Analysis of Problems Associated with Diagnostics Combat Post-Traumatic Stress Disorder in a Psychiatric Hospital

Background: in recent years, it has become relevant to study the effects of military operations on the mental health of veterans. The aim was to identify and evaluate the leading psychopathological symptoms in veterans of a special military operation (SMO), as well as to compare diagnoses upon admission and discharge from the hospital. Patients and Methods: 140 male veterans of local wars and armed conflicts who were treated at N.A. Alekseev Psychiatric Clinical Hospital No. 1 in the period from 2023 to 2024 were examined. The average age of the participants was 34.2 ± 8.3 years. During the study, a clinical and psychopathological analysis of the identified symptoms and risk factors in patients was carried out. Results: the study revealed a high prevalence of anxiety (75.7%) and depression (51.4%) among participants with a preliminary diagnosis of post-traumatic stress disorder (PTSD). An analysis of the symptoms of PTSD showed that intrusion (72.1%) is the most common. The high incidence of organic mental disorders caused by traumatic brain injury (TBI) (26.4%), PTSD (18.6%) and affective disorders (20%) was confirmed, in addition, the presence of patients with preliminary diagnoses of the schizophrenic spectrum (15.7%) was noted, which are subsequently confirmed. Conclusions: in clinical practice, the phenomenology of mental disorders due to combat stress is characterized by a variety of symptoms, many of which are not specific to PTSD and therefore are not included in the set of diagnostic criteria. The observed dominant severity of affective register disorders, behavioral disorders, asthenia and individual symptoms of organic brain damage determines the evolution of the diagnosis from the initial examination to the time of discharge with a decrease in the frequency of diagnosed PTSD. Despite the presence of leading or even typical symptoms of PTSD, attention should be paid to other complaints and psychopathological signs, since they can be predominant in the picture of the disease, have a significant impact on the patient’s quality of life and become the most important or promising target of therapy.

1. Reznik AM. Overview of research on external fac tors and genetic predispositions of combating post-traumatic stress disorder. Bulletin of the Medical Institute of Continuing Education.2022;(4):46–55. (In Russ.). doi: 10.46393/27821714

2. Schein J, Houle C, Urganus A, Cloutier M, Patterson-Lomba O, Wang Y, King S, Levinson W, Guérin A, Lefebvre P, Lori L. Davis Prevalence of post-traumatic stress disorder in the United States: a systematic literature review. J Current Med Res Opinion. 2021;37(12):2151–2161. doi: 10.1080/03007995.2021.1978417

3. Utzon-Frank N, Breinegaard N, Bertelsen M, Bor ritz M, Eller NH, Nordentoft M, Olesen K, Rod NH, Rugulies R, Bonde JP. Occurrence of delayed-onset post-traumatic stress disorder: a systematic review and meta-analysis of prospective studies. Scand J Work Environ Health. 2014:215–229. doi: 10.5271/sjweh.3420

4. Litvintsev SV, Snedkov EV, Reznik AM. Combat Psychic Trauma: a guideline for physicians. Moscow. “Izda telstvo “Medicine”, 2005;432 (In Russ.).

5. Judkins JL, Moore BA, Collette TL, Hale WJ, Pe terson AL, Morissette SB. Incidence rates ofposttraumatic stress disorder over a 17-year period in active duty military service members. J Trauma Stress. 2020;33(6):994–1006. doi: 10.1002/jts.22558

6. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comor bidity Survey. Arch Gen Psychiatry. 1995;52(12):1048 1060. doi: 10.1001/archpsyc.1995.03950240066012.

7. Schaefer LS, Lobo BO, Kristensen CH. Transtorno de es tresse pós-traumático decorrente de acidente de tra balho: implicações psicológicas, socio econômicas e jurídicas Estudos de Psicologia (Natal). 2012:(17):329 336. doi: 10.1590/S1413-294X2012000200018

8. Brady KT. Posttraumatic stress disorder and comor bidity: recognizing the many faces of PTSD. J. Clin. Psychiatry. 1997:58(9):12–15.

9. Compean E, Hamner M. Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): diag nostic and treatment challenges. Prog Neuropsycho pharmacol Biol Psychiatry. 2019;10(88):265–275. doi: 10.1016/j.pnpbp.2018.08.001

10. Fastovtsov GA, Sokolova EA. PTSD and Comorbid Mental Disorders. The Russian Journal of Psychiatry. 2012;(3):77–82. (In Russ.).

11. Wimalawansa SJ. Causes and risk factors for post-trau matic stress disorder: the importance of right diagno sis and treatment. Asian Journal of Medical Sciences. 2014;5(2):1–13. doi: 10.3126/ajms.v5i2.8537

12. International Classication of Diseases, 10th Revi sion. Mental and behavioral disorders. Class V ICD-10, adapted for use in the Russian Federation, Moscow. Russian Society of Psychiatrists. 1998.

13. Lytkin VM, Shamrey VK, Kostyuk GP. On the problem of mental health of combatants. The Russian Journal of Psychiatry.2007;(6):63–68. (In Russ.).

14. Shamrey VK, Nechiporenko VV, Lytkin VM, Kurasov ES, Zun SA, Barazenko KV. On post-combat personality changes in veterans of local wars. News of the Rus sian Military Medical Academy. 2020;39(3-4):185–192. (In Russ.).

15. Shamrey VK, Lytkin VM, Barazenko KV, Zun SA. On the dynamics of development of the problem of post-traumatic stress disorder. Medical-biological and socio-psychological problems of safety in emergen cy situations. 2023;(1):68–77. (In Russ.).

16. Bryant RA, O’Donnell ML, Creamer M, Mc Farlane AC, Silove D. Posttraumatic intru sive symptoms across psychiatric disorders. J. Psychiatr. Res. 2011;45(6):842–847. doi: 10.1016/j.jpsychires.2010.11.012

17. Gros DF, Price M, Magruder KM, Frueh BC. Symptom overlap in posttraumatic stress disorder and major depression. Psychiatry Res. 2012;196(2-3):267–270. doi: 10.1016/j.psychres.2011.10.022

18. ICD-11. Chapter 06. Mental and behavioral disorders and disorders of neuropsychiatric development. Statistical classification. M: “KDU”, “University Clinic”. 2021;432. (In Russ.). doi: 10.31453/kdu.ru.91304.0143

19. McFarlane AC. The duration of deployment and sen sitization to stress. Psychiatr. Ann.. 2009;39(2). doi: 10.3928/00485713-20090201-05

20. Gandubert C, Scali J, Ancelin M-L, Carrière I, Dupuy A-M, Bagnolini G, Ritchie K, Sebanne M, Martrille L, Baccino E, Hermès A, Attal J, Chaudieu I. Biologi cal and psychological predictors of posttraumatic stress disorder onset and chronicity. A one-year prospective study. Neurobiol. Stress. 2016;(3):61–67. doi: 10.1016/j.ynstr.2016.02.002

21. Fisun AYa, Shamrey VK, Rusanov SN, Kostyuk GP, Lyt kin VM, Turlakov K.S. Multidimensional assessment of mental health of military personnel during mass psychoprophylactic examinations. Military Medical Journal. 2007;238(6):1–10. (In Russ.)

22. Reznik AM. Mental disorders of Local Wars Vete rans Suffered from Traumatic Brain Injury. Health, Food & Biotechnology. 2020;2(1):11–23. (In Russ.). doi: 10.36107/hfb.2020.i1.s168.

23. McLay RN, Webb-Murphy J, Hammer P, Volk ert S, Klam W. Post-traumatic stress disorder symptom severity in service members returning from Iraq and Afghanistan with different types of inju ries. CNS Spectr. 2012;17(1):11–15. doi: 10.1017/S1092852912000016

24. Koren D, Norman D, Cohen A, Berman J, Klein EM. Increased PTSD risk with combat-related injury: a matched comparison study of injured and un injured soldiers experiencing the same combat events. Am J Psychiatry. 2005;162(2):276–282. doi: 10.1176/appi.ajp.162.2.276

25. Simmen-Janevska K, Brandstätter V, Maerck er A. The overlooked relationship between mo tivational abilities and posttraumatic stress: a review. Eur J Psychotraumatol. 2012;3(1):18560. doi: 10.3402/ejpt.v3i0.18560

26. Quarantini LC, Netto LR, Andrade-Nascimento M, Galvão-de Almeida A, Sampaio AS, Miranda-Scippa A, Bressan RA, Koenen KC. Comorbid mood and anxiety disorders in victims of violence with posttraumatic stress disorder. Braz. J. Psychiatry. 2009;31:66–76. doi: 10.1590/S1516-44462009000600005

27. Cheng KY, Robinson N, Ploner A, Kuja-Halkola R, Molero Y, Lichtenstein P, Bergen SE. Impact of trau matic brain injury on risk for schizophrenia and bipolar disorder. Psychiatry Res. 2024;339:115990. doi: 10.1016/j.psychres.2024.115990.