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SOF personnel combined with a possible biologic explanation 4. Greer N, Sayer NA, Spoont M, et al. Prevalence and severity of
available, the combined KI and CSB impact on clinical symp- psychiatric disorders and suicidal behavior in service members
toms should be evaluated in the near future. and veterans with and without traumatic brain injury: Systematic
review. J Head Trauma Rehabil. 2020;35(1):1–13. doi:10.1097/
HTR.0000000000000478
Conclusion 5. Frueh BC, Madan A, Fowler JC, et al. “Operator syndrome”:
A unique constellation of medical and behavioral health-care
As demonstrated by this case study, combined KI and CSB ap- needs of military special operation forces. Int J Psychiatry Med.
pear to have a profound and long-lasting impact (over 2 years) 2020;55(4):281–295. doi:10.1177/0091217420906659
on the symptoms of bTBI and PTSD. Although the mechanisms 6. Watts BV, Schnurr PP, Mayo L, Young-Xu Y, Weeks WB, Fried-
of the effect are not fully elucidated, this treatment approach man MJ. Meta-analysis of the efficacy of treatments for posttrau-
provides a very effective new treatment for this unique and matic stress disorder. J Clin Psychiatry. 2013;74(6):e541–e550.
doi:10.4088/JCP.12r08225
complex patient population. Further study is needed to deter- 7. Hoge CW. Interventions for war-related posttraumatic stress dis-
mine the true promise of this combined KI/CSB technique. order: meeting veterans where they are. JAMA. 2011;306(5):549–
551. doi:10.1001/jama.2011.1096
Author Contributions 8. Lipov E, Sethi Z, Nandra G, Frueh C. Efficacy of combined sub-
EL conceived the study concept. ZS collected the data. HR anesthetic ketamine infusion and cervical sympathetic blockade
assembled the manuscript. All authors read and approved the as a symptomatic treatment of PTSD/TBI in a special forces pa-
tient with a 1-year follow-up: A case report. Heliyon. 2023;9(4):
final manuscript. e14891. doi:10.1016/j.heliyon.2023.e14891
9. Peters AJ, Villasana LE, Schnell E. Ketamine alters hippocampal
Disclosures cell proliferation and improves learning in mice after traumatic
The authors have nothing to disclose. brain injury. Anesthesiology. 2018;129(2):278–295. doi:10.1097/
ALN.0000000000002197
10. Browne CA, Wulf HA, Jacobson ML, Oyola MG, Wu TJ, Lucki
Funding I. Long-term increase in sensitivity to ketamine‘s behavioral ef-
No funding was received for this work. fects in mice exposed to mild blast induced traumatic brain in-
jury. Exp Neurol. 2022;350:113963. doi:10.1016/j.expneurol.
References 2021.113963
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