Persistent post-traumatic stress disorder Role of alcohol ignored

EDITOR, - The grand round presented by Brigitta C Bende and Robin M Philpott contains two major logical errors, and I am surprised that these were not mentioned in the discussion.1 The patient was a heavy drinker with all the features of an organic mental disorder, including cognitive impairment. While he may have suffered a traumatic neurosis in the aftermath of his wartime experience, the continuing features that were the basis for the diagnosis of post-traumatic stress disorder should have been ascribed to alcohol unless they were still present after a lengthy period of abstention. In fact, all symptoms cleared when he abstained. Frightening ideas and nightmares are common in heavy drinkers, and their content is determined by the previous experience of the sufferer.

Secondly, how can improvement be attributed to the various psychological treatments that the patient received when he simultaneously received a far more powerful treatment for his brain disorder - namely, abstention from alcohol? Had his doctors waited to see the effects of this they would probably have found that no other treatment was necessary.

Forty per cent of all patients diagnosed as having …