Post-traumatic stress disorder in the aftermath of a police operation
Marc Ziegenbein, M.D., Social Psychiatry and Psychotherapy, Medical School Hanover (MHH), Germany.
Stefan Kropp, M.D., Clinical Psychiatry and Psychotherapy, Medical School Hanover (MHH), Germany
Post-traumatic stress disorder (PTSD) is an anxiety disorder which occurs following exposure to atraumatic, potentially life threatening event (1). It is frequently comorbid with other anxiety and mood disorders, substnace misuse and physical symptoms that may cloud its presentation. In itself, PTSD is a frequently chronic disabeling condition associated with a marked impact on social, occupational and family functioning that also carries an increased risk of suicide.
Early intervention once the disorder is present, represents the most effective chance of reducing disability. PTSD is treated by a variety of forms of psychotherapy and drug therapy. There is an ongoing debate on which risk factors for developing posttraumatic stress symptoms are more important--personality traits reflecting vulnerability, previous stressful experiences or characteristics of the traumatic event (2). Some occupational groups are at increased risk of developing mental health problems due to the nature of their work, which can sometimes be extremely traumatic. Studies have shown that there is a high prevalence of PTSD and other psychiatric impairments in firefighters and police officers (3,4).
Here we report the case of a patient who falsely became victim of a police operation. To our knowledge, no simliar case has been published yet.
We describe a 38-year-old female Caucasian patient who was admitted to our psychiatric hospital at 07.00 a.m. for crisis intervention. She was accompanied by family members and two police officers. The patient was alert but neither oriented towards person, situation, nor time. The police officers reported that a special forces unit of the local police prepared an operation in order to arrest a drug dealer in the house where the patient was living. Unfortunately the police selected the wrong floor. At 06.00 a.m. the special forces unit opened the door of the patients dwelling. They used smoke granates and CS spray. The female patient, its two children and the dog were in the dwelling. The dog started barking and the situation went out of control. Finally one of the police officers shot the dog.
Pharmacotherapy with 4mg lorazepam daily was started. Blood tests, ECG, EEG and an the MRI of the brain revealed no abnormal findings. After two days she was discharged against our recommendations. Two weeks later she was admitted again, complaining about recurrent and intrusive distressing recollections of the trauma, nightmares and daytime flashbacks of the event. Furthermore she avoided activities, places and people that arouse recollections of the trauma. She also reported a feeling of estrangement from her family.
We diagnosed PTSD (meeting DSM-IV criteria). Escitalopram 10mg daily was established, combined with eye movement desensitation and reprocessing (EMDR) in conjunction with stabilizing therapy elements (5). The therapy was beneficial and the symptoms started to disappear, but she still avoided to visit her dwelling. The family moved in a new dwelling and after four weeks she was discharged and treated in our outpatient clinic. The symptoms remitted completely within the next months and she got a financial remuneration.
This extraordinary case might encourage collecting further clinical experience with the combination of EMDR and pharmacotherapy in patients with PTSD. Future improvements in the treatment of this disorder await further controlled clinical trials and neubiological research.
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5. Liebermann P, Hofmann A, Flatten G. (2003; ) Psychotherapeutic treatment of traumatic stress with the EMDR (Eye Movement Desensitization and Reprocessing) method. MMW Fortschr Med. 14:39-41