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Introduction The psychological changes caused by trauma reflect the difficulty of overcoming the traumatic event. This study is a trial to approach the clinical and evolutionary aspects of post traumatic pathology through an observation of a recently hospitalized patient in our military psychiatric department. Clinical observation Mr M., 28 years old, was surprised by the sound of distant gunshots. Going on site, he found six of his friends killed and his best friend dying. Developing severe symptoms of acute stress disorder, he was hospitalized and treatment by an antidepressant and anxiolytics has been established. Two weeks after, anxiety and nightmares decreased but repetition and avoidance syndromes did not improve. Meanwhile, the patient was obliged to face major confrontations consisting of interrogations and legal proceedings concerning his conduct after the accident. He was suspended from his job and all his professional papers were confiscated. The patient developed consequently a major depressive episode; however, an important event occurred: the repetition syndrome disappeared. Thereafter, the mood disorder has improved and we have seen a more combative attitude from the patient. Conclusion In this case, how can we explain the relatively early disappearance of the repetition syndrome? Is it the confrontation with facts of reality even more traumatic than the trauma itself? The long-term evolution towards recovery or towards a new relapse will clarify us on this issue. |
