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Case study on PTSD

Case study: post-traumatic stress disorder

Sean is a 37-year-old lorry driver in the army, who was involved in a civilian rescue following a coach crash. He was the first rescuer on the scene and climbed into the crashed coach when it was still unstable and when petrol was pouring out of the tank. While climbing in he saw one person who was dead and her limbs were grotesquely twisted around her. He gave immediate f irst aid to as many people as he could and remembers holding one man’s hand while he died only to notice afterwards that the hand had been completely severed. There were people screaming and crying for help who were trapped and many died within 10 minutes of the crash. Later, other passersby assisted before the emergency services arrived 20 minutes later. Five years later, he still could not drive. He had been sacked and was drinking a bottle of whisky a day, taking 30 mgs valium daily as well as sleeping tablets, night sedation and approximately five to six cannabis ‘joints’. He was terrif ied of sleeping as his nightmares woke him up. He had intrusive thoughts about the ‘hand’ constantly and his nightmare involved seeing the woman who had died and whose limbs were twisted suddenly opening her eyes and screaming ‘help me’. He was hypersensitive to noise, and avoided anything which reminded him of his trauma. He felt ‘guilty’ all the time and regularly had thoughts, ‘If only I had …’ or ‘I should have …’ These thoughts made him feel he could have saved more people, and because he did not, he felt responsible. He was severely depressed and had twice attempted suicide by overdose.

Treatment efficacy: post-traumatic stress disorder

The NHS Centre for Reviews and Dissemination’s (2002c) meta-analysis of the comparative efficacy of treatments for post-traumatic stress disorder supports the use of behaviour therapy, eye-movement desensitization, reprocessing, and selective seretonin reuptake inhibitors. However, it noted also that ‘it remains to be seen whether the efficacy of treatment can be improved by using these interventions in combination’.

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