[Psychotherapeutic effect on cerebral blood flow--case report].

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.