Volodymyr Korostiy,

Doctor of Medicine, professor of Kharkiv National Medical University, Ukraine

Dariia Molchaniuk

Clinical presentation and diagnosis of PTSD: the case report

The research relevance is caused by modern importance of posttraumatic stress

disorders (PTSD) and by number of unresolved diagnostic issues that create а
background for many diagnostic errors and discrepancies, interferes the adequate,
timely initiated, differentiated treatment and prevention. PTSD diagnosis is made by
identifying specific clinical symptoms, thorough history taking (the most important is
the fact of the traumatic event not more than one month before the patient survey)
and performing the psychodiagnostic tests described below.

Impact of Event Scale-Revised (IES-R). The questionnaire reveals which

symptoms dominate - intrusion, avoidance, increased excitability. Test for wide use,
was used to study effects of various traumatic factors (loss of loved ones, a car
accident, military events). Mississippi rating scale post-traumatic reactions. Civilian
and military options were used. Allows you to evaluate the severity of posttraumatic
reactions. These scales can diagnose late posttraumatic disorders. The results allow to
make a differential diagnosis of adjustment disorder. Symptom Check List-90-revised
(SCL-90-R). The technique allows to assess the psychological symptomatic status of
both general type patients and persons with mental disorders. The Diagnostic and
Statistical Manual of Mental Disorders (DSM) provides standard criteria and
common language for the classification of mental disorders. It is published by the
American Psychiatric Association. The fifth revision (DSM-5) was released in May
2013. This revision includes changes to the diagnostic criteria for PTSD and Acute
Stress Disorder.

We examined a patient at the age of 31, a military man, who have been
examined and treated at Military Medical Clinical Centre of Northern Region since
03.12.15 till 18.12.15. The patient was hospitalized with complaints of calf muscles
cramps, leg weakness, dizziness, clean intense headache, whistling in the ears,
persistent insomnia (slept 2-3 hours a day), fear of loud sounds and "approaching
vehicle noise", feeling of danger, impaired memory, decrement in visual and auditive
acuity. The mental status on admission : fully conscious, fully oriented, conversant.
The facial expression is blank and tense, movements are constrained and contain
motor tics. Periodically suffers from "intense whistling" and covers his ears tight with
hands during the conversation. Patient answers questions about a woman who died
during his vacation very briefly and hides his emotions. His mood is closer to be
calm. Emotionally constrained, unexpressive. The thought process is coherent, slow.
Hallucinations and delusions are absent. The attention is impaired. The judgement is
declined. The patient has performed such tests: the Mississippi Scale for combat-
related PTSD with the subdivision for civilian PTSD, DSM-V, SCL-90-R. Patient's
test result for Mississippi Scale is 116 points, which indicates a high level of impact
of traumatic events (the result of above 100 points is typical of PTSD). According to
DSM-V scale the patient has all the symptoms except depersonalization and
derealization, in particular: symptoms of invasion – 4/5, symptoms of avoidance –
1/2, cognitive impairment – 4/7, hyperactivation – 3/6, he has an apparent distress:
impaired social functioning and professional activities. According to SCL-90-R scale
the dominant symptoms are somatization, depression and obsession.

Consequently, these psychodiagnostic tests can not only confirm the diagnosis
of PTSD, set on the basis of complaints, anamnesis and physical examination, but
also to identify key symptoms and assess the dynamics after performed treatment.

References

1. Kohanov V.P. Emergency and disaster psychiatry / V.P. Kohanov, V.N.

Krasnov. / – М. : Practical medicine, 2008. – 448 p.

2. World federation of Society of Biological Psychiatry (WFSBP) Guidelines of

the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post. –
Traumatic Stress Disoders. - First Revision. The World Journal of Biological Psychiatry.
– 2008. - 9(4). – P. 248-312.