Treatment of Psychiatric Disorders Onboard an Aircraft Carrier Assisted with Psychotropic Medication: A Retrospective Review Describing One Aspect of Navy Force Health Protection

Military Medicine, Apr 2006 by Wood, Dennis Patrick, Walker, Errika, Moses, Kennett, Gilleran, Louis

Navy clinical psychologists, assigned to aircraft carriers, are playing an increasing role in not only implementing Navy force health protection, but also in further specializing the delivery of mental health evaluation, treatment, and disposition services at the "tip of the spear." An aircraft carrier's medical department, augmented with a clinical psychologist, is now better able to coordinate diagnostic, psychotropic, and psychotherapeutic treatments for both shipboard and air wing personnel. This retrospective review reports the outcomes of a 6-month treatment program for personnel, assigned to the USS Constellation (CV-64), who were prescribed a psychotropic medication while receiving psychotherapy. We concluded that psychotropic medications can be safely and effectively used onboard an aircraft carrier. Furthermore, personnel prescribed psychotropic medication successfully completed their assigned duties and obtained recommendations for advancement and retention. Lastly, our medical department proactively fulfilled the Navy force health protection tenet of preserving a healthy and fit force.

Introduction

Onboard the aircraft carrier, clinical psychologists, flight surgeons, general medical officers (GMOs), and physician assistants (PAs) frequently complete initial evaluations, dispositions, and treatment of sailors and officers with psychiatric disorders. Among the 5,200 members of the ship's crew and air wing, personnel may self-refer or be referred by their command due to problems with work performance, behavior, relationships, and/or suicidal ideation or suicidal gestures. Following an alcohol-related event, personnel receive a mental health evaluation to determine the presence of alcohol abuse or alcohol dependency. Importantly, improper or untimely mental health evaluations and dispositions of personnel may negatively affect flight safety or mission accomplishment.1-3

Psychiatric conditions diagnosed onboard aircraft carriers have included the full spectrum of axis I and axis II disorders, including those associated with the presence of suicidal ideation/intent.1-5 Of note, there is enhanced psychiatric concern, onboard operational platforms, when personnel report suicidal ideation/intent due to the fact that suicide has been the second or third leading cause of death in the Navy.6 Since the assignment of a clinical psychologist to each aircraft carrier's medical department, once shipboard personnel have been evaluated, they have successfully participated in individual, crisis intervention, and/or group psychotherapy and psychotropic medication intervention programs.3-5 The psychotropic medication interventions have typically been affected with one of the selective serotonin reuptake inhibitors (SSRI) or newer generation psychotropic medications.4,5

SSRI and newer generation psychotropic medications have been documented as safe and effective in treating a wide spectrum of psychiatric disorders.7-18 Importantly, appropriate and timely psychiatric evaluation and psychotherapeutic treatment programs, supported by psychotropic medication, have enabled active duty personnel to not only successfully perform their assigned duties, but also to carry out both the training and the war-fighting missions of the aircraft carrier even while the aircraft carrier is deployed overseas for 6 or more months.4,5

The utilization of psychotropic medications, in conjunction with psychological evaluation, psychotherapeutic interventions, and crisis interventions by the shipboard clinical psychologist, is also compatible with the Navy's evolving force health protection doctrine that mandates a "healthy and fit force."3,19 This doctrine describes a "unified strategy designed to protect service members from all health and environmental hazards associated with military service."19 The USS Constellation's Mental Health Treatment and Psychotropic Medication Surveillance Program was designed to be a component of the Navy's force health protection doctrine.

Our retrospective review discusses the results of the Constellation's Mental Health Treatment and Psychotropic Medication Surveillance Program that involved the prescription of SSRI and newer generation medications to active duty personnel before, during, and after the Constellation's 2001 6-month Persian Gulf deployment in support of Operation Southern Watch.

Methods

Patient Selection

Between January 2001 and June 2002, 33 active duty personnel, assigned to the U.S.S. Constellation or the Constellation's air wing, were enrolled in the Constellation's Mental Health Treatment and Psychotropic Medication Surveillance Program. Of note, 27 of these personnel were enrolled in the Program between January 2001 and September 2001. The Constellation's 6-month deployment to the Western Pacific and to the Persian Gulf, in support of Operation Southern Watch, was between March and September 2001.

All 33 personnel met enrollment criteria: (1) possessed the DSM-IV20 criteria for an axis I or axis II diagnosis: (2) accepted a SSRI or newer generation psychotropic medication prescription; and (3) were found psychiatrically fit and suitable for full duty. A clinical psychologist or a psychiatrist initially evaluated all 33 patients and their psychotropic medication was prescribed by a psychiatrist, a flight surgeon, a GMO, or a PA. The prescription of psychotropic medication was in keeping with the Navy's proposed policy concerning the deployability of active duty personnel taking antidepressant medication21 and the Navy's guidance concerning physical examinations and standards.22