Louisville Medicine Volume 69, Issue 8 - Page 24

AUTHORS Carolyn Furdek , DPT & Rif El-Mallakh , MD


AUTHORS Carolyn Furdek , DPT & Rif El-Mallakh , MD

The invisible wounds afflicting our military veterans are burdens that these brave men and women carry for a long time after they have performed their duties . The burden may even be greater when the wound you have is not a recognized illness within the medical community ’ s official framework . Such was the case of a medically retired Captain who suffered two psychotic breaks while on two different combat deployments . Dr . Furdek told her story in a book ( pictured to the right ) and virtually to the Cato Society attendees in their monthly meeting on Nov . 9 , 2021 . 1

She was 27 years old when she was sent to Afghanistan on her third deployment as a seasoned , combat-hardened officer . While with her platoon on a mission one day , she had the sudden onset of paranoia , a sense of overwhelming failure , delusional guilt , withdrawal from those around her , difficulty in articulating her sensations and an initial inability to sleep . There was no disturbance of energy or mood , but her symptoms and associated psychotic fear rendered her incapable of functioning . She was medevaced to Europe and then the U . S .; in Europe she was initially treated with an antipsychotic with rapid and complete resolution of her symptoms ( within a few days ), followed by discontinuation of her medications and a four-month observation period to ensure that she was well . She returned to active duty without any medications and was subsequently sent on her fourth deployment in Afghanistan . Within three months , and in an active combat zone , her symptoms suddenly returned and again without mood symptoms or sleep disturbance . She was again medevaced to Europe and then the U . S ., and again responded quickly to antipsychotic medications . At this time she was medically discharged from the Army after six years of service . She joined the civilian workforce seven months after her return from overseas . Unfortunately , she experienced a recurrence of her psychosis one year and nine months after being tapered off her medication . She was hospitalized in a civilian hospital in Virginia . Over the subsequent 11 years , she experienced seven additional episodes , but because of her rapid response and knowledge of what happens during these episodes , she was hospitalized for only two of them at the Veterans Administration ( VA ) Hospital . But the pattern remained very uniform , she would have a normal sleep pattern of seven to eight hours per night , she lacked pressured speech , motor changes or any other indications of a mood disorder , but the memory of her military duty was always there and was associated with a sense of dread , fear and anxiety and occasionally with paranoid delusional content . In the inter-episode periods , she never experienced her combat service as a traumatic event . Despite these recurrences , she was able to obtain her doctoral physical therapy degree , work nearly full time , marry and have two children . However , her treatment at the VA was marked by difficulties because she did not fit into any clear diagnostic category . Ultimately , it was recognized that her symptoms were compatible with the diagnostic criteria of “ cycloid psychosis ” an illness in the scientific literature but not in either the Diagnostic Statistical Manual of Psychiatric Disorders ( DSM ) or the International Classification of Diseases ( ICD ). 2 , 3
Cycloid psychosis is a recurrent psychotic illness that has a rapid onset and a rapid response to antipsychotic medication , with full symptomatic and functional recovery in the inter-episode periods . It does not appear to be a mood disorder and is not associated with any family history of mood disorders . It occurs more frequently in females . Etiology and pathophysiology are unknown . Treatment beyond the acute periods focuses on prevention of recurrence and is accomplished by mood stabilizers ; antipsychotics do not appear to prevent recurrence .
Editor ’ s note : What is hard is living with the knowledge that this could disrupt your life , unpredictably , at any moment . Yet Captain Furdek , a West Pointer who became a combat heavy engineer and leader of many , has persevered . She has forged a life in the present dedicated to helping others , especially her fellow veterans . Join us in saluting her - and read her wonderful book .
Furdek , C . Locked-In : A Soldier and Civilian ’ s Struggle with invisible wounds .