ABSTRACT
We described a case in which a heavily-traumatized patient had been under psychiatric treatment for seven years (five of them in a university mental health clinic) but was never diagnosed with PTSD and, therefore, did not receive the proper treatment for a very long period. After the correct diagnosis was made and personalized treatment instituted, the patient has shown marked improvement in functionality and wellbeing. The key element in this case, was the adequacy of psychiatric training. Our report suggests that psychiatrists are not being adequately trained to identify traumatic events and to diagnose atypical cases of PTSD. With that in mind, we emphasize that theoretical modules on trauma and trauma-related disorders and practical training in specialized PTSD clinics should be incorporated into the psychiatric residency training programs wherever they may be missing, particularly in countries most impacted by violence. Furthermore, continuing medical education on trauma and PTSD should be provided by medical associations and journals to keep physicians updated on recent progress in the field.
PTSD; post-traumatic stress disorders; psychiatric training; delayed diagnoses; psychopharmacology
Thumbnail
The figure 1 shows the psychometric evolution of the clinical status of the patient after admission to the PTSD outpatient clinic. Although initially all values were well above the cutoff point (PCL-C = 78, BDI = 39, BAI = 53), there was a gradual improvement with treatment. The effect of new traumatic events can also be seen. With the exception of the BAI, the final values were within the normality range. Blue arrows: new traumatic events. BL: baseline; M: month; PCL-C: Post-traumatic Stress Checklist – Civilian Version; BDI: Beck Depression Inventor; BAI: Beck Anxiety Inventory. PCL-C cutoff = 50 points. BDI cutoff = 19 points. BAI cutoff = 16 points. Note: for the sake of comparability, raw data have been transformed into percentage of the maximum score of each scale.