Warren P. Klam

Insomnia is the most commonly reported symptom and predicts other symptoms of post-traumatic stress disorder in U.S. service members returning from military deployments

ABSTRACTThis study retrospectively reviewed records from current members of the U.S. military who had completed the PTSD Checklist (PCL) at 0 and 3-months after returning from deployments. Insomnia was the most commonly reported symptom of PTSD on the PCL and had the highest average severity scores. At initial screen, 41% of those who had been to Iraq or Afghanistan reported sleep problems. Those who had initially reported any insomnia had significantly higher overall scores for PTSD severity at follow-up than did service members without such a complaint. These results show that insomnia is a particularly frequent, severe, and persistent complaint in service members returning from deployment. Such complaints merit particular attention in relation to the possibility of PTSD.This study retrospectively reviewed records from current members of the U.S. military who had completed the PTSD Checklist (PCL) at 0 and 3-months after returning from deployments. Insomnia was the most commonly reported symptom of PTSD on the PCL and had the highest average severity scores. At initial screen, 41% of those who had been to Iraq or Afghanistan reported sleep problems. Those who had initially reported any insomnia had significantly higher overall scores for PTSD severity at follow-up than did service members without such a complaint. These results show that insomnia is a particularly frequent, severe, and persistent complaint in service members returning from deployment. Such complaints merit particular attention in relation to the possibility of PTSD.

Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports

Traditional factors that once explained men’s sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brains motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography’s unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.

Internet addiction disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program ☆ ☆☆

INTRODUCTION Internet addiction disorder (IAD) is characterized by the problematic use of online video games, computer use, and mobile handheld devices. While not officially a clinical diagnosis according to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), individuals with IAD manifest severe emotional, social, and mental dysfunction in multiple areas of daily activities due to their problematic use of technology and the internet. METHOD We report a 31year-old man who exhibited problematic use of Google Glass™. The patient has a history of a mood disorder most consistent with a substance induced hypomania overlaying a depressive disorder, anxiety disorder with characteristics of social phobia and obsessive compulsive disorder, and severe alcohol and tobacco use disorders. RESULTS During his residential treatment program at the Navys Substance Abuse and Recovery Program (SARP) for alcohol use disorder, it was noted that the patient exhibited significant frustration and irritability related to not being able to use his Google Glass™. The patient exhibited a notable, nearly involuntary movement of the right hand up to his temple area and tapping it with his forefinger. He reported that if he had been prevented from wearing the device while at work, he would become extremely irritable and argumentative. CONCLUSIONS Over the course of his 35-day residential treatment, the patient noted a reduction in irritability, reduction in motor movements to his temple to turn on the device, and improvements in his short-term memory and clarity of thought processes. He continued to intermittently experience dreams as if looking through the device. To our knowledge, this is the first reported case of IAD involving problematic use of Google Glass™.

Tendon Rupture Associated With Excessive Smartphone Gaming

IMPORTANCE Excessive use of smartphones has been associated with injuries. OBSERVATIONS A 29-year-old, right hand-dominant man presented with chronic left thumb pain and loss of active motion from playing a Match-3 puzzle video game on his smartphone all day for 6 to 8 weeks. On physical examination, the left extensor pollicis longus tendon was not palpable, and no tendon motion was noted with wrist tenodesis. The thumb metacarpophalangeal range of motion was 10° to 80°, and thumb interphalangeal range of motion was 30° to 70°. The clinical diagnosis was rupture of the left extensor pollicis longus tendon. The patient subsequently underwent an extensor indicis proprius (1 of 2 tendons that extend the index finger) to extensor pollicis longus tendon transfer. During surgery, rupture of the extensor pollicis longus tendon was seen between the metacarpophalangeal and wrist joints. CONCLUSIONS AND RELEVANCE The potential for video games to reduce pain perception raises clinical and social considerations about excessive use, abuse, and addiction. Future research should consider whether pain reduction is a reason some individuals play video games excessively, manifest addiction, or sustain injuries associated with video gaming.

Excessive Video Game Use, Sleep Deprivation, and Poor Work Performance Among U.S. Marines Treated in a Military Mental Health Clinic: A Case Series

Excessive use of video games may be associated with sleep deprivation, resulting in poor job performance and atypical mood disorders. Three active duty service members in the U.S. Marine Corps were offered mental health evaluation for sleep disturbance and symptoms of blunted affect, low mood, poor concentration, inability to focus, irritability, and drowsiness. All three patients reported insomnia as their primary complaint. When asked about online video games and sleep hygiene practices, all three patients reported playing video games from 30 hours to more than 60 hours per week in addition to maintaining a 40-hour or more workweek. Our patients endorsed sacrificing sleep to maintain their video gaming schedules without insight into the subsequent sleep deprivation. During the initial interviews, they exhibited blunted affects and depressed moods, but appeared to be activated with enthusiasm and joy when discussing their video gaming with the clinical provider. Our article illustrates the importance of asking about online video gaming in patients presenting with sleep disturbances, poor work performance, and depressive symptoms. Because excessive video gaming is becoming more prevalent worldwide, military mental health providers should ask about video gaming when patients report problems with sleep.

Risk of PTSD in service members who were fired upon by the enemy is higher in those who also returned fire

An unusual characteristic of the recent wars in Iraq and Afghanistan is that, because of attacks by snipers and improvised explosive devices (IED), many U.S. service members may come under attack without having exchanged fire. It was hypothesized that this would be associated with greater severity of post-traumatic stress disorder (PTSD) symptoms. The severity of self-reported symptoms of PTSD and depression were examined among service members who reported being shot at or attacked by an IED, those who had these experiences but who also shot at the enemy, and those who reported neither experience. Results showed that those with neither exposure reported the lowest symptom severity, but, contrary to expectations, service members who had been attacked but not shot at the enemy had less severe symptoms than those who had exchanged fire. This may support findings from earlier generations of veterans that shooting at or killing the enemy may be a particularly traumatic experience.

Correction: Park, B.Y., et al. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav. Sci. 2016, 6, 17

The conflict of interest section of the published paper[...].

PD69-12 SURVEY OF SEXUAL FUNCTION AND PORNOGRAPHY

INTRODUCTION AND OBJECTIVES: In evaluating a male with sexual dysfunction, psychosexual factors should be considered. One potential but not well examined psychosexual factor is the impact of pornography use on sexual function. Given the large proportion of young men in the military and the potential detrimental effects of sexual dysfunction on quality of life, we sought to determine if there exists a correlation between degree of pornography use and sexual dysfunction. METHODS: After local institutional review board approval, patients aged 20-40 years presenting to a urology clinic were offered an anonymous survey consisting of self-reported medical history, demographic questions, validated questionnaires (including the International Index of Erectile Function [IIEF-15]), and novel questions addressing sexual function, pornography use, craving behavior, and obsessive behavior. For an interim analysis of those surveyed between February and August 2016, descriptive data were compiled and evidence for correlation between domains of the IIEF-15 and various aspects of pornography use was examined using linear regression tests. RESULTS: Surveys were completed by 312 respondents. The sample was generally healthy: 12% indicated a comorbidity other than tobacco use, 19.2% indicated tobacco use. The mean age was 31 years (sd1⁄45.9). Common demographics included white race (64.4%), non-Hispanic ethnicity (74.6%), active duty (96.8%), enlisted (77.3%), and married (68.8%). The mean scores of the IIEF-15 domains were: 26.2 (sd1⁄46.0) for erectile function, 8.6 (sd1⁄42.1) for orgasmic function, 8.1 (sd1⁄42.0) for sexual desire,10.7 (sd1⁄43.4) for intercoursesatisfaction,and7.9 (sd1⁄42.3) foroverall satisfaction. When asked how they best satisfied sexual desires, 96.6% indicated intercourse (with or without pornography) versus 3.4% who indicatedmasturbation topornography.Weekly pornographyusevaried: 25.9% indicated less than weekly, 24.6% indicated 1-2 times, 21.3% indicated 3-5 times, 5.0% indicated 6-10 times, and 4.3% indicated greater than 11 times. The typical media for viewing pornography were internet on a computer (72.3%)or asmart phone (62.3%). Therewere statistically lower scores in all IIEF-15 domains amongst respondents reporting a preference for masturbating to pornography rather than intercourse (p <0.05). However, there were no significant correlations between frequency or duration of pornography use and IIEF-15 domain scores (p> 0.05). CONCLUSIONS: There appears to be a relationship between pornography use and sexual dysfunction in men who report a preference for masturbation to pornography rather than sexual intercourse.

Internet Gaming Disorder and Internet Addiction Disorder: Future Careers in Research, Education, and Treatment

Technology and the Internet facilitate robust advances in science, medicine, and business. We estimate that mental health careers involving technology will grow, and the need for mental health professionals who can recognize, assess, and treat disordered behaviors associated with technology use will also increase. There will be opportunities as treatment providers and as educators. Given the vast expansion and accessibility of technology, it is important that mental health professionals study, understand, and when appropriate, apply evidenced-based approaches to increase benefits and reduce risks to their patients. Chapters in this book provide numerous examples of benefits of technology in behavioral health careers and to the healthcare delivered to patients. It is our hope that mental health professionals incorporate technology and leverage technology in their careers. This chapter will equip scientists and healthcare providers for new career opportunities related to excessive use and abuse of video games, the Internet, and other technological devices that facilitate access to online activities.

Responding to Trauma at Sea: A Case Study in Psychological First Aid, Unique Occupational Stressors, and Resiliency Self-Care

The U.S. Navy deploys Special Psychiatric Rapid Intervention Teams (SPRINT) to sites of military disasters to assist survivors and the command. SPRINT functions primarily as a consultant to help commands effectively respond to the mental health needs of their service members following a traumatic event. Utilizing the principles of psychological first aid, the overall goal of SPRINT is to mitigate long-term mental health dysfunction and facilitate recovery at both the individual and unit level. We present a case study of a SPRINT mission to a deployed U.S. Navy ship in response to a cluster of suicides and subsequent concerns about the well-being of the remaining crew. Throughout this mission, important themes emerged, such as the impact of accumulated operational stressors and the subsequent development of mental health stigma. Also, this case study demonstrates the potential effectiveness of introducing resiliency self-care meditation training to remote environments that lack ready access to mental health resources. From here, SPRINT can provide a model for immediate disaster mental health response that has potential relevancy beyond the military.