PSYCHOTHERAPEUTIC EFFECT ON CEREBRAL BLOOD FLOW – CASE REPORT

Autori:

Rudolf Gregurek, Ratimir Petrović

Sažetak

Sažetak. Prikazan je 36-godišnji pacijent, veteran Domovinskog rata koji je zatražio psihijatrijsko liječenje zbog smetnja iz kruga posttraumatskoga stresnog poremećaja. Dijagnoza je postavljena u skladu s kriterijima MKB-10 pri čemu nije postojala ni jedna komorbidna dijagnoza. Nakon detaljne psihijatrijske, psihologijske i neurološke obrade učinjena je jednofotonska emisijska tomografija (SPECT) pri čemu pacijent nije uzimao nikakvu medikamentnu terapiju. Snimanje je ponovljeno nakon dva tjedna da bi se izbjegli mogući artefakti i povećala statistička pouzdanost mogućega patološkog nalaza. Rezultati snimanja pokazali su ¬unilateralno signifikantno povećanje regionalnoga moždanog protoka (više od 20% povećana moždana aktivnost u dominantnoj hemisferi) u odnosu na suprotnu hemisferu u projekcijskom području nukleusa akumbensa/amigdaloidnih jezgara. Nakon završene obrade pacijent je uključen u intenzivnu grupnu psihoterapiju tijekom godine dana, fokusiranu na interpersonalne i socijalne odnose. Nakon godinu dana došlo je do ublažavanja simptoma, prikladnije kontrole pulzija i prestanka agresivnih »acting out« reakcija, što je bilo objektivizirano i heteroanamnestičkim podatcima. Ponovljena jednofotonska emisijska tomografija u dva navrata s dvotjednim razmakom pokazala je normalizaciju nalaza i odsutnost signifikantne razlike u regionalnoj moždanoj cirkulaciji između moždanih hemisfera.

Summary

Summary. This is a case report on a 36-year-old Croatian war veteran who was seeking psychiatric treatment because of disturbances which were manifesting in: difficult impulse control, aggressive acting out reactions, continuous conflict with surroundings, and in traumatic and repeating nightmares. Posttraumatic stress disorder (PTSD) was diagnosed according to MKB-10 criteria and comorbid diagnoses were not found. After detailed psychiatric, psychological and neurological testing, brain SPECT was performed while the patient was medication free. Brain imaging was done twice within two-week period to avoid possible artefacts and to enhance statistical significance of possible pathological findings. SPECT results showed significant unilateral increase of regional cerebral blood flow (over 20% increased brain activity in dominant hemisphere,analyzed semiquantitatively using region-of-interest based method, and normalized to the mean brain activity) relative to opposite hemisphere in projection area of amygdala/nucleus accumbens. After the completion of all testing the patient started intense group psychotherapy of one year duration which was focused on interpersonal and social relations. After one year symptoms diminished, his impulse control became more adequate and he had no more aggressive acting out reactions,all of which was also objectified with information from patient family. Brain SPECT imaging was then repeated, twice within two-week period, and it showed normalization of findings and no significant differences in regional cerebral blood flow between cerebral hemispheres.

Volumen: 8-9, 2007

Liječ Vjesn 2007;129:265–268