Post-Traumatic Stress Disorder (PTSD) in Sub-Saharan Africa.
A.B, a 35-year-old market vendor, sought help at a local clinic due to persistent symptoms of distress following a traumatic event. Three months ago, A.B was involved in a violent attack by armed robbers who raided her market stall, during which she witnessed the shooting of a friend and experienced physical assault.
Since the incident, A.B has been plagued by recurrent flashbacks of the attack, vivid nightmares, and severe anxiety. She reports avoiding the market and other places that remind her of the trauma. She has also been experiencing heightened startle responses, irritability, and difficulty sleeping.
A.B has become increasingly withdrawn, has lost interest in her usual activities, and is struggling to maintain her daily responsibilities at home and work. She denies any substance abuse or prior mental health issues.
- No significant past medical or psychiatric history.
- No history of substance abuse.
Family History:
- No family history of PTSD or other mental health disorders.
Social History:
- Living Conditions: Lives with her husband and two children in a small home in a rural village. The family relies on her market business for income.
- Education: Completed primary school education.
- Support System: Limited social support beyond immediate family.
- General Appearance: A.B appears anxious and distressed, with visible signs of fatigue.
- Vital Signs: Temperature: 36.7°C, Heart Rate: 88 bpm, Respiratory Rate: 18 breaths/min, Blood Pressure: 125/80 mmHg.
- Mental Status Examination:
- Mood: Anxious and distressed.
- Thought Process: Coherent but focused on the trauma.
- Thought Content: Recurrent intrusive thoughts about the attack, avoidance behaviours.
- Insight: Aware of her symptoms but distressed by them.
Initial Assessments:
- PTSD Symptoms: Recurrent flashbacks, nightmares, avoidance of reminders, hyperarousal symptoms (e.g., startle response, irritability).
- Screening Tools: Positive for PTSD symptoms based on initial clinical assessment and standardized PTSD questionnaire.
- Post-Traumatic Stress Disorder (PTSD): Consistent with symptoms of re-experiencing trauma, avoidance, and hyperarousal.
- Acute Stress Disorder: Considered, but symptoms have persisted beyond the typical 30-day period.
- Major Depressive Disorder: May co-occur but primary symptoms align with PTSD.
- Generalized Anxiety Disorder: Possible but less specific to the traumatic event.
- Psychological Interventions: Refer for trauma-focused cognitive behavioural therapy (CBT) to address PTSD symptoms and improve coping strategies.
- Pharmacological Management: Consider starting an SSRI (e.g., sertraline) if symptoms are severe and affecting daily functioning.
- Support and Education: Educate A.B and her family about PTSD, its symptoms, and coping strategies. Encourage participation in support groups if available.
- Follow-Up: Schedule regular follow-up appointments to monitor progress, adjust treatment as needed, and provide ongoing support.
A.B was diagnosed with PTSD following the traumatic market attack. She began trauma-focused CBT and was prescribed sertraline. Over several months, her symptoms improved, including reduced flashbacks and nightmares. She gradually resumed her market activities and reported better coping with reminders of the trauma. A. B’s family remained supportive, and she continued with follow-up care to maintain her progress.
A). Acute Stress Disorder
B). Generalized Anxiety Disorder
C). Post-Traumatic Stress Disorder (PTSD)
D). Major Depressive Disorder
A). Trauma-focused Cognitive Behavioural Therapy (CBT)
B). Electroconvulsive Therapy (ECT)
C). Dialectical Behaviour Therapy (DBT)
D). Psychoanalysis
A). Sertraline (an SSRI)
B). Diazepam (a benzodiazepine)
C). Prednisone (a corticosteroid)
D). Haloperidol (an antipsychotic)
A). Elevated mood and increased energy
B). Recurrent intrusive thoughts about the traumatic event
C). Avoidance of all social interactions
D). Sudden onset of manic episodes
