Spotlight on VA Research
Spotlight on VA Research Advances Mood Disorders
VA Research is making important headway
in the treatment, screening, and diagnosis
of mood disorders such as depression, bipolar disorder, persistent despondency, and seasonal affective disorder.
Important areas of VA research on mood disorders
- Determining the benefits of cognitive behavioral therapy, a type of psychological therapy that examines patterns of thought and belief.
- Developing models of family interventions and social support to promote recovery from mood disorders.
- Understanding whether certain risk factors make a person more likely to suffer from depression or respond to a specific medication.
- Identifying and testing potential new drugs for depression.
Anxiety is a normal biological reaction to a
stressful event, but in some cases, anxiety continues for a long period and may worsen over time, with symptoms such as nightmares, racing pulse, and overreactions. In persistent cases, anxiety disorders such as posttraumatic stress disorder (PTSD), panic disorders, or phobias may develop.
VA research toward improving treatment for
patients with anxiety disorders includes:
Using brain imaging to study differences
between patients with and without anxiety
Studying anti-anxiety (as well as
anti-depressive) drugs to determine how
they work in the brain, and how hormones
and other chemicals may influence drugs'
- Further exploring the VA-discovered genetic and biochemical pathways that show a link between anxiety and alcohololism and may point the way to new drug targets for both conditions.
Posttraumatic Stress Disorder
In recent years, VA investigators have made
vital strides in understanding how the brain
works in PTSD, an anxiety disorder often associated with Veterans exposed to combat but that also occurs in the general population. VA researchers have established much of the evidence relating to the biological basis of PTSD—a disorder that during past wars was called "soldier's heart," "shell shock," or "combat fatigue."
VA researchers have looked at many different aspects of PTSD, including associated brain changes; factors that may increase a person's risk for developing the disorder; and strategies for prevention and treatment.
Some important ongoing studies are:
- Testing whether computer-simulated, "virtual reality" combat environments can enhance the effectiveness of prolonged exposure therapy.
- Exploring whether prazosin, a commonly prescribed high blood pressure medication,
can lessen sleep disturbances and nightmares in patients with PTSD.
- Determining the most effective ways to deliver psychotherapy—in individual or group settings or with telephone or Internet reminders, for example.
VA researchers often focus on particularly challenging or less-studied aspects of mental health. Two recent examples are:
- While most patients recover from PTSD, some develop chronic cases that do not respond well to medication or therapy.
The VA Cooperative Studies Program is conducting a large, multi-site clinical trial in this population to determine whether the drug risperidone helps to relieve chronic PTSD when added to standard medication.
- VA researchers' recent findings from the
largest study to date involving women Veterans with PTSD indicate that a type of therapy called prolonged exposure therapy is effective for this group. The VA is systematically adopting this treatment approach.
Journal of the American Medical Association. 2007;297(8):820-30.
Psychotic disorders such as schizophrenia affect a small proportion of the general and
Veteran population but can have devastating effects. Each year, VA provides care to about 100,000 Veterans with schizophrenia.
Important areas of VA research into schizophrenia
- Using state-of-the-art imaging techniques to identify brain structures important in schizophrenia and studying how the structures respond to various medications.
- Determining how Veterans with schizophrenia can function at their highest level through improvements in vocational rehabilitation and social cognition training.
Dementia and Memory Disorders
Dementia is a general term for disorders
involving a decline in memory, thinking,
judgment, and learning ability. As the Veteran population ages, Alzheimer's disease and other forms of dementia are an increasingly pressing concern.
VA research related to dementia include:
- Investigating certain proteins in the blood that appear to predict the onset of Alzheimer's disease and could be the basis of a screening test.
- Studying the dietary supplements DHA
(docosahexaenoic acid, a type of fat found in fish, fish oil, and certain nuts) and curcumin (a yellow pigment found in the spice turmeric) for their possible role in the prevention and treatment of Alzheimer's disease.
- Investigating the biological basis of memory to help identify abnormalities in patients with
dementia or other memory disorders.
Substance Use Disorders
Substance use and abuse, with its associated health consequences, is a major public health problem and commonly occurs with other mental and physical problems such as depression or chronic pain. Health care costs associated with substance abuse amount to more than $484 billion per year-more than twice the national cost of caring for cancer.
Important areas of VA research into substance
use and abuse include:
- Demonstrating that telephone counseling helps Veterans quit smoking.
- Studying interventions, such as antidepressant medication, to simultaneously treat depression and substance abuse.
- Showing that timely treatment by a health care professional and/or participation in Alcoholics Anonymous is associated with faster improvement and higher long-term remission in alcohol use disorders than "natural remission" (getting sober without formal treatment or help).
"Creative research of this nature is a major factor leading to continuous improvement of the medical services we provide to our Nation's Veterans." —Dr. Joel Kupersmith, Chief Research & Development Officer, Department of Veterans Affairs
Innovative team care model
A study including about 300 Veterans with
bipolar disorder at 11 VA Medical Centers
found that those receiving care through a new collaborative model utilizing clinical treatment teams and patient-management skills had better outcomes than those in usual care, without added costs.
Link between anxiety and alcoholism;
A VA research team in Chicago has discovered a genetic and biochemical pathway linking anxiety and alcoholism. Their studies focus on a molecule called CREB, which activates various genes and may point the way to new drug targets for both conditions.
Improving mental health outcomes
for Veterans who are homeless
Researchers with VA's Northeast Program
Evaluation Center recently documented the effectiveness of a program to help improve housing and mental health outcomes after hospitalization for Veterans who have been homeless.
Fostering dynamic collaborations
To advance Veterans' health care and further its national impact, VA's Research and Development program collaborates in its mental health research efforts with federal agencies such as the National Institutes of Health and the Department of Defense, private research organizations, and Veterans Service Organizations.
VA Research's "Translating Initiatives for
Depression into Effective Solutions" (TIDES) project has shown that most Veterans with depression and no other serious medical conditions can be effectively treated in primary care settings. The TIDES model of care is a team approach in which primary care providers and mental health specialists work together, with a "care manager" to help with coordination.