There is also recent evidence that even among "mild" cases, some individuals fail to recover fully, either cognitively or emotionally. Army scientists report that 1 in 20 infantry soldiers sustained injuries with loss of consciousness during a year-long deployment to Iraq, and 1 in 10 report altered mental status (consistent with at least mild TBI). Nearly half of those reporting loss of consciousness also developed PTSD, suggesting an important, but presently poorly understood relationship between PTSD and TBI.
"Both PTSD and TBI frequently occur in the same patient after an injury. The Clinical Consortium will be devoting special efforts to understand and develop treatments for the overlap between these two conditions," Stein said.
"The focus of the San Diego TBI/PTSD Clinical Research Site will be on the integration of all aspects of trauma, neurosurgical, neurological, psychological, and psychiatric care into an organized network to allow population-based research," said Coimbra. "The leadership provided by UC San Diego trauma, neurosurgery and psychiatry specialists in trauma care and injury-related research over the last 20 years makes this the ideal setting to conduct this type of research, especially with the Veterans Affairs San Diego Health System (VASDHS) and our regional military hospitals providing opportunities for partnership as we develop our study protocols."
Participants in the San Diego TBI/PTSD Clinical Research Center with Coimbra are Lawrence Marshall, M.D., Professor of Surgery and Chief of Neurosurgery; Ariel Lang, Ph.D., Associate Professor of Psychiatry; and James Lohr, M.D., Professor of Psychiatry, all at UC San Diego. Stein, Lang and Lohr also have appointments with the Veterans Affairs San Diego Health System (VASDHS).
Funded through the DoD Congressionally Directed Medical Research Program, the PTSD-TBI Clinical Consortium will also attempt to develop more personalized therapies by identifying predictors of favorable treatment response, in order to determine in advance which individuals will respond to which treatments: pharmacological, psychosocial, and complementary or alternative therapies. State-of-the-art technologies such as magnetic resonance neuroimaging techniques and genetic testing will be used to help researchers understand the underlying causes of impairment, and the mechanisms by which successful treatments work.
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