An Army private, who recently was sentenced by a military court to 12 ½ years in prison for the murder of an Afghan detainee, walked into a cell at a U.S. outpost in Afghanistan and shot the sleeping prisoner, according to prosecutors. Army doctors later found that the soldier was suffering from schizophrenia and PTSD.
Cases such as these make accurate schizophrenia screening and treatment critical for the military, but the process is complicated by a simple fact: The age of initial onset of schizophrenia symptoms coincides closely with the age at which many enter the military; schizophrenia usually appears between ages 16 to 25 with an average onset of age 18 for men and slightly older for women.
Schizophrenia is a chronic, severe, and disabling brain disorder that appears to be caused by some combination of genetic makeup and brain chemistry, according to the NIH.
While the consequences of enlisting a schizophrenic servicemember can be significant, screening also is difficult because of the relative rarity of the disease and because sufferers are likely to try to hide it, if they can.
“You have to realize that while schizophrenia is prevalent, there has been found to be a lifetime occurrence of between .3% and .7% in various studies in the population,” Navy Capt. Paul S. Hammer, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, told U.S. Medicine.
“You need to remember that the incidence of psychotic disorders is less than 100 a year in the entire military, so it’s not all that common,” Hammer says. “When it does occur, it’s obvious enough that people know what to do and they are able to get the individual appropriately referred.”
What the Military Does
Mental health screening questions are included on health-related questionnaires, but Hammer said they tend to be general and are more likely to address concerns for depression.
Routine mental health screenings also occur when servicemembers present for primary care. For example, Hammer says, the physician might wish to screen for depression,i.e., “Do you feel sad or down?”. “For large troop concentrations they may also ask questions related to PTSD,” he adds.
When patients say they are feeling depressed or having difficulty sleeping, more questions are asked to gauge the seriousness of the problem, according to Hammer.
“If they say they’re sad, you would ask them to tell you about it; whether there are is anything going on in their lives, issues they’re having difficulty dealing with, and so on, although these are more targeted towards depression,” he says.
Specific behaviors that could indicate the possible presence of schizophrenia, Hammer says, might include paranoia or hallucinations, adding that it’s rare for such an individual to come forward and admit they have a problem and, “Usually there is an attempt to hide it and be in denial.”
Clinicians should take a close look at individuals who are attempting to isolate themselves, according to Hammer, who explains that, with symptoms of schizophrenia, “They might behave in an odd or bizarre manner; personal or social interactions might be rather odd – or they become overly suspicious.”