Post-Traumatic Stress Disorder

Traumatized

Step 1: View clinicals

A 22 year old soldier complains of frequently experiencing nightmares, which cause him to wake up in distress. He also has recurrent flare-ups of anger during the day. These symptoms date from the time of his return from Afghanistan, 2 months ago; while on his tour of duty, he had been in multiple firefights, and witnessed many dead and mutilated bodies. Upon further inquiry, he reveals that he occasionally has flashbacks of traumatic events, and tries his best to avoid thinking of his war experiences. He has also lost interest in his daily activities, and claims that he often feels detached from others. Currently he consumes alcohol 3 to 4 times a week, having upto 6 drinks each time. He claims that this helps him "forget his experiences". Prior to this, he only drank socially. He strongly denies using controlled substances. His medical and surgical histories are unremarkable, and there is no history of psychologic difficulties or psychiatric disease. However, his family history is positive for alcohol use disorders and depression.


Step 2: Order all relevant investigations

AUDIT Score

The Alcohol Use Disorders Identification Test score: Total 15/40; Dependence score 3/12

CT Brain

The CT scan of the brain appears completely normal.

Liver Profile

Total bilirubin: 0.7 mg/dL (<1.2) Direct bilirubin: 0.08 mg/dL (<0.2) AST: 48 U/L (10-45) ALT: 65 U/L (10-45) GGT: 78 U/L (0-60)

Urine Drug Screen

The urine drug screen is negative for controlled substances, but positive for alcohol.


Step 3: Select appropriate management

Cognitive Behavioural Therapy
Fluphenazine
Chlordiazepoxide
Clonidine


Score: ★★☆