Proving the existence of Post Traumatic Stress Disorder (PTSD) following a motor vehicle accident*

keywords: PTSD, motor vehicle accident, medicolegal, forensic, memory loss, treatment

Occupation:
Administration Clerk and Home Maker

Question:
Is the claimant suffering from a debilitating psychiatric illness? Did the claimant suffer traumatic brain injury from her motor vehicle accident?

Problem:
Insurer?s medical practitioner had accused her of feigning impairment so the insurer had ceased payments for treatment and wages.

Complications:
It has been 3 years since the claimant?s accident.

Outcome:
We used objective brain function analysis to evaluate the claimant?s condition. This indicated that she was suffering from a genuine psychiatric condition known as PTSD, rather than a traumatic brain injury (Araki et al., 2005; Buckley et al., 2000; Johnstone et al., 2005; Kanagaratnam & Asbjornsen, 2006; Karl et al., 2006; Lindauer et al., 2006; Vasterling et al., 1998; Vasterling et al., 2002; Veltmeyer et al., 2006).

The claimant was now able to obtain the appropriate treatment for her condition which included access to a new novel pharmacological compound used in PTSD known as seroquel (quetiapine) and cognitive behavioural therapy.

Conclusion:
Our tests revealed objective brain profile of findings that are consistent with post-traumatic stress disorder. In addition we were able to quantify that she had experienced a greater than 10 % loss of cognitive function.

Finally, it was suggested that he prolonged level of stress and high cortisol levels may have lead to organic damage, as supported by clinical studies (Baker et al., 2005; Bremner et al., 2003; Buckley et al., 2000; Lindauer et al., 2006; Sapolsky et al., 1990; Wignall et al., 2004). The permanency of this condition would require retesting at a later date to confirm.

References

Araki, T, Kasai, K, Yamasue, H, Kato, N, Kudo, N, Ohtani, T, Nakagome, K, Kirihara, K, Yamada, H, Abe, O, and Iwanami, A (2005). Association between lower P300 amplitude and smaller anterior cingulate cortex volume in patients with posttraumatic stress disorder: a study of victims of Tokyo subway sarin attack. NeuroImage , 25 , 43-50.

Baker, DG, Ekhator, NN, Kasckow, JW, Dashevsky, B, Horn, PS, Bednarik, L, and Geracioti, TD, Jr. (2005). Higher Levels of Basal Serial CSF Cortisol in Combat Veterans With Posttraumatic Stress Disorder. Am J Psychiatry , 162 , 992-994.

Bremner, JD, Vythilingam, M, Vermetten, E, Adil, J, Khan, S, Nazeer, A, Afzal, N, McGlashan, T, Elzinga, B, and Anderson, GM (2003). Cortisol response to a cognitive stress challenge in posttraumatic stress disorder (PTSD) related to childhood abuse. Psychoneuroendocrinology , 28 , 733-750.

Buckley, TC, Blanchard, EB, and Neill, WT (2000). Information processing and ptsd: A review of the empirical literature. Clinical Psychology Review , 20 , 1041-1065.

Johnstone, J, Gunkelman, J, and Lunt, J (2005). Clinical database development: characterization of EEG phenotypes. Clinical EEG & Neuroscience , 36 , 99-107.

Kanagaratnam, P and Asbjornsen, AE (2006). Executive deficits in chronic PTSD related to political violence. Journal of Anxiety Disorders , In Press .

Karl, A, Malta, LS, and Maercker, A (2006). Meta-analytic review of event-related potential studies in post-traumatic stress disorder. Biol Psychol , 71 , 123-147.

Lindauer, RJL, Olff, M, van Meijel, EPM, Carlier, IVE, and Gersons, BPR (2006). Cortisol, Learning, Memory, and Attention in Relation to Smaller Hippocampal Volume in Police Officers with Posttraumatic Stress Disorder. Biol Psychiatry , 59 , 171-177.

Sapolsky, RM, Uno, H, Rebert, CS, and Finch, CE (1990). Hippocampal damage associated with prolonged glucocorticoid exposure in primates. The Journal of Neuroscience: the Official Journal of the Society for Neuroscience , 10 , 2897-2902.

Vasterling, JJ, Brailey, K, Constans, JI, and Sutker, PB (1998). Attention and Memory Dysfunction in Posttraumatic Stress Disorder. Neuropsychology , 12 , 125-133.

Vasterling, JJ, Duke, LM, Brailey, K, Constans, JI, Allain, J, and Sutker, PB (2002). Attention, Learning, and Memory Performances and Intellectual Resources in Vietnam Veterans: PTSD and No Disorder Comparisons. Neuropsychology , 16 , 5-14.

Veltmeyer, MD, McFarlane, AC, Bryant, RA, Mayo, T, Gordon, E, and Clark, CR (2006). Integrative assessment of brain function in PTSD: brain stability and working memory. Journal of Integrative Neuroscience , 5 , 123-138.

*The case examples are based on clinical experience but are dissimilar from real cases. The examples provided are for illustrative purposes only and any resemblance to a real life case is of coincidence.