Abstract
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.
Highlights
Post-traumatic stress disorder (PTSD) is a common and debilitating condition that may develop when a person is exposed either directly or indirectly to a traumatic event involving actual or threatened death, including serious injury and sexual violence
We described a case in which a recurrently traumatized patient had been under psychiatric treatment for seven years but had never been diagnosed with PTSD and, in consequence, did not receive the recommended treatment
PTSD and its comorbidities tend to be refractory to treatment and the use of off-label medications is often mandated on a case-by-case basis, as it was the case of clozapine[11]
Summary
Post-traumatic stress disorder (PTSD) is a common and debilitating condition that may develop when a person is exposed either directly or indirectly to a traumatic event involving actual or threatened death, including serious injury and sexual violence. The diagnosis of PTSD may seem straightforward, this condition often goes unnoticed. Low detection rates for PTSD have been reported even among psychiatric outpatients assisted by well-trained psychiatrists. Howgego et al described that a PTSD diagnosis was found in the medical records of only one of the 27 patients suffering from PTSD (3.7%)[3], while Mkize reported that none of the 18 patients with PTSD had been correctly diagnosed in their medical records[4]
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