Individual selection of therapy for post-traumatic stress disorder in the paradigm of partnership with the patient, clinical case study

Post-traumatic stress disorder (PTSD) is currently the focus of attention among specialists. Practitioners point to the need for thorough differ- ential diagnosis; to confirm the diagnosis, it is necessary not only to have a history of stressful exposure, but also to meet the necessary diagnostic criteria. Current real-world studies are focused on accumulating large databases of clinical cases for evaluation using machine learning and other innovative methods, as well as creating algorithms for personalized therapy. The article presents two clinical cases of PTSD associated with the death of loved ones. The first case describes the symptoms of re-experiencing associated with the loss of a spouse in a special military operation, identifies triggers that provoke the development of intrusions, and describes symptoms of psychophysiological arousal and avoidance of contact with traumatic stimuli. The process of joint decision-making with the patient on the choice of therapy in the presence of a history of negative experience with antidepressants is presented in detail. The second case is devoted to the development of PTSD due to the fact that the patient was a direct witness to the unexpected death of the important one. A detailed description of the symptoms of re-experiencing is provided, and a low level of social support, which is a significant risk factor for the development of PTSD, is highlighted. The fragmentary nature of mem ories of the traumatic event is demonstrated. Additionally, symptoms of psychophysiological arousal and avoidance are presented. In both cases, data on the dynamics of the condition during subsequent visits are provided. An algorithm for discussing the appropriate therapy with the patient is presented. In real clinical practice, the model of joint decision-making, when therapy is selected taking into account the patient's opinion, helps to significantly increase adherence to treatment.

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