Introduction: The forward psychiatry practice in the combat field has proven effective in reducing the attrition rates due to combat and operational stress of the service members. The concept has evolved over the years with the same objective to conserve the fighting troops' strength and minimize the incident rates of post-traumatic stress disorder among the soldiers. The Combat and Operational Stress Reaction (COSR) team has been deployed to the conflict zone and applied the forward psychiatry principles to the troops on the battlefield. Case Series : Here, we presented 3 case series of service members that were attended by the COSR team during their deployment on the frontline. First, a serviceman presented with late recognition of acute stress symptoms following active combat duty with poor support from his unit. Second, a combat engineer presented with anxiety and somatic symptoms after combat duty; third, a combat radio operator with early detection of acute stress symptoms by his unit commander. Results: In the first case, the patient's psychological condition deteriorated, requiring frequent sedation and transfer to a military tertiary hospital. In the second and third cases, both patients improved and returned to their duties with individualized psychotherapy and relaxation techniques. Conclusion Early detection of the symptoms and intervention based on the principles of forward psychiatry in active combat zone facilitate service members' return to function and reduce complications and morbidity to their psychological health

Objectives: Soldiers can manifest a wide range of psychological symptoms that varies from anxiety, depression to somatic symptoms in combative and noncombative situations. This paper aims to discuss the issue related to the challenges of establishing the diagnosis of a soldier in a stressful non-battlefield condition. Methods: : We herein report a young soldier with no underlying medical condition who presented with initial abnormal behaviour associated with progressive mutism for two years. Physical examination was unremarkable. Relevant blood investigations and Magnetic Resonance Imaging (MRI) brain revealed no abnormalities. He was initially treated as brief psychotic disorder and was revised into Schizophrenia based on Diagnostic and Statistical Manuals of Mental Disorders (DSM-5) and was started on antipsychotics. However, he showed no improvement after two years on treatment. He was on the verge of being discharged from the service due to medical reasons. Therefore, he was readmitted to the ward for evaluation of the diagnosis while all of his medications were withheld. Different psychological approaches including supportive therapy and occupational therapy were employed. Results: Following series of individual supportive therapy sessions, we uncovered the unconscious psychological conflicts within him. He gradually started to communicate verbally and his psychosocial functions began to improve. Upon discharged, the soldier was diagnosed as Functional Neurological Symptom Disorder. Conclusion A thorough and careful evaluation was crucial in assessing patients with progressive mutism to ensure a correct diagnosis was made. In a patient who failed to improve after optimum treatments were given, a different approach may be utilized to explore the possible factors that hindered the patient’ recovery.