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Patient: 21-year-old man
Present illness: The patient was 8 years old, when the Great Hanshin Earthquake hit the city of Kobe, Japan and killed some 6500 persons and injured 44 000 persons (https://en.wikipedia.org/wiki/Great_Hanshin_earthquake). Although the patient's house was shattered, all his family was safe and alive. However, he had many friends at school and some relatives who were killed. In particular, one of his best friends was lost. He recalls that he was despondent for a few years but gradually started living a normal life for a young boy. He graduated from primary school, junior high school and high school without any remarkable incidents.
After high school, he chose to become a nurse and entered a professional school for nurses. It was in his first year of this school that the whole class participated in an emergency drill for earthquakes, in which all the students were supposed to experience an earthquake in a simulation car. When the patient also experienced this artificial earthquake, he fainted.
Present status: It was after this simulation that he started suffering from nightmares of earthquakes shattering the house and he also had similar flashbacks during the day. He became extremely depressed and anxious, and started avoiding any news or talks that were possibly related to earthquakes or disasters. Eventually he was no longer able to attend school and dropped out. It was ∼1 year after this event when his primary care doctor consulted you, as a psychiatrist, about what treatment/specialist was available for his condition. The patient had already been on selective serotonin reuptake inhibitors (SSRIs) for several months but has shown only partial response. You are aware that there are several non-pharmacological approaches to post-traumatic stress disorder (PTSD), each of which would need a specialist training, and there are several colleagues who practice such approaches. However, you wonder which …
Competing interests TAF has received lecture fees from Eli Lilly, Janssen, Meiji, MSD, Otsuka, Pfizer and Tanabe-Mitsubishi, and consultancy fees from Sekisui Chemicals and Takeda Science Foundation. He has received royalties from Igaku-Shoin and Nihon Bunka Kagaku-sha publishers. He has received grant or research support from the Japanese Ministry of Education, Science, and Technology, the Japanese Ministry of Health, Labour and Welfare, the Japan Society for the Promotion of Science, the Japan Foundation for Neuroscience and Mental Health, Mochida and Tanabe-Mitsubishi. He is diplomate of the Academy of Cognitive Therapy.
Provenance and peer review Commissioned; externally peer reviewed.