Commentary On Forensic Neuropsychopathological Analysis on Altered Brain Structures in Combat Veterans: A Systematic Review

Review ariticle

Commentary On Forensic Neuropsychopathological Analysis on Altered Brain Structures in Combat Veterans: A Systematic Review

  • Monique M. Chouraeshkenazi

*Corresponding Author: Chouraeshkenazi, Department of Psychology, 111 W. Congress Street, WV 25414.

Citation: Monique M. Chouraeshkenazi, (2024), Commentary On Forensic Neuropsychopathological Analysis on Altered Brain Structures in Combat Veterans: A Systematic Review, J. Brain and Neurological Disorders, 7(3): DOI:10.31579/ 2642-973X/121

Copyright: © 2024, Monique M. Chouraeshkenazi. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 30 August 2024 | Accepted: 16 September 2024 | Published: 26 September 2024

Keywords: clinical psychology; combat veterans; combat exposure; forensic neuropsychopathology; forensic psychology; civilian and military law; military justice system; Mtbi; posttraumatic stress disorder; trauma; violent crimes

Abstract

This commentary reviews Chouraeshkenazi’s (2023) systematic analysis of forensic neuropsychopathology, focusing on altered brain structures in combat veterans. The study explored how neuropsychopathologies such as PTSD, mTBI, and depression affect brain regions (i.e., frontal lobe and prefrontal cortex), impairing cognitive performance and increasing violent behavior risks. Emphasizing DoD’s insufficient mental health standards as of 2020 (U.S. Inspector General, 2020), the study highlights the need for advanced neuropsychopathological evaluations and neuroimaging to improve military mental healthcare and address readiness and criminal liability issues.

Chouraeshkenazi (2023) advances forensic neuropsychopathology by identifying neuropsychopathological markers linked to violent behavior and suggests integrating these findings into legal and policy frameworks for better judicial outcomes. Using a robust systematic literature review (SLR) methodology, the research analyzed data from over 500,000 combat veterans over 11 years, revealing significant research gaps and leading to the development of forensic neuropsychopathology as a new subdiscipline.

Despite its contributions, the study faced limitations due to insufficient clinical results and limited sample representation, impacting the generalizability of findings on long-term combat exposure and its effects. As a result, this commentary proposes an updated definition of forensic neuropsychopathology as an interdisciplinary field examining how neurological conditions impact cognitive performance and behavior within legal contexts. This is to provide a better understanding and to encourage additional research to mitigate limitations and increase clinical findings. Nonetheless, future research should address these gaps with detailed neuropsychopathological evaluations and neuroimaging to enhance accuracy in diagnosing and treating severe neuropsychopathologies in military settings. This commentary further discusses integrating neuropsychopathological markers into clinical practice and legal decision-making to improve forensic outcomes. It advocates for ongoing research and interdisciplinary approaches to develop effective interventions and support systems for service members, veterans, and their families. 

Introduction

Chouraeshkenazi (2023) investigated the impact of neuropsychopathologies in combat veterans who served in Operation Iraqi Freedom and Operation Enduring Freedom. Military service personnel who served in those campaigns were diagnosed with severe neuropsychopathologies due to combat exposure and trauma. Numerous studies on how combat exposure and trauma significantly impact the brain were examined for a plethora of concerns related to personnel and military readiness obligations (Krancevich, 2020; MacQuarrie et al., 2020; Giardino, 2019; Sreenivasan et al., 2013). Also, the relationship between severe neuropsychopathologies, altered brain regions, and cognitive performance was examined to determine whether combat veterans were predisposed to commit violent crimes (Chouraeshkenazi, 2023). 

A systematic literature review (SLR) provided significant data regarding combat exposure effects and trauma and how this affected the brain, particularly cognitive performance. Data were analyzed using the PRISMA method, reviewing pre-existing studies to support and substantiate findings. Results revealed the leading severe neuropsychopathologies were PTSD, mTBI, and depression comorbidities among combat veterans diagnosed sometime after their return from deployment (Chouraeshkenazi, 2023). Also, existing studies showed that the specific brain regions affected were the frontal lobe and the prefrontal cortex (Chouraeshkenazi, 2023). Not only did findings support information regarding how the brain is altered due to combat exposure and trauma as well as the regions are impacted, but evidence suggested that combat veterans diagnosed with such severe neuropsychopathologies were not “mission ready” to complete the responsibilities required of them to serve in the military and meet deployment requirements (Acosta et al., 20214). Also, findings indicated that combat veterans with severe neuropsychopathologies are at a higher risk of predisposition to commit violent crimes (Chouraeshkenazi, 2023). The complexity of the findings made it challenging to determine if combat veterans are criminally liable, although some met the criteria for the insanity defense (Umbrasas, 2020). Also, findings questioned whether combat veterans diagnosed with severe neuropsychopathologies are mentally and physically fit to remain on active duty (Deployment Health Clincial Center [DHCC], 2017). The conceptual framework developed through the process of study, forensic neuropsychopathology, identified the relationship between mental health issues, severe neuropsychopathological diagnoses, and its effects on the military legal system. Based on the research conducted, it was deemed necessary that further research is needed to examine severe neuropsychopathologies, specific brain regions, and cognitive performance through specific neuropsychopathological evaluations and assessments and neuroimaging techniques to provide advanced neuropsychological initiatives and improve mental healthcare practices within the Department of Defense (DoD).

Significance of the Study  

As of 2020, the DoD had not met the required standards for mental health programs for military service members (U.S. Inspector General, 2020). Severe neuropsychopathologies such as PTSD, mTBI, and depression were the most significant mental concerns among the U.S. Armed Forces. However, there were no neuropsychological or neuropsychopathological initiatives to determine how severe mental illnesses impact not only brain regions but cognitive performance. Exploring this phenomenon is paramount, as there have been increased military discharges and violent crimes due to mental healthcare concerns (Cesur et al., 2020; Krancevich, 2020; MacQuarrie et al., 2020; Giardino, 2019; Acosta et al., 2014; Elbogen et al., 2014). 

 Chouraeshkenazi (2023) provided awareness of the relationship between neuropsychopathological deficits and criminal behavior, marking a significant advancement in forensic neuropsychopathology. The research identified neuropsychopathological markers associated with violent or criminal behavior. These findings could influence federal policy and legal frameworks by advocating for including neuropsychopathological evidence in legal decisions, leading to more informed and equitable judicial outcomes. Additionally, it implicates future research by examining the relationship between neuropsychopathological and environmental factors, potentially enhancing prevention and rehabilitation strategies within the DoD. 

Forensic Neuropsychopathology 

Forensic neuropsychopathology is the “combination of clinical neuropsychological practices and the scientific study of mental disorders that pertain to decision-making within the civilian and military legal systems” (Chouraeshkenazi, 2021). However, the findings from this study required the researcher to consider a more profound understanding of neuropsychopathology and provide a more precise definition of the framework. As previously stated, Chouraeshkenazi’s (2023) findings revealed that severe neuropsychopathologies (i.e., PSTD, mTBI, MDD) altered the brain’s prefrontal cortex and frontal lobe regions. Therefore, the term forensic neuropsychopathology should reflect the effects of psychopathology on the brain and its implications for military and even legal sysetems. This commentary incites a new definition of neuropsychopathology and an improved explanation of forensic neuropsychopathology to better understand their impact on clinical neuropsychology and psychology, forensic psychology, and military neuropsychology (Chouraeshkenazi, 2023). Through four years of research, the researcher was unsuccessful in finding the expert(s) who coined “neuropsychopathology.” However, it appears that medical physician Sir William Osler was “the first to formally use the term ‘neuropsychology’ in 1913” (Bruce, 1985). Now, the researcher believes a simplistic definition of neuropsychopathology is defined as “the study of psychopathology and its effects on the brain and cognitive performance” (Chouraeshkenazi, 2024). 

Also, an updated definition to further explain forensic neuropsychopathology is as follows: 

“An interdisciplinary field that applies principles of neuropsychology to understanding and evaluating the intersection of neurological conditions, psychological functioning, and legal issues. It focuses on how changes within the brain affect cognitive performance and how mental disorders influence behavior within legal contexts, such as criminal responsibility, competency to stand trial and risk assessment. This field combines neuroscience, clinical neuropsychology and psychology, forensic psychology, and the law to address complex questions about cognitive performance and emotional functioning related to legal questions and decisions” (Chouraeshkenazi, 2024). 

Strengths of the Study

Chouraeshkenazi (2023) employed a robust and innovative research design; the SLR methodology enhanced the precision and reliability of the findings. The SLR approach is a rigorous methodology (Sataloff et al., 2021); therefore, it was the best approach for reviewing peer-reviewed articles on neuroscience, clinical neuropsychology and psychology, forensic psychology, and the law. Such a method requires researchers to meet strict standards for the entire research study, including sensitive research and appraisal of significant and relevant studies, increasing inter-rater reliability (Mancin et al., 2024). It served as an asset in providing a clear, comprehensive overview of available data to understand the complexity of combat exposure, trauma, severe neuropsychopathologies, the military, and violent crimes. This method produced a large sample size (over 500,000 combat veterans over 11 years) to produce statistically significant findings (Chouraeshkenazi, 2023). 

In addition, using SLR allowed the researcher to understand the grand scheme of the findings, showing that advanced neuropsychological initiatives are needed within the DoD to provide improved mental healthcare programs for military service members (Sataloff et al., 2021). Also, incorporating SLR into the research studies identified significant informational gaps in clinical neuropsychology and psychology, forensic psychology, and military neuropsychology. As a result, the birth of a conceptual framework, forensic neuropsychopathology, was presented as an emerging subdiscipline to address the psychological field’s many complexities and informational limitations concerning psychopathology and its effects on the brain and cognitive performance (i.e., neuropsychopathology) (Chouraeshkenazi, 2023). 

The SLR method does not only include qualitative data and its analyses; the researcher also had a unique ability to incorporate meta-analysis practices into the research to amalgamate qualitative and statistical findings that were deemed significant within the study (Sataloff et al., 2021). This provided a comprehensive understanding of the research topic through anecdotal, instinctive, quantifiable, and measurable approaches. Chouraeshkenazi (2023) utilized comprehensive data collection strategies, including large and diverse samples of combat veterans over 11 years. This broad data set increased the generalizability of the results. Also, it allowed for a more nuanced understanding of the neuropsychopathological profiles associated with various forms of criminal behavior highlighted in the study (Mancin et al., 2021; Sataloff et al., 2024). 

In addition, the multidimensional analysis approach was significant; by integrating multiple neuropsychopathological dimensions, such as executive function, memory, and emotional regulation, the study offered a multidimensional analysis of cognitive deficits. This comprehensive approach provided a deeper insight into how different cognitive impairments contributed to criminal behavior, particularly violent crimes. The study’s findings directly impact clinical practice, offering practical tools for clinicians to assess and manage individuals with neuropsychopathological impairments (Chouraeshkenazi, 2023). This was not highlighted in the study (Chouraeshkenazi, 2023); however, it was revealed in this commentary, which is critical to incorporation in future research.

The identification of specific neuropsychopathological markers (i.e., altered brain regions such as the frontal lobe and the prefrontal cortex that can cause impairment) linked to violent crimes can enhance risk assessment and intervention strategies. Chouraeshkenazi (2023) provided evidence that can inform policy and legal frameworks (which will be incorporated in the future research section). By demonstrating the connection between neuropsychopathological deficits and violent crimes, the study supports the need for incorporating forensic neuropsychopathological evaluations and assessments into legal decision-making, potentially leading to more just and individualized legal outcomes (Chouraeshkenazi, 2023). These strengths highlighted the study’s contribution to advancing forensic neuropsychopathology, enhancing our understanding of the cognitive factors in criminal behavior, and providing valuable insights for clinical and policy applications. 

Weaknesses of the Study 

There were limitations in this study, mainly insufficient clinical results that are paramount in proving the theory that long-term combat exposure and trauma not only altered brain regions and affected cognitive performance but predisposed veterans to commit violent crimes (Chouraeshkenazi, 2023). Validity is of the utmost importance in all research studies; therefore, examining a phenomenon with limited clinical studies in this area could have compromised the study’s findings (Patino & Ferreira, 2018). Though there was significant peer-reviewed work in neuroscience, neuropsychology, forensic psychology, psychology, and military mental health concerns, additional information is needed to examine the relationship to theorize (will be provided in future research) that increased violent crimes within the military due to severe neuropsychopathologies (Chouraeshkenazi, 2023). 

The study had a limited sample representation (neuropsychological longitudinal and clinical studies), which slightly affected the generalizability of the findings. For instance, although there were over 500,000 combat veterans to sample from 11 years, there was only one peer-reviewed article that examined the implication of an insanity defense due to severe neuropsychopathologies revealed during court trials (Umbrasas, 2020). Also, this study did not provide evidence that the combat veteran was evaluated for cognitive impairment. 

Emerging research in this area is critical for statistical and clinical significance to hypothesize that increased violent crimes within the military are due to severe neuropsychopathologies (Chouraeshkenazi, 2023). Also, this concern warrants further exploration of advanced neuropsychological initiatives within the DoD. In addition, there were insufficient clinical studies to focus on the association between altered brain regions, cognitive performance, and violent crimes within the U.S. military. This form of study may not be conducted due to various reasons such as ethical concerns, limited scope, longevity, time commitment, cost-effectiveness, manpower, and participant recruitment and attrition. 

Nonetheless, to better understand this phenomenon, such research approaches are required. Further, there was a significant limitation in research regarding results from combat veterans completing neuropsychopathological evaluations and neuroimaging for further diagnostic clarification. Neuropsychopathological evaluations and assessments are relatively new (Chouraeshkenazi, 2024). However, neuropsychological evaluations are standard reports conducted for further diagnostic clarification (Schaefer et al., 2023; Schroeder et al., 2019). 

Such evaluations assist in diagnosing complex neurodevelopmental, neurocognitive, and mental disorders by interviewing, administering assessments, conducting research, and determining diagnostic criteria of how these aspects impact the brain and behavior (Schroeder et al., 2019). Nonetheless, a step further, neuropsychopathological evaluations and assessments not only include aspects of a neuropsychological evaluation but focus on how psychiatric conditions impact the brain (i.e., changes within the brain), cognitive performance, and mental health. 

Neuropsychopathological evaluations and assessments can provide additional insight into cognitive performance, particularly behavior, cognition, and emotion (Schroeder et al., 2019). Also, such evaluations can improve diagnosis accuracy for better treatment planning options tailored to everyone. In forensic or legal settings, neuropsychopathological evaluations and assessments focus on standard proceedings without the court, such as competency to stand trial, criminal responsibility, and other legal implications (Hoge, 2016). 

Regular evaluations are essential in tracking an individual’s progress and assessing the intervention or treatment effectiveness. As a result, these evaluations can provide objective and scientific value that is pivotal within the legal system (Reed et al., 2021; Samartzis & Talias, 2020). Finally, neuropsychopathological evaluations and assessments aid in understanding complex cases, particularly the intersection of clinical neuropsychology and psychology, forensic psychology, and military neuropsychology. These weaknesses highlighted areas where the study might be improved, or further research is needed to validate and extend its findings. Addressing these limitations can enhance the strength and applicability of research in forensic neuropsychopathology (Chouraeshkenazi, 2023; Malik & Norman, 2023). 

Implications

Practical Applications 

Chouraeshkenazi’s (2023) findings from this study offered several critical implications for advanced clinical practice in forensic neuropsychopathology. Identified neuropsychopathological markers associated with violent behavior and actions can provide clinicians with valuable tools for assessing risk and implementing preventative measures in the future (Chouraeshkenazi, 2023). By integrating these markers into neuropsychopathological evaluations and assessments, practitioners can enhance their ability to predict and manage potential threats, ultimately improving safety and outcomes in forensic settings. 

Implications for Policy and Legal Frameworks 

From a policy perspective, Chouraeshkenazi’s (2023) results emphasized the necessity for updated guidelines incorporating neuropsychopathological findings into legal decisions. Forensic neuropsychopathology will influence the civilian and military justice systems. Findings showed that integral agencies such as Congress, the White House, DARPA, and DoD are responsible for significant initiatives regarding neuropsychological initiatives (Chouraeshkenazi, 2023). Based on the results of this study, it would be beneficial for federal, state, and local institutions to consider revising criteria for insanity defenses and sentencing guidelines to reflect the cognitive and behavioral patterns identified in this research. Such revisions could lead to a more nuanced understanding of criminal behavior, ensuring that legal outcomes are better aligned with individuals’ neuropsychopathological profiles. Therefore, future research is vital to addressing these concerns. 

Additionally, Chouraeshkenazi (2023) revealed the necessity of integrating forensic neuropsychopathological evaluations or assessments into pre-sentencing and court-martial hearings for the military justice system and pre-sentencing and parole hearings within the civil justice system. By providing a broader perspective of a veteran’s cognitive functioning and potential risks, these assessments can inform more equitable and individualized legal decisions. Policymakers must advocate for including forensic neuropsychopathological expertise in forensic evaluations to enhance the fairness and effectiveness of the legal system. 

Further, Chouraeshkenazi (2023) effectively integrated neuropsychology, neuroscience, forensic psychology, and criminal justice, fostering an interdisciplinary approach to understanding and addressing criminal behavior, particularly violent crimes among combat veterans. This integration enriched the study’s contributions to the field and promoted collaboration across disciplines. Finally, this study adhered to high ethical standards, ensuring acknowledgment of potential bias, limitations, and possibly erroneous information provided during the research process. 

Direction of Future Research 

Chouraeshkenazi (2023) opened several avenues for future research in forensic neuropsychopathology. One critical area for further investigation is the longitudinal impact of identified neuropsychological markers on behavioral outcomes through clinical studies. The researcher discussed in the research study that a mixed methods approach should be completed; however, this commentary revealed a significant need for clinical information using forensic neuropsychopathology as a foundational basis for neuropsychopathological evaluations and assessments while incorporating Norman Garmezy’s resilience theory. 

Also, Chouraeshkenazi’s (2023) study explained that a cohort study would further examine the outcomes and effects of variations in psychiatric conditions and environmental influences as they impact neuropsychopathologies progression, social change, emotional regulation, and behavioral effects. In addition, a longitudinal study is well-suited for future research in forensic neuropsychopathology for several vital reasons critical to this commentary and will serve as the pinnacle of change (Tuthill et al., 2020).  For instance, forensic neuropsychopathology often involves examining how neuropsychological deficits influence criminal behavior over time. 

A longitudinal clinical study tracks participants across multiple timelines, showing how these cognitive deficits develop, change, or persist. This temporal dimension allows researchers to observe how early neuropsychopathological impairments might predict future criminal behavior or how such impairments evolve concerning legal outcomes and interventions (Tuthill et al., 2020). Also, longitudinal and clinical studies are instrumental in establishing causal relationships between neuropsychopathological deficits and criminal behavior (Tuthill et al., 2020). By collecting data at various stages, researchers can better determine whether cognitive impairments precede or follow criminal conduct. This causal understanding is crucial for developing effective preventions and intervention strategies tailored to the specific needs of individuals with neuropsychopathological deficits (Tuthill et al., 2020). 

Forensic neuropsychopathology will aim to evaluate the effectiveness of interventions, such as therapeutic programs or cognitive training (Chouraeshkenazi, 2023). Longitudinal designs enable researchers to assess the long-term impact of these interventions on both neuropsychopathological functioning and criminal behavior. Tracking over time provides valuable data on whether interventions lead to sustained improvements or reduced recidivism. Neuropsychopathological deficits and criminal behavior may be influenced by developmental and environmental factors that unfold over time. 

A longitudinal approach can examine how these factors interact and contribute to changes in neuropsychopathological functioning and criminal behavior (Tuthill et al., 2020). This perspective is essential for understanding developmental trajectories and the role of early-life experiences or ongoing environmental stressors. Longitudinal studies allow for identifying risk and protective factors associated with neuropsychopathological deficits and criminal behavior.

By following individuals over an extended period, researchers can detect patterns and factors that mitigate or exacerbate the risk of criminal behavior. This information is valuable for creating targeted prevention programs and informing policy decisions. Tracking individuals over time improves the predictive accuracy of neuropsychopathological assessments concerning criminal behavior. Longitudinal data help refine predictive models by providing a more comprehensive view of how neuropsychopathological profiles relate to long-term outcomes, enhancing the precision of risk assessments (Sanip, 2020). 

Finally, a longitudinal study design is ideal for forensic neuropsychopathology because it provides a dynamic and comprehensive understanding of how neuropsychopathological deficits and criminal behavior interact and evolve. This approach is essential for developing effective interventions, understanding causal relationships, and informing policy and clinical practices. A longitudinal approach for this research study must include clinical trials, as this method is highly valuable in forensic neuropsychopathology (Sanip, 2020). Many clinical trials are designed to follow participants over time, providing valuable longitudinal data on the progression of neuropsychopathological conditions. This data can help understand how these conditions evolve and how distinctive factors influence development. 

Clinical trials provide a controlled environment to study specific forensic neuropsychopathological evaluations and possible interventions (Kandi & Vadakedath, 2023). A controlled environment is critical to isolating possible confounding variables and understanding the direct effect of distinctive factors on conditions relevant to forensic contexts (Singh & Okpeku, 2024). For instance, rigorous scientific methods, including randomization and blinding, enhance the reliability and validity of the findings. This rigor is crucial in forensic neuropsychopathology, where accurate assessments and interventions are critical for diagnosis accuracy, treatment planning, and legal decisions. Clinical trials for this research study could generate evidence-based data that can be used to establish original diagnostic criteria, treatment protocols, or risk assessments (Tenny & Varacallo, 2024). This is vital for developing reliable tools and methods in forensic evaluations. 

Most importantly, using clinical trials for this study is essential to adhere to strict ethical guidelines, ensuring that research is conducted with the highest standards of care (Kandi & Vadakedath, 2023). This is especially important in forensic neuropsychopathology, where ethical considerations are paramount due to the legal implications of the research outcomes. Finally, by testing interventions and treatments in clinical settings, trials provide insights into how these approaches work in real-world scenarios. This can be particularly useful for forensic neuropsychologists applying findings to practical, legal contexts. Clinical trials provide a robust framework for generating high-quality reliability for forensic neuropsychopathology, which is essential for advancing knowledge, improving diagnostic accuracy, and developing interventions (Stensland et al., 2022). Future research would examine severe neuropsychopathologies (i.e., PTSD, mTBI, MDD) and affected brain regions through neuroimaging (i.e., fMRI).

Additionally, Chouraeshkenazi (2023) explored the relationship between severe neuropsychopathologies and a predisposition to commit violent crimes (i.e., severe military offenses, killings, robberies, and domestic violence). Further, additional research would explore how combat veterans directly impact national security. Longitudinal and clinical studies could provide insights into how neuropsychopathological markers affect the progression of criminal behavior and inform the development of more effective intervention strategies (Kandi & Vadakedath, 2023; Tuthill et al., 2020; Sanip, 2020). 

Moreover, research should explore the relationship between neuropsychopathological deficits and environmental factors, such as socio-economic status and exposure to combat and trauma. Understanding how these factors interact with neuropsychopathological vulnerabilities will offer a more comprehensive view of criminal behavior and inform more comprehensive approaches to prevention and treatment. As previously mentioned, examining the connection between neuropsychopathological deficits and violent crimes incorporating forensic neuropsychopathological evaluations or assessments into legal decision-marking could lead to improved treatment planning options and more just and individualized legal outcomes. Incorporating advanced neuroimaging techniques and neuropsychopathological evaluations or assessments to identify specific neurocognitive deficits associated with criminal behavior is significant. Chouraeshkenazi (2023) emphasized the importance of multidimensional approaches to forensic neuropsychopathological evaluations or assessments.

Clinicians are encouraged to consider not only traditional diagnosis criteria but also the specific neuropsychopathological profiles of combat veterans identified in this research (Gettings et al., 2022; Murphy & Smith, 2018). This comprehensive outlook can facilitate more accurate risk assessments and tailored intervention strategies for military service members. For instance, combat veterans (active duty, transitional members, or retirees) demonstrating neuropsychopathological deficits may benefit from targeted cognitive-behavioral therapies designed to address their specific impairments.

Finally, there is a need for research on the effectiveness of specific interventions tailored to individuals with neuropsychopathological impairments. Evaluating the efficacy of these programs in reducing recidivism and improving cognitive functioning will be crucial in refining treatment approaches and enhancing overall outcomes in forensic civilian and military populations. 

Conclusion

Chouraeshkenazi (2023) highlighted the importance of integrating neuropsychopathological insights into forensic neuropsychology across clinical, policy, and research domains. This approach can improve our understanding of criminal behavior and contribute to a fairer legal system. The study underscored the role of neuropsychopathological factors in criminal actions, particularly among combat veterans. It stressed the need for interdisciplinary evaluations combining neuropsychopathological, psychological, and behavioral analyses. The research revealed that deficits in brain regions like the prefrontal cortex are linked to a higher risk of criminal behavior and highlighted the impact of combat exposure on neuropsychopathologies such as PTSD, mTBI, and MDD. The study emphasized that addressing these issues through advanced neuropsychological methods can enhance diagnosis, treatment, and overall support for veterans, advocating for continued research to develop effective interventions.

This research study that commentary is provided for was published by F1000 Research in May 2023. I have no known conflict of interest to disclose.

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

img

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

img

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

img

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

img

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

img

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

img

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

img

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

img

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

img

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

img

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

img

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

img

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

img

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

img

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

img

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

img

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

img

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

img

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

img

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

img

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

img

Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

img

Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

img

Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

img

Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

img

Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

img

Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

img

Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

img

Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

img

Dr Susan Weiner

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

img

Lin-Show Chin

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

img

Sonila Qirko

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

img

Luiz Sellmann