doiSerbia

Post-traumatic stress disorder psychotic subtype or comorbid psychotic disorder and evaluation of military service ability

Živić Bratislav (Military Medical Academy, Clinic for Psychiatry, Belgrade, Serbia)
Joković Danilo (Military Medical Academy, Clinic for Psychiatry, Belgrade, Serbia)
Vranić Marija (Military Medical Academy, Clinic for Psychiatry, Belgrade, Serbia)
Stojanović Zvezdana (Military Medical Academy, Clinic for Psychiatry, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia)

Introduction. Recent studies have shown that diagnostic differences in the opinion whether some case is a psychotic subtype of posttraumatic stress disorder (PTSD) or a comorbid psychotic disorder still exist. In a case of mental disorders, a specific nature of military environment requires a detailed evaluation of abilities for military service (MS). Case report. A 34-year old male noncommissioned officer (NCO) showed symptomatology of PTSD (according to the Diagnostic and Statistical Manual of Mental Disorders – DSM-IV) after experiencing a traumatic event in peacetime conditions. In addition to experiencing trauma as an adult, the patient was also exposed to early-age trauma, when his father committed suicide. After a pharmacotherapy and cognitive behavioral therapy treatment, he was remitted and returned to his duty. Triggered by new stress caused by unfavorable environmental factors (occupational environment), psychotic phenomenology appeared. After two years of psychiatric treatment, patient was evaluated unfit for MS. Conclusion. Early-age trauma and/or PTSD are predispositions for a comorbid psychotic disorder, while the diagnostic entity of psychotic subtype of PTSD requires further research. Evaluation of MS abilities in patients with psychotic disorder based on our clinical experience, will require a psychiatric treatment for at least two years, which is in accordance with a research conducted in the British Army.

Keywords: stress disorders, post-traumatic, psychotic disorders, comorbidity, military personnel, drug therapy, recurrence, professional competence