Clinical Case Study: Combat Ptsd

The patient reported that her primary mamba duties Included driving fuel tankers In a convoy from base to base and performing guard duties to secure the perimeter of the base. In the context of that duty she reported being exposed to multiple life-threatening situations, witnessing dead and mutilated bodies, a near plane crash, daily mortar attacks on the base, making many split-second life-or-death decisions, and the loss of one of her soldiers. After returning to the united States she began to experience at least five distinct intrusive memories and nightmares from these combat experiences.

She engaged in avoidance through attempted thought suppression, conversation redirecting, and alcohol abuse. She avoided crowds and social situations and began to fail out of college because she felt unable to focus on her academic duties as a result of her symptoms. She expressed severe nightmares/tremors and had an eradicated sleep schedule.

She wakes up numerous times throughout the night and on some nights avoids sleeping completely. On presentation to the postgraduates stress clinical team, she was diagnosed with PETS.

In addition to her other symptoms, the patient reported engaging in compulsive checking behaviors. She reported checking her front door lock 5 to 10 times a day and peering out of her windows on a constant for lurking individuals. The patient also reported engaging in checking behaviors whenever she had an intrusive memory or nightmare, whenever she heard anything “suspicious” (e. G.

, a barking dog or rustling leaves), and whenever she was about to relax, as a preemptive measure to combat anxiety. She reported that she was hiding weapons all over her house and planning attacks for if someone were to invade her home.

She also planned out intrusions in where household Items could be used as paeans In the event that she could not reach any of her hidden weapons. Along with the checking behavior, patient Is self-described as “socially awkward” In large crowd celebrations with an ample amount of noise. She recounts an Incident where she was at a town fair and was gathering at the beer tent with friends, unexpectedly Tattler’s Degas going or.

Seen clams a lapse In memory Ana when Seen came to Seen was crouched under a nearby table.

She now avoids large social gatherings to evade judgment, embarrassment, and explanations of her behavior. Patient reports an increased alertness in her driving behavior. She finds herself swerving to miss potholes and slamming on brakes to avoid running anything over, including but limited to trash, sand mounds, and already deceased animals. She also conveyed an extreme fear for flying that was not present before her near plane crash experience. She states that she has uncontrolled outbursts on planes during takeoff, landing, and turbulence.

She reported no significant psychological difficulties or medical problems before military service. She reported a family history positive for alcohol use and depression. Patient recounted growing up in an upper-middle class military family. She described her father as a hardworking and functioning alcoholic, her mother as a party-going and non-present homemaker. Her mother has been battling depression off and on throughout the years. Patient denies physical and mental abuse in the home.

She stated that she began socially drinking with her peers at the age of 16, but denied alcohol abuse before military service. She describes her childhood and adolescence as average and typical of that of her peers. She also has three other siblings that she grew up with that have no reported psychological disorders or alcohol dependencies. While serving in Iraq, the patient experienced a severe head injury and back injury from a near plane crash which led to loss of consciousness. She sought medical care immediately after the incident and received 5 staples in the back of her head.

A computed tomography (CT) scan also revealed a significant concussion.

Two months subsequent to this injury, the patient experienced another blast in which a mortar blew up the office building in which she was working, which led to confusion, headaches, and a loss of hearing for several days. Both of these injuries resulted in documentation of TUB. MEDICAL FINDINGS AND DIAGNOSIS After review of the primary care PETS screening, the PETS checklist, and the initial meeting, the patient has been diagnosed with Combat PETS.

Patient has present symptoms of being exposed to several traumatic events which led to significant injuries and TUB within the course of her deployments that have persisted and been ongoing over the past several years. She is reliving these events on a daily basis through her nightmares/tremors and flashbacks of events.

Patient avoids situations that may bring up thoughts or feelings of the events she experienced. She is extremely hyperventilating in her home surrounding as well as her driving habits.

Evidence in family depression and alcohol dependency supports a predisposition for PIPS Patient presents several criteria In all tenure clusters to soups diagnosis. Patient has been referred for treatment. PLAN art combat P Patient has been prescribed an SIR medication, Florentine (Approach), to help combat symptoms of both depression and anxiety.

She has also been prescribed the drug Proposing (Nippiness) to help suppress her recurrent nightmares/tremors and block her brain’s response to morphogenesis. In addition to medication the patient has been recommended to participate in psychotherapy sessions. TREATMENT

Patient has been participating in ongoing psychotherapy sessions over the course of nine months and taking medication as prescribed. She has reported that the nightmares are fewer and farther apart. She has become more relaxed with her checking behavior, but still feels at ease from time to time.

She stated that she is sleeping better and no longer stays up for days at a time. She is still reluctant to fly and now is prescribed Syntax for her flights. She denies alcohol abuse at this time. Patient has expressed her wishes to discontinue psychotherapy at this time, but continues to take medication as prescribed. Prognosis for patient is good.