Military cultural competence has recently gained national attention. Experts have posited that limited outcomes in the treatment of posttraumatic stress disorder and depression in the military may be related to limited familiarity with the military. National surveys have indicated low military cultural competence among providers and limited educational efforts on military culture or pertinent military pathology in medical schools and residency training programs. Military families, with their own unique military cultural identity, have been identified as a population with increased risks associated with deployment. In response to these findings, several curricula regarding military culture have been established and widely distributed. Assessments of military cultural competence have also been developed. The clinical impact of enhanced cultural competence in general has thus far been limited. The military, however, with its highly prescribed cultural identity, may be a model culture for further study.

Abstract-Executive Clock Drawing Tasks (CLOX parts 1 and 2) can predict functional impairment. This study determined the correlation between CLOX and other psychometric screening instruments with the Structured Assessment of Independent Living Skills (SAILS)-defined performance-based functional status in people with combat-related mild traumatic brain injury (TBI) and comorbid posttraumatic stress disorder (PTSD). We hypothesized that CLOX would correlate significantly with functional performance. This prospective, crosssectional study design determined the correlation between a structured neuropsychological battery and functional status assessment. We calculated Pearson correlation coefficients between neuropsychological instruments and functional status scores. We entered neuropsychological measures correlating p < 0.1 with functional status into a linear regression model to determine independent contributions. Fifteen Operation Iraqi Freedom veterans participated. Only CLOX1 correlated significantly with functional competency and efficiency. Only mean CLOX1 scores were significantly lower in those scoring below the median for SAILS competency and in those scoring above the median for SAILS efficiency. CLOX1 contributed significant variance to functional status independent of mood or anxiety symptoms and was not affected by age or time since injury. Executive dysfunction per the brief, easily administered CLOX1 is sensitive to functional status following combatrelated mild TBI, independent of PTSD anxiety with or without depression.

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Traumatic brain injury (TBI) is a growing national health issue that commonly results in clinically significant cognitive impairments. This article reviews and evaluates the many proposed psychopharmacological treatments for TBI-related cognitive impairment. A literature review was utilized to focus on stimulant and nonstimulant dopamine enhancing agents, acetylcholinesterase inhibitors, antidepressant agents, mood stabilizers, antipsychotics, and benzodiazepines. The most consistent evidence supports the use of dopamine enhancing medications. However, other medications such as acetylcholinesterase inhibitors and antidepressant agents may help select subgroups. A need remains for well designed, sufficiently powered studies that incorporate functionally relevant neuropsychological outcome measures.