Psychotic Disorders and Best Models of Care

Schizophrenia is uncommon in active duty military members. Presentation of psychosis in a military setting requires immediate steps to ensure safety and appropriate medical referral. A thorough fitness for duty evaluation proceeds and determines disposition to return to duties, limit duties, or refer for military separation. Supportive military commands, skilled medical teams, and family engagement are utilized to lessen the severity of illness and improve recovery and independent function. However, veterans may experience challenges including stigma, decreased access to care, medication side effects, and poor treatment adherence. These challenges may cause deterioration in health, relapse of addictive substances, re-hospitalizations, suicide attempts, or other dangerous behaviors. Understanding of veterans’ degree of suffering requires a review of prevalence, morbidity, and mortality of these illnesses. Etiology of schizophrenia is complex, however studies on whole-genome sequencing and single nucleotide variants are promising. Improving transitions of care, expanding programs for outreach, and innovating new treatments for veterans with psychosis are needed to foster recovery and re-integration into the community.