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Grand Rounds - Royal Liverpool University Hospital: Persistent post -traumatic stress disorder Often missed but worth treating

BMJ 1994; 309 doi: (Published 20 August 1994) Cite this as: BMJ 1994;309:526

Department of Psychogeriatrics, Mossley Hill Hospital, Liverpool L18 8BV.

Post-traumatic stress disorder has a lifetime prevalence of 1% in the community and up to 20% in veterans of the Vietnam war.1 The term is used to describe emotional disorders after traumatic war experiences or other trauma that is outside normal experience such as rape, serious vehicle accidents, and earthquakes.2 The symptoms may persist for many years and psychiatric morbidity is often associated.3 We present the case of a soldier in the second world war who had experienced severe trauma.

Case history

An 80 year old man was referred urgently by his general practitioner to the psychogeriatric service with depression and suicidal impulses. Since the second world war he had had recurrent flashbacks and frequent nightmares. He was the sole survivor of the tank he commanded and had witnessed the death of his crew when the tank was struck by a German shell. He had been outside the tank but was hit by shrapnel in the left temporal area.

He had been treated for shellshock, possibly with abreaction, with partial remission. Ten weeks later he had returned to downgraded operational duties. After initial “survivor guilt” he had tried to block out memories of the event. He did not talk about it and avoided watching war films or documentaries. He developed an aversion to social groups as they reminded him of his life as a soldier.

He became a heavy bout drinker with periods of abstinence. He had increased his alcohol intake to get rid of memories of the war and drank at least one and a half bottles of whisky a week. He described craving, loss of control, and morning withdrawal shakes. Over the past four years he had also developed auditory hallucinations of a male and female …

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