Samardžić Radomir M, Živić Bratislav, Krstić Dragan, Joković Danilo, Dolić Mirko, Stojanović Zvezdana, Eror Aleksandar, Đokić Milan, Milojević Slavoljub, Mandić-Gajić Gordana
Vojnosanit Pregl. 2016 Oct;73(10):945-9. doi: 10.2298/VSP150124090S.
BACKGROUND/AIM: Sametimes war veterans may resort to such strategies as preducing exaggerated symptoms and malingerating in order to obtain material compensation rights. The aim of this study was to assess the accuracy of the diagnosis of posttraumatic stress disorder (PTSD) on the basis of which war veterans were entitled to a financial compensation due to their disability.
The diagnoses of 259 war veterans were re-evaluated. Veterans were previously diagnosed by a psychiatrist on local level, while regional state medical commission determined the degree of disability and the right to a financial compensation. A team of experts, consisting of psychiatrists with research experience in the field of traumatic stress and who were trained to use a structured interview for PTSD, conducted the evaluation of medical data from veterans’ military records. The diagnostic process was conducted using the standardized diagnostic interview (Clinician-Administered PTSD Scale – CAPS), after which the diagnosis was reaffirmed or reviewed. This influenced disability status and consequential financial compensation.
There was a remarkable difference between the first diagnostic assessment of PTSD, conducted by the psychiatrists on local level, and the second evaluation conducted by the team of experts. In more than half of 259 veterans (52.1%) diagnosed with PTSD in the first assessment the diagnosis was not confirmed. The diagnosis was confirmed in 31.7% of veterans. Those veterans who were diagnosed with lifetime PTSD (7.3%) should also be treated as accuratelly diagnosed. This means that a total of 39% of the diagnoses were accurate. The rest (8.9%) were diagnosed with other diagnoses, but not PTSD, as was the case in the initial assessment.
The possibility for war veterans to obtain the right to disability and financial compensation due to a diagnosis of PTSD might interfere with the proper diagnostic assessment and thus the treatment outcome. During the procedures for the obtention of these rights, exaggeration or simulation of symptoms are common. The quality of the diagnostic assessment of PTSD can be improved by applying evidence based standardized procedures.
背景/目的：有时退伍军人可能会采取夸大症状和装病等策略来获取物质补偿权利。本研究的目的是评估创伤后应激障碍（PTSD）诊断的准确性，基于此诊断退伍军人因残疾有权获得经济补偿。
对259名退伍军人的诊断进行重新评估。退伍军人此前由当地的精神科医生进行诊断，而地区国家医疗委员会确定残疾程度和获得经济补偿的权利。一个由在创伤应激领域有研究经验且接受过使用PTSD结构化访谈培训的精神科医生组成的专家团队，对退伍军人军事记录中的医疗数据进行评估。诊断过程使用标准化诊断访谈（临床医生管理的PTSD量表 - CAPS），之后对诊断进行确认或复查。这影响了残疾状况和相应的经济补偿。
当地精神科医生进行的首次PTSD诊断评估与专家团队进行的第二次评估之间存在显著差异。在首次评估中被诊断为PTSD的259名退伍军人中，超过一半（52.1%）的诊断未得到确认。31.7%的退伍军人诊断得到确认。那些被诊断为终身PTSD的退伍军人（7.3%）也应被视为诊断准确。这意味着总共39%的诊断是准确的。其余（8.9%）被诊断为其他病症，而非最初评估中的PTSD。
退伍军人因被诊断为PTSD而获得残疾和经济补偿权利的可能性可能会干扰正确的诊断评估，进而影响治疗结果。在获取这些权利的过程中，症状的夸大或伪装很常见。应用基于证据的标准化程序可以提高PTSD诊断评估的质量。
